Greenhermit

We recently switched from group report (4-5 nurses per shift) to face-to-face bedside report, despite many objections. Group report, where the oncoming shift would hear from each nurse in-person (not on tape), allowed us to allocate assignments more appropriately, share suggestions, and plan for situations that may need two or more nurses (e.g., dressing changes). Face-to-face bedside report causes less sharing of ideas and expertise and more staff fragmentation. Patient privacy was one concern, especially in semi-private rooms, where there were relatives of other patients present. In the hallway, visitors linger within earshot. People quote HIPAA regs, saying that communicating confidential information in front of others while providing care is acceptable. Giving report is not same as talking while providing direct patient care. The next major concern is patient safety. We know nothing about any of the other patients on the floor other than our own. What happens when the assigned nurse is tied up with another patient? We've already had situations where a patient had seizures but no one knew if these were new onset, febrile, or parameters for intervention. Two pregnant nurses became parvovirus positive after assisting a patient not their own. A family requested that non-family males not enter a patient's room, but that was not known when the nurse responded to the call-light. Just this morning I discovered that the oncoming and leaving aides were not aware that one of our patients has "brittle bone," because they no longer sit in group report with us but have their own face-to-face report.. One option is to tell the patient or family to wait until their nurse is free, even though some of our procedures or dressing changes can last a hour. At night, bedside report can disrupt hard-won sleep. It also can tie up two nurses attending to an awakened patient's requests. During the individual face-to-face reports there is no one at the desk to respond to emergencies in the other rooms. Report becomes a frustrating "musical chairs," trying to find 4 or 5 different nurses to get report from. There are other drawbacks to that system, but these give you an idea. Most of the articles I've read about transition to bedside reporting were efforts to get away from tape-recorded report methods, which I consider the worst of all shift report techniques. The touchy-feely theory of bedside report is to involve patients in their care. Using a flawed report system to do what should already be done 24 hours a day creates more problems than it accomplishes - it's more symbol than actual doing. It's another fad that sweeps nursing periodically when management nurses with minimal direct care experience read a journal article written by someone with even less real life experience. An ideal method would be to have group report, then immediately go to the bedside to quietly check the patient, IVs, fluids and other items, before running to the cafeteria for breakfast.

We recently switched from group report (4-5 nurses per shift) to face-to-face bedside report, despite many objections. Group report, where the oncoming shift would hear from each nurse, allowed us to allocate assignments better, share suggestions, and plan for situations that may need two or more nurses (e.g., dressing changes). Patient privacy was one of the concerns, especially in semi-private rooms, where there were relatives of other patients present. In the hallway, visitors linger within earshot. The next major concern was that we knew nothing about any of the other patients on the floor other than our own. We've already had situations where a patient had seizures but no one knew if these were new onset, febrile, or parameters for intervention. Two pregnant nurses became parvovirus positive after assisting a patient not their own. A family requested that non-family males not enter a patient's room, but that was not known when the nurse responded to the call-light. One option is to tell the patient or family to wait until their nurse is free, even though some of our procedures or dressing changes can last a hour. At night, bedside report can disrupt hard-won sleep. It also can tie up two nurses attending to an awakened patient's requests. During the individual face-to-face reports there is no one at the desk to respond to emergencies in the other rooms. Report becomes a frustrating "musical chairs," trying to find 4 or 5 different nurses to get report from. There are other drawbacks to that system, but these give you an idea. Most of the articles I've read about transition to bedside reporting were from tape-recorded report methods, which I consider the worst of all shift report techniques. There is less sharing of ideas and expertise and more staff fragmentation with the face-to-face bedside report.