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?

[gettingbsn2msn, MSN, RN]

Excellent! However, I see it happening differently. Nurses will be written up due to the fact that they cannot manage their time well. I have seen this happen.

[missmollie, ADN, BSN, RN]

Bedside shift report sounds great on paper but is ridiculous in reality. Sleep is important and there is no need to wake up a sleeping patient. At least we know the moment a hospital is sued for a HIPAA violation because of bedside shift report, the bedside shift report movement will end.

[keto]

hmm im not sure but ive heard of this happening to people, none seemed ecstatic about it but i guess its not super uncommon

[NurseKatie08, MSN]

I'm a fan of bedside report, but only when it's done right.

First, the whole point of bedside report is to engage the patient in their care and their discharge planning. Thus, an effective bedside report is one that the off-going nurse AND THE PATIENT give to the oncoming nurse. It should not be two nurses talking over the patient's head.

Second, having both nurses go into the room and lay eyes on the patient provides accountability for care. If you're looking at the patient together and you see a bag of fluids that have run dry, or an infiltrated IV site, or a soiled dressing, or a foley that hasn't been emptied all shift, the offgoing nurse can't say "It wasn't like that when I left!"

We have implemented it at our facility, and as part of the group that planned the roll-out, I gave my vehement objection to any kind of scripting. I am NOT requiring the nurses in my unit to say "Is there anything else you need before I leave? I have the time!" or anything else by rote, even though it says that's supposed to be done on the audit tool that we will use to audit all nurses.

Part of effective bedside report is providing education to the patient before it occurs on WHY we're doing it and what to expect. Part of that education is discussing with them beforehand on whether they want their friends and family present for report.

Finally, if patients insist they do not want to be woken for report, then we don't wake them. However, the nurses are still required to go into the patient's room to lay eyes on them, check lines and drains, and do a safety check (bed down, locked, call light in reach). That's just good nursing practice, and should happen with EVERY patient, every shift.

It's completely unreasonable and unnecessary to do an assessment during hand-off. You also shouldn't be toileting or providing pain medication. Each hand-off should take no longer than about 5 minutes. If you're taking much longer than that, you're doing it wrong, and/or your facility is being unreasonable in their expectation of what should occur during shift report.

This this this!

I agree completely with what klone has written here. I think a huge component of making bedside shift report work is doing a round on all your patients one hour beforehand and assessing for needs such as bathroom & pain meds so that more than likely those requests won't come up during report. We do bedside shift report and I actually really like it. Within EPIC we have a handoff tool that (in a perfect world) is updated daily and basically sums up the patient's story and plan. I find I do not even need to refer to my own notes to give report anymore.

[CrunchRN, ADN, RN]

Yuck. As a patient or family member I would dislike hearing that as much as you would hate saying it.

[DeeAngel]

Honest to God, you are supposed to, wake the patient up? ������

You cannot accurately assess all aspects of the patient without waking them up and yes, some places expect you to wake everyone up for assessments. Its beyond stupid.

[K9lover, ASN, RN]

I hate beside report because I don't feel comfortable talking about the patient in front of the patient.

Making the next shift wait through an assessment? Heck no!

As do I, it ends up being double shift report;

*Report #1 "This is Ben, he will be your oncoming nurse. He comes to us with glowing recommendations! He will be changing your dressing @ 2200 hours and if you need anything don't hesitate to call, we all have the time!"

*Report #2 out of the room "Mr. Room 5 is very tolerant to Dialuadid due to his 20 year Heroin habit, he has an abscess on r arm; do not think about touching it without 1st calling the doctor for a 'one time' extra 1 mg dose of Dilaudid. The last RN who did that was bit on the hand."

Unless you want to combine the two reports with all family sitting in the room:

*Combined report: "Here is Mr. B, has a rather high tolerance for pain meds owing to you Heroin habit, Mr B how has that been working out for you? Mr. B kicked the last noc nurse when she attempted a dressing change without calling the doc 1st, isn't that right, Mr. B? Also he does not like Asian nurses but he has promised to keep his racial epithets to a minimum while he is here. Family of Mr. B can we count on your help with the racial slur reminders? Of course do not hesitate to call if you and/or your 5 family members want water, ice, take-out, TV fixed, a dime bag; we have the time! "

[K9lover, ASN, RN]

Then we do it all over again when we are out of the room with the additional information the patient does not want to hear!

[K9lover, ASN, RN]

The reason would be to NOT give up CMS money. CMS is not different from every other insurance in that they are not exactly looking for ways to reimburse.

A lot of folks are not in the best of moods while hospitalized and I can see why, they are sleep-deprived enough without private rooms, monitors, labs drawn all of the time.

[TeeKay12]

One of the things I hated most about bedside nursing. Scripted performance. I'm very much for keeping the patients informed. I'm opposed to the idea of 'selling' the services of my colleagues - especially if I am required to either lie or state a fact I do not know. I refused to do this. I would just say "Good morning, Mr. Smith. This is Jean. She'll be your nurse for today."

We also had the patient white boards, and I found they took more time and energy to answer patient questions about them than they saved.

[amcmillan67]

Hospitals have been doing this for awhile-it's really not that bad. Most patients don't say anything and sometimes you think of things or see things that might not come up in report.

[calivianya, BSN, RN]

Now, in the ICU, yes, this was a good idea. Easy way to check drips, vent settings, do a visual once-over and help with a turn. But giving report on two patients was much quicker (I was never late clocking out in the ICU) so these things could be managed must simpler; also, we didn't need to wake the patients. Often times they were sedated or not going to wake up so that element was removed.

I wish I was never late clocking out in ICU. Out of the past 10 shifts I've worked, according to my staffing software, I've clocked out on time three times. I've had patients where the report on one patient alone took greater than 30 minutes.

Granted, day shift huddle typically seems like it takes forever, so I usually only have 20 minutes or less to give report before I'm "late" clocking out.

We also have totally open visitation, so there are usually visitors in the room at shift change, so if we even remotely try to do bedside report it turns into a giant Q&A session. It is policy for us to give bedside report, and I understand why it's helpful - but I personally refuse to, and if they want to fire me for it, they can go right ahead and fire me. The one time I tried, the visitors asked so many questions that I was 45 minutes late leaving, and I'm not putting myself through that again.