Is this reasonable or just over the top?

[Lakeshore18]

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?

[rescueninja1987]

You lost me at "wake the patient up", and it gets increasingly ridiculous from there. Whoever made this stupidly goofy decision shouldn't be running a child's lemonade stand, much less a nursing unit.

[FolksBtrippin, BSN, RN]

"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.

My hospital does not educate nurses (and other employees) on the link between patient satisfaction and improved care. It's not part of the general employee orientation, although there is a strong emphasis on the idea of patient satisfaction.

I did some research and saw a lot of information about HCAHPS and poor outcomes. It seems like it's much more controversial than I thought.

However there is also good evidence tying patient experience to measurable clinical outcomes. This one is about MI:

Patient-centered processes of care and long-term outcomes of myocardial infarction. - PubMed - NCBI

Also 30 day readmission and mortality:

Patient-centered processes of care and long-term outcomes of myocardial infarction. - PubMed - NCBI

I read an article from NEJM that says we need to look at how we measure the patient experience. I can't seem to link to it. It's called "The Patient Experience and Health Outcomes" in the New England Journal of Medicine.

[ruralnurse84]

We moved to bedside reporting last year, which was actually an improvement because we used to have to listen to report on every single patient, frequently putting us into overtime. Fortunately we are not at a scripted stage yet and can often get away with doing report in the med room, especially if there is a lot of family in the patient's room or if the patient is sleeping. However, our hospital is in the process of becoming a Studer hospital, hopefully this does not make us do a scripted report. That's so completely asinine. People like to be individualized not made to feel like the same old thing over and over again. Also, doing a mini assessment at report is absolutely ridiculous. One of the nurses I frequently give report to likes to do this while I'm talking to her so she misses half the things I tell her and then will say at the next shift change that I didn't tell her so and so, but that's a whole other issue.

[Erocknurse]

This is ridiculous!!!!!! Honestly, I think bedside report is rude. You are talking about a patient like they aren't there! When I have attempted to do it, patients have become scared by all of the clinical talk no matter how many times it may have been explained previously. And then you have he family. The only place where I see value in bedside reporting would be in the ICU. And that scripting? Please! Nursing has just become ridiculous.

[Here.I.Stand, BSN, RN]

What fresh hell is this? I've been out of nursing for only three years, but from so many discussions about scripting and bedside report (hello, HIPAA anyone?)

I'm thinking this would be considered an incidental disclosure, much like when the medical/IDT rounds. However, I would think that the goal should be to minimize this -- especially from nursing, who is perceived as the ones who are trustworthy, the ones who treat the person vs the disease.

I'm all for both nurses laying eyes on the pt -- although I will admit this is much easier in the ICU vs the floor, where one nurse may be reporting off to multiple nurses d/t assignment adjustments. But discussing the pt's loose stools or 5 days with no BM, new penile/lady partsl discharge, pre-op transgender status, mental illness or bloodborne pathogen history in front of the roommate? No, just no.

[dbabz]

Haha! Thanks for the laugh. If the nursing thing doesn't work out, you have a future in comedy writing!

[SmilingBluEyes]

Haha! Thanks for the laugh. If the nursing thing doesn't work out, you have a future in comedy writing!

Please quote to whom you are talking.

[DeeAngel]

Do what they did at my old hospital, do report following every single guideline they lay out for you to follow and take your time to be thorough. Do not rush, you don't want the patient to feel rushed at report, so feel free to be relaxed and calm They will change their minds when they are paying all their nurses an hour or more overtime every shift. This cannot be done in 30 minutes and they are delusional if they think it can be. Don't rush to accomodate *their* timeline, accomodate the activities you are supposed to be doing and let it take as long as it takes. They will reassess their protocol when the see the OT mount up, a more accurate expectation for a report of this depth would be around an hour. A report of this depth on 5 patients in 30 minutes is ridiculous and anyone who has worked patient care knows that it is.

[daytoday]

I have worked on a general oncology floor that required this type of report, and I regularly had to hand off six patients from night shift. The pt load itself was barely manageable, we regularly had charting left to do after report. We had a two page checklist of everything we had to do in report, in order, and management followed us in the morning, marking what we hit and what we forgot. We also had to check all orders in the computer, and discontinue orders appropriately. If anything went wrong- like an IV that infiltrated at shift change, a pt in need of pain meds, we were expected to do that as well before leaving. I'll be honest, it was a disaster. I understand the concept of preparing for the next shift, but at some point your shift has to end- not all loose ends can be tied up before shift change, nursing is a 24 hour job. In fact, most of our codes and falls happened at shift change, because the nurses were so tied up for over an hour giving/getting report! Not only that, but on top of everything, before we could even start getting report, we had a huddle at every shift change that regularly took 30 minutes. So shift change started at 0645, and was usually over at 0815. True story. I worked at another hospital on a heme/onc floor, where report was much more effective, and usually done in 20 minutes. The night shift nurses had four or five patients to hand off (better ratios), we got report at the nurses station or outside the room at a computer- if oncoming shift had any questions about orders on the computer they were answered right there, then we went in the rooms, looked at IV/ports/PICC sites, checked fluid bags and pumps, looked at any wounds together, introduced ourselves, asked the pt if they had any questions, and would let the pt know pertinent things, like "I told Sally you'd like to ask your doctor about..." Or "Sally is aware that your second bag of chemo will go up this afternoon..." Etc. If they were asleep, we did not wake them. Ever. We could communicate our professional report to each other much more effectively away from the pt, while still keeping the pt informed about their care. All of our patients had an excellent grasp on their care plan. It was a GREAT method, and just as I was leaving that job, they were starting to implement "full bedside report" and shift change huddle.

[klone, MSN, RN]

This is ridiculous!!!!!! Honestly, I think bedside report is rude. You are talking about a patient like they aren't there!

Then you're doing it wrong. You're not supposed to be talking about the patient like they're not there. You AND THE PATIENT are updating the oncoming nurse about the patient's status, goals for the next shift, discharge plan, etc. The purpose is to ENGAGE the patient, not talk over him.

[Rexie]

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.

I agree that the pt has a right to know everything about their care but there are certain things that they do not need to hear from nursing. The worst examples have been times when there was a question of cancer but we're waiting on radiology reports or lab results (or for the physician to speak with the pt). If the physician hasn't already shared this with the pt, bedside report is the wrong time for the pt to learn this kind of news. And I've seen it happen.

My favorite bedside report is when we've covered the basics, discussed the plan for the day (as far as we know it) and update the white boards. I never want to wake a sleeping pt - they get little enough sleep as it is. And I never want to have to use a script. I've pushed back hard on that in the past and hopefully will never have to use one. It's insulting to the pt and to the staff.

[gettingbsn2msn, MSN, RN]

And this is why I wrote on another thread that "older" nurses are leaving the bedside. We no longer can tolerate the BS.

Happy to be out of the hospital!