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?
Wonder how they would feel if I told the truth, instead of "I'm going home to be with my family, your day nurse sure is super fabulous!": "Mr Smith, sorry for waking you after you finally managed to fall asleep at 6AM. I'm going home to eat a Lean Cuisine in front of the TV with my three cats and try to forget the fact that if I was killed by falling down the stairs at home, no one would notice unless I failed to show up for work, but by that time, said cats would have already chewed my dead face off. This is your day shift nurse... um, whatever her name is. Probably Katie or Abby, most of our 40 new nurses are one of the two. I'm sure she'll take great care of you, especially since management just sent out that super helpful email reminding people that the proper procedure to take off a stuck microclave from a PICC doesn't involve cutting it off with a pair of scissors. Anyway, she's been a nurse for like six months but she's already in FNP school, so I'm sure it'll be fine. Bye!"
What an absolute load of rubbish, try the is the UK and you would be in front of the regulatory body in particular for breech of confidentiality talking about a patient in front of relatives or anybody else who is not authorised to receive that information. Best option is to fire the suit who has come up with this bs.
Specializes in Nurse Leader specializing in Labor & Delivery.
I am looking forward to bedside report on me, while I am in a semi-private room, with another patient in the next bed. I will be go after everyone in sight!. There is absolutely no reason to devulge anything in front of another patient. There is no such thing as "low, hushed voices" when there is someone in ear shot. Even the hard of hearing will perk up when private information is being discussed.
So is your nurse just not supposed to talk to you while providing you care, taking your vitals, etc?
Whether or not you agree, bedside report does fall under incidental disclosure, and the law is behind it.
Specializes in Med/Surge, Psych, LTC, Home Health.
I love bedside report, and insist on doing it for every patient - HOWEVER... I refuse to be scripted, wake a sleeping patient, or engage in a long discussion when myself or the other nurse is trying to leave. I say, "Morning, Mr. X, My name is Oranges, I'm taking over for Apples. We are just going to give a quick report."
We do so, check drips, IV sites, bed alarms, sometimes look at (major) skin issues if there are any, change the whiteboard, make sure items are in reach. Done. Takes all of 3 minutes.
I then say, "I'm going to finish getting report on my other patients, but I'll be back shortly. If you need anything urgent in the meantime, press that button, but like I said, I will be back." Boom, leave the room.
If a patient or family has involved questions about the plan of care, labs, pathology, whatever, I tell them, "I need to look over the notes and morning labs have not been resulted yet. But I'll be better able to answer your questions after I have organized myself for the morning. Like I said, I'll be back shortly."
Of course labs have resulted, path and imaging are in and read, and by 07:30 I've probably touched base with the medical team and know exactly what the plan is... but I'm trying to get the nurse who has been there for 13-14 hours HOME! I try and stress this before we go in, and hope that the next shift will have the same respect for me - I try and lead by example.
Bedside report is a great tool both for patients and for nurses, but only if it's done right...
This. Couldn't have said it better.
Go in, introduce the next nurse, peek at IV, brief shift report, ask
about goals, any questions? Do you need anything? Update
whiteboard. Done.
Like I said though, we don't ALWAYS do all of this, okay?
I'm not a fan of waking up a sleeping patient at 7am, when
it's just unnecessary. Plus, there are simply some patients
that I'm totally uncomfortable doing all of this with.
This won't be popular, but the truth is that patient satisfaction is tied to outcomes. So there is a good reason why the govt reimburses based on patient satisfaction. I don't know why hospitals arent educating their nurses about this part of the equation, but I did learn it nursing school as I am a recent grad.
"Patient satisfaction is tied to outcomes" is something every one of us on this thread has heard. It's a convenient statement in that it encourages people to make inferences that go well beyond the facts we currently have, and even reason sometimes. What outcomes are we talking about? Improved blood pressure control? Better HgbA1C? Decreased mortality? Anything clinical? The evidence is weak at this point.
Yes, HCAHPS ties reimbursement to patient satisfaction and there is a good reason for it. Ask yourself what that reason might be at this particular juncture when there isn't a ton of good evidence that shows a clear positive correlation between patient satisfaction and measurable clinical outcomes.
I will say that when I worked on the medical units, they pushed for bedside report. During this we would update the grease boards with the oncoming nurses names and let them know that their care was being transferred- however using nursing judgement if the patient had a rough night and didn't fall asleep until 3AM we would generally just do report outside of the room.
That being in mind- remember HIPAA. If the patient is in a semi-private room, you're sharing proprietary information with other ears without the patient's consent. This can be an issue.
We also were told to do assessments of IV sites to make sure they had not infiltrated or were beyond the expiration date. Back in my day we only had 3 days before we had to do a site rotation. However, with EBP we are not told that we can leave IVs in for up to 7 days if there is no issues with the site or IV.
Specializes in Critical Care; Cardiac; Professional Development.
I love bedside report, and insist on doing it for every patient - HOWEVER... I refuse to be scripted, wake a sleeping patient, or engage in a long discussion when myself or the other nurse is trying to leave. I say, "Morning, Mr. X, My name is Oranges, I'm taking over for Apples. We are just going to give a quick report."
We do so, check drips, IV sites, bed alarms, sometimes look at (major) skin issues if there are any, change the whiteboard, make sure items are in reach. Done. Takes all of 3 minutes.
I then say, "I'm going to finish getting report on my other patients, but I'll be back shortly. If you need anything urgent in the meantime, press that button, but like I said, I will be back." Boom, leave the room.
If a patient or family has involved questions about the plan of care, labs, pathology, whatever, I tell them, "I need to look over the notes and morning labs have not been resulted yet. But I'll be better able to answer your questions after I have organized myself for the morning. Like I said, I'll be back shortly."
Of course labs have resulted, path and imaging are in and read, and by 07:30 I've probably touched base with the medical team and know exactly what the plan is... but I'm trying to get the nurse who has been there for 13-14 hours HOME! I try and stress this before we go in, and hope that the next shift will have the same respect for me - I try and lead by example.
Bedside report is a great tool both for patients and for nurses, but only if it's done right...
I can't love this enough. Not comfortable talking about the patient's care in front of the patient? Read that statement again....there is something hugely wrong with that. The patient has a right to know everything about their care and nobody should be uncomfortable with that.
Personally I hate bedside rounds because if the truth be told at the end of a 12 hour shift my back hurts and I want to sit down and gather my thoughts and check I've finished everything. As an oncoming nurse I prefer to sit at a desk because I take copious notes and I prefer to sit where I can comfortably write. Having said that, my unit give report at the desk first with all the details, and then do a quick bedside rounds afterwards. I think that's the best compromise.
guest974915
276 Posts
Hilarious! Thanks for that laugh!