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Most of our docs are using Acticoat or Mepilex silver dressings. Applied in the OR, they are not removed for at least 7 days, or at their first postop visit, unless they have excess drainage.

1. If you think something is wrong, it usually is. 2. Nursing is a 24 hour job, everything does not have to get done on your shift. 3 Never mention a former patient's name (especially the trying ones), they will show up in a hurry!

I get that part, but how does the charge nurse and the manager stay informed about each patient so they can help where needed, answer questions and make appropriate assignments.

From what I am reading, those who like the process, it is really a way to check up on the nurse you are following and make sure they have left nothing over from their shift for you to do. I am seeing nothing about the patient involvement in the report which is really what this is supposedly about. And still not seeing how the rest of the staff stays informed about what is going on on the floor.

I need help- Our CNO and hospital administrators are now making manditory on all units, bedside reporting. We call it Walking Rounds, but it is really bedside report. A little backround on our unit: We work on a busy orthopedic unit where most patients follow a predicted course of treatment. Their mornings start early with lab draws every morning at 4am, doctors in between 5:30-7am, techs taking vitals and blood sugars at 7am, CPM machines go on at 6, and therapists are in the rooms starting at 7:30am. Now they are asking us to interupt them one more time with bedside report. Our patients chief complaint is interruption of sleep. They are busy from 4am-4pm really. They see a minimum of 2 doctors, PT twice, OT twice, care coordinator, social worker, hourly rounds by nurses and PCA's. They are very informed of their care from every person. We are having a very difficult time coming up with positives for true bedside reporting. Right now everyone is giving report int he halls, and then if necessary going into rooms to check PCA machines, dressings, etc. What I need from you all is some positives that come from your bedside reporting. Seems everything I have read on here has the same problems we are experiencing. Our negatives include: -multiple nurses to get report from -no one to get pain meds and potty trips during shift report times -oncoming nurses who want to do their assessments during report -those who arrive late, or floating from other floors -waking patients who have finally fallen off to sleep, and interrupting naps in the afternoon -families, visitors- how do we handle this and HIPPA -Charge nurse not getting adequate report on patients and not beign aware of problems on unit, and other nurses on the shift not being aware of other assignments, whether it be deterioration in condition of a certain patient, or difficulty of others assignments -Difficulty writing report down and concentrating on what needs to be said if interrupted during report Anxious to hear some positives so I can take them to my staff and maybe convince myself that this is really best practice

1. Nurses have to take up the slack for all departments, and when something isn't right it always come back on the nurses. 2. New policies instituted by the hospital governing body for changes in nursing policies without ever consulting the floor nurse to see what is best for their unit. Most of these decision makers have been behind a desk for 20 years, and barely even walk onto a nursing unit. 3. Nurses who are always too busy to take an admission 4. Floor nurses can be talked meanly to by doctors and other departments and we are just supposed to take it. Whatever happened to please and thankyou?

"Make it a point to understand the realities of the floor. Pick up various shifts every couple weeks...you can't really effectively make rules up for people when you don't understand what their job actually entails." Amen to this. We have a new CNO at our facility and she really is gunho about change and making things better and family/patient centered care. But somewhere in the mix we have to remember those who are providing this care. What is deemed n some book as "best practice" may not always be best practice. If almost EVERY NURSE who is providing this care, has misgivings about new policies, it is not because we want to be negative...it is because we are the ones who live it. Every new policy takes times, every new piece of electronic charting or paper flow sheet takes time, just because something is new in some workshop somewhere does not mean it is the best for every unit every time. My advice, listen to your nurses. Listen to their concerns and act on them. They want to provide the best care they can, but most changes cost them time, which really in the long run takes more time from the bedside. Yes,I am frustrated! Sorry for the rant. :grn:

Almost on a daily basis, I hang up the phone and work and wonder why we on the nursing floors are expected to be nice to everyone, but we have to take everyone else's cr__! You talk to any other department including the doctors, and they can be rude, rude, rude! But we would get reported if we talked to them like that. Goes for ER, OR. PACU, dietary, maintenance, sometimes even security...and I am getting tired of it!!!! And Doctors..they can be the worst. Everyone needs to get over themselves and talk civilly like they would like to be talked to! I really do feel your pain.

It is all about Patient Satisfaction scores.

If all you say in front of the patient is what you describe above, then where do you get the rest of the report. If you have never had "patient A & B" then you know nothing about them and "ok" just doesn't cut it.

I am wondering how many floors use "Walking Rounds" as a means of shift to shift report. 1) How do you go about it? 2) What if a patient needs something during this time (call lights,help to bathroom, pain meds, dr phone calls, etc). 3) How do charge nurses handle getting report on the whole floor 4)Do your patients like them? 5) What if a nurse is running late, or has to leave early and someone is covering her patients for a short time? 6) Night shift to day shift is more nurses getting report from less nurses and visa versa We are going to have to start them soon, work on a busy floor and mornings for the patients are already so busy for them with lab, doctors, therapy and they already complain that they don't get enough sleep/ We are trying to make this a smooth transition for both staff and patients, but really have been given no info on how to implement it other than an article on the subject to read. Thanks for any info you can give.

Out total knees and hips length of stay is generally 3 days on our ortho floor. That means if they have their surgery on Monday they are ready to go by Thursday, regardless if it is single or bilatteral. We have a few surgeons who do the bilatteral, mostly at the patient's choosing because they cannot take that much time off work, or don't want the lengthy rehab choices. We have had a good deal of patients leaving on the 2nd day lately, but they are usually the younger patients.

[ My only thought was thank God I am such a stubborn nurse! If the patient had an ortho nurse, she may have gone home with a PE. Has anyone else noticed that mentality in the hospitals? treat only the problem you specialize in? Wow! Not sure what type of hospital you work in, but I am the CN on a busy orthopedic unit and never would have sent a patient home with those symptoms. When in doubt, always call the doc. All of our patients have medical coverage either through their own primary cares, or hospitalist coverage for just those type of things. Good for you to be diligent in your care, and shame on the "specialty" nurses who focus on ortho only. Sent home, that patient likely would not have made it. That is one of the most common complications of orthopedic surgery, and everyone should be on the lookout for that. I must say I am flabergasted at the attitude of that charge nurse.

I would have felt this way long before HIPAA also, but what HIPAA has done is make people more aware of this. I just felt really uncomfortable giving and receiving report this way. I asked some of the nurses on the floor about this, and they seemed uncomfortable about it also, but their nurse manager was all for it.

Do any of you have experience with walking report? I was floated to another unit yesterday where they have instituted this. (We still use taped report on our unit) While I understand the premise, I am not sure how this can coincide with HIPPA. I met the nurse going on shift at the patients room, which was semi private. We are in front of the door, and she proceeds to give me report on the patients in the room, within easy earshot of anyone in the hall or patient room. We are not the only ones in the hall. There are 4-5 other sets of nurses doing the same thing. Lots of information being passed around. Later int he shift one of my male patients mentioned to me that he thought he might have bone cancer, because he heard someone mentioning it in the hall talking. This was not him, but another patient that was newly diagnosed. I just have a bad feeling about giving that type of information in the hall, we give alot of information during report, some that is not meant to be heard by patients and their families. The other thing I did not like was not knowing what was going on on the floor around me, in case of an emergency, or question asked by doctor or family member. I guess it is old school, but I was always taught and still believe, that is good knowing what is going on with other patients and nurses around you in case of an emergency or other thing that might come up. I guess I just don;t like the thought of walking report, I hope our unit does not institute it.