Recently our Nurse Manager informed the nursing staff that we were now to conduct our shift report using certain "scripted" parameters. Basically, we are to wake patients up, conduct shift report at the bedside, include he patient in the process by giving him/her the opportunity to ask questions and add to the information we pass on to the oncoming shift, check all patient orders on the computer and then conduct a brief"physical exam" of the patient with the oncoming nurse. There are certain scripted things we are to say as well. For example the nurse going off shift is supposed to say:
"Good morning, Mr. Jones. I will be leaving shortly to go home to my family. This is Sally and she will be your nurse for the next shift. I have known Sally for 4 years and she is a fabulous nurse with excellent clinical skills. I feel confident I will be leaving you in good hands wth Sally as your nurse!"
After this, we are to continue on with the above outlined report, conduct the mini physical exam, check the orders in the computer and give the patient the opportunity to give feedback during our report. Generally we each have 5-6 patients on our very busy cardiac monitoring unit and our shift report is 30 minutes long!! My colleagues and I are at a loss to figure out how we will accomplish all of this in 30 minutes! I am all for including the patient and allowing them to give feedback, but I fear shift report will now take so long we won't be able to get all our work done! And what about visiting hours? Shift report takes place right in the middle of them at 7pm. Now there will be visitors for both patients adding their comments as well.
In addition, I am uncomfortable giving my opinion about the skills and expertise of the oncoming nursing staff. We are expected to stick to the script and give positive reinforcement about the capabilities of the next nurse coming on shift. What if he/she isn't a very good nurse or has poor clinical skills? Am I supposed to lie to the patient? And if I do, won't I be undermining my own credibility? Does anyone else think this is a little over the top?
Therefore, I am against any family being in the room for bedside report, under any circumstances, in a semi-private situation. My roommate and her husband had no business knowing my personal loss and medical history. But, they did, because of bedside reporting, done wrong.
It (beside report) may improve outcomes; I have not done the reading on all the studies, but in semi-private rooms, it should never happen. As a patient, I am completely against it unless the hospital room is PRIVATE. This "incidental" sharing of my information was completely out of line and it hurt.
We brought up scenarios like this to upper management re: privacy. So then we were told we could ask the patients whether we can start the bedside report in the presence of others...to which if the pt said no, we'd still have to walk in and introduce the next shift and then leave it at that. Which makes as much sense reading it as it does actually performing it. It has no effect on patient outcome whatsoever. before all this bedside stuff, we would just inform our patients we were leaving and that another nurse was going to take over.
THIS is why we as nurses, need to take the bull by the horns (or other attention grabbing part of the anatomy) and get involved politically. Everyone BUT nurses are making the rules. WE need to take charge. WE know what works and what is just crap. WE need to be heard by our legislators. Until we do, nothing will change for the better. WE NEED TO EDUCATE OURSELVES ON THE POLITICAL PROCESS!
THIS is why we as nurses, need to take the bull by the horns (or other attention grabbing part of the anatomy) and get involved politically. Everyone BUT nurses are making the rules. WE need to take charge. WE know what works and what is just crap. WE need to be heard by our legislators. Until we do, nothing will change for the better. WE NEED TO EDUCATE OURSELVES ON THE POLITICAL PROCESS!
LOL.
This is why we need to be more politically active? Scripts?
What would you do, legislate away scripts? When it comes down to it a hospital is a business like any other and some businesses are better than others. Considering most hospitals run on a 1-3% profit margin (same ballpark as grocery stores) they tend to be highly focused on maintaining and increasing their customer base. Not saying scripting is right or wrong but I think there are far more important things for the legislature to focus on.
Satisfaction is a function of expectations. To attempt to impact the satisfaction (survey results) without managing expectations is utterly baffling to me, as this is a no brainer. The hospital is NOT a hotel, but hotel marketing Could be a great benchmark for managing expectations! Imagine "Hilton TV" that is the default channel when you flip on the hotel TV.
Tell patients exactly what to expect (these aspects will be congruent with survey question verbiage).
For example, a common sensical approach (to me), is a Patient & Family Channel on the hospital TV, which is a default channel. Short video clips, sort of like commercials, that play on a loop. Channel can be changed, of course, but watchers will probably stay 4-6 minutes before flipping. Examples:
"Being away from home in the hospital is stressful, so here is how we are going to support your healing:
-All health care providers will perform hand hygiene before giving you care. It is important that ALL of your visitors wash their hands, too!
-You, the patient, are the center of you treatment plan. You can expect your provider to tell you what changes are being made as well as anticipated discharge, including post-discharge plan.
-Family support is an important aspect of healing. For the convenience of your visitors, they can get snacks in the cafeteria from 7am to 8pm or get a soft drink in the vending machine in the lobby.
(It's a huge pet peeve of mine when VISITORS utilize nursing time requesting a soft drink for themselves, and more time is spent re-directing to where they need to go to get their needs met.
Once upon a time, the Patient Orientation booklet/binder may have been effective, but that was preceding Press Ganey and preceding a TV at every bed.
When "customers" are allowed to invent their own expectations, there is likely little chance of of achieving the lofty, unrealistic, or mis-aligned expectations.
Tell patients, family, visitors what to expect. As those execrations are met, the stated satisfaction will align. I don't see where hospitals are uniformly communicating to patients what expectations they should have - satisfaction scores will always fall short until expectations are first managed.
Perform hand hygiene? I'm a nurse, but if I were a patient and maybe doped up, I'd be wondering what in the world that meant. LMBO
Execrations - how I have to go to the dictionary. Work, work, work. LOL
BTW, this scripting is beyond outlandish. Oh, it sounds good on paper, but the people wanting to institute it need to consult with those who would actually be doing it.
We do this on my unit but we obviously make the "script" our own so now it's almost just a habit and feels natural. I do have to say that I work in the ICU and I can see how it would be more difficult on a medsurg floor.
I actually prefer bedside shift report and often the patient/family have valuable info to add/questions to ask. I know families appreciate this. The quick initial assessment is mostly just a visual and occurs simultaneously with report/introductions.
When I "talk my coworker up" I never mention years of expierence or specific jobs. I usually say something along the lines of " This is ___, she/he is going to be your nurse for the day/night. She/he is really great and will take good care of you. You're in good hands."
As far as waking patients up, we always ask the patient (if they can talk/participate) if they would like to be woke up for report in the morning. We also use common sense, if a patient hasn't slept in days and finally fell asleep we obviously don't wake them.
You guys will just have to tweak it to make it work for your unit but its really not so terrible.
When we have medsurg overflow I am able to complete the entire process in 5-10 minutes.
Political action makes a difference. We did not get staffing laws implemented in California without a protracted legal battle and a nurse-friendly Democratic ally as Governor.
I can understand, if the patient is awake, coming in to introduce her day nurse. It can help foster a sense of trust and get rid of any feelings they might have that they are being passed around. Doing bedside report in front of the patient can also be useful to an extent. It can give the patient a chance to elaborate, ask questions, etc. and help them feel like we are paying close attention to them. We use our discretion to decide whether or not this is a good idea on a patient to patient basis. For example, giving report in front of a detoxing patient is probably not the best idea. We do this as CNAs as well. I work days, so we do rounds around 7 PM and my patients are usually awake. I'll usually say something to the effect of, "Okay so and so, I'm leaving for the night but this is so and so, she will be taking over for me tonight and you'll be in good hands with her." If we have them as a high fall risk, I'll remind them to call her to get up just like they have been doing for me all day, etc. If I have a good rapport with the patient, I'll elaborate some more, wish them a good night, tell them when I'll see them next, etc.
HOWEVER, we never wake the patient up to do this! If they are sleeping, we will simply erase the day shift name and fill in the night shift name on the white board in the room, and then the nurse or CNA will introduce themselves when they next see the patient awake or if they have to wake them for something. Following a set script is simply ridiculous. And after a day or two, patients are going to wonder why each of their nurses is saying the same damn thing. It smacks of corporate buzz talk. It won't ever sound sincere, and it won't foster patient trust in the same way letting nurses and CNAs do their job will.
How about having Education come up with a 1-2 page document for those patients whom are aa&0x4 that tells them all their tests results, orders, plans for the day, etc. Give them it late in the evening telling them it will shorten things in the morning plus help everyone communicate. As for the rest of that nonsense...good luck!
Stupidest stuff ever. Just hire a robot. We're supposed to do bedside report too with the magic script. You sound like an idiot. If I know the nurse I will probably talk her up but if not...nope. I will NEVER wake my patient up if I don't have to. My place is adding electronic rounding. You have to go into the room, ask the same 5-6 scripted questions and log onto a computer to chart it. Computer garbage is more important than patient care. Incredibly frustrating.
The comic possibilities of the script are endless.
Good morning, Mr. Jones. I will be leaving shortly to go home to my smokin-hot husband. His girlfriend will stop by in a few hours, and we will enjoy an evening of intense, passionate lovemaking. I was suspicious when my husband said he wanted to open up our marriage, but it has made us so much stronger as a couple. We're always looking for new playmates. Wink wink, nudge nudge, say no more.
Sally will be your nurse for the next shift. I have known Sally for 4 years and she is a fabulous nurse with excellent clinical skills. She was our playmate for a few years, untill her husband announced he was gay and ran off to Guatemala to be with Pablo, their recently-deported pool boy. Do you know any good divorce lawyers? She had been extremely lonely since then, and was recently reprimanded for sex with a patient. You don't look like her type, so feel confident I will be leaving you in good hands wth Sally as your nurse!"
Good morning, Mr. Jones. I will be leaving shortly to go to CrossFit! I am PUMPED! I've been doing CrossFit for 3 months, and it has changed my life! l have more energy, I'm more regular, and I've lost a LOT of weight! CrossFit and my new vegan diet mean I'm going to live forever!
Sally will be your nurse for the next shift. I have known Sally for 4 years and she is a fabulous nurse with excellent clinical skills. She eats dairy, and doesn't do CrossFit. Her digestive system is full of rotten food, and she will probably drop dead of a horrible diet- related disease next week. I feel confident I will be leaving you in good hands with Sally as your nurse, assuming she survives the shift.
NuGuyNurse2b
927 Posts
We brought up scenarios like this to upper management re: privacy. So then we were told we could ask the patients whether we can start the bedside report in the presence of others...to which if the pt said no, we'd still have to walk in and introduce the next shift and then leave it at that. Which makes as much sense reading it as it does actually performing it. It has no effect on patient outcome whatsoever. before all this bedside stuff, we would just inform our patients we were leaving and that another nurse was going to take over.