"Nurse Bedside Shift Report" Survey

Published

{ NURSE SURVEY }

*Implementation of "
nurse bedside shift report
" is being attempted by so many hospitals now in an effort to improve quality of care.

*I created a fun survey! to assess nurses' stance and view towards "
nurse bedside shift report
" as part of my last BSN project.

*There are 13 questions, and I appreciate your time to respond to my survey:cat:

1. Do you feel that nurses' "
bedside shift report"
improves quality of care?

*2. Which of the following improve(s) by implementing "
nurse bedside shift report"
? (Select all that apply)

Patient-centered care

Teamwork and collaboration

Quality of care

Safety

None

Other

*3. Is
bedside shift report”
explained to patients during the admission process?

Yes

No

I forget to explain it at times.

*4. Are patients asked if they are comfortable with
bedside shift report”
every time? (Assume your patient is awake.)

Yes

No

I forget to ask at times.

*5. Were you trained in bedside shift report” prior to its implementation?

Yes

No

*6. If you were trained, what method was used? (Select all that apply)

Trained by education department (class, online module, etc.).

Mentioned in staff meeting by management team.

Assumed that all nurses will do bedside shift report” the same way.

No training offered.

Other method (please specify)

*7. Are sensitive topics always discussed as part of
bedside shift report”
?

Yes

No

I follow patient's preference.

*8. Do you like
bedside shift reporting”
as a nurse?

Yes

No

*9. Do all nurses participate in
bedside shift report”
during shift change?

Yes

No

*10. What are the barriers in implementing
bedside shift report”
? (Select all that apply)

It takes longer time than non-bedside shift report does.

Too many patients are assigned to each nurse to have enough time.

I don't like to talk to patients and/or family.

I am too busy in general.

No barriers.

Other barrier (please specify)

*11. Are patients encouraged to participate in
bedside shift report”
?

Yes

No

*12. How are patients encouraged to participate in
bedside shift report”
? (Select all that apply)

Before report starts, patient is reminded to participate.

This is talked about during admission.

Assume that patient will participate if nurses are in room.

Nurses stop at various times during report and ask patient for their comments or questions.

I don't encourage them.

Other (please specify)

*13. Do you have any other comments, questions, or concerns about
nurse bedside shift report”
as a nurse?

No

Yes (please specify)

When a family member was hospitalized recently we experienced what appeared to be bedside report. I wish we could have been involved in the discussion about my family member re their care, or even given the opportunity to speak. The uncomfortable appearing offgoing nurse hastily relayed some brief information about my family member to the oncoming nurse in our presence, almost as though my family member was an inanimate object, and when I politely interjected with pertinent information the nurse looked at me as if to say: "What does this have to do with you?"

I am sure that used intelligently, with sensitivity and regard for the patient's wishes, bedside report can be very beneficial for the handover of care for both patients/family and staff. I agree with HouTx, Klone, ArtClass, and Coyboyardee. As HouTx pointed out, it's quite likely and hopefully desirable that the patient/family will become more informed about the care the patient is receiving as a result, and while this may result in some unexpected outcomes, such as the patient complaining about their physician (or another staff member) because they more fully understood that person's role in their care, or heaven forbid, asking questions about their care, we're all big enough (aren't we) to not allow such minor considerations to color our view of bedside report or detract from our wholehearted attempts at it's implementation.

Specializes in Nurse Leader specializing in Labor & Delivery.
How does this work with dementia patients?

Report would be with patient's family.

Specializes in ICU, LTACH, Internal Medicine.
Report would be with patient's family.

... which is:

- never there;

- in total denial for the last 10 years asking everyone when The Mother will be finally fix'ed up;

- partially there and asking you to wait for Cousine Mary who wants to speak, too, and will be there soon (you have to leave 7:35);

- holding on that last straw and do not let you go for half an hour; you have to do the same with your other 6 patients, and clock out at 7:35 latest or go see manager yet again;

- deep in anticipatory grief and only able to complain about every single little thing for now.

Bedside reports, like too many "innovations" in modern American nursing, was concieved and brough to life by people who've never practiced nursing in real life in any capacity. If you take a look on that so- called "research" done to justify it, you'll see that it was all conducted in high-level academic centers. The problem is, the clientelle of said centers, and particularly specialty units, have nothing in common with one of critical rural access 25 total bed hospital in Tennessee or inner city facility in Bronx. If you read a bit more, you'll be surprised that many studies either do not mention ethnicity of subjects or have ethnicity gap as compared with demographics of surrounding area. The authors, not willing to grape with cultural, ethical and other problems, just pick up "typical" subjects for recruiting and, as a result, get data based on reactions of population which is overwhelmingly Caucasian, educated, US- born, outgoing, enjoys speaking about life with complete strangers, etc., so they love to "participate" in bedside report, especially if nurses are given additional time and other small insensitives because "it is a study". But it still has nothing at all to do with real life of a med/surg nurse who has 7 patients and 30 min, and already half dead after 12 hours running like crazy.

As things stand for now, bedside reports can be done as they were thought of in either boutique medicine like Cancer Centers of America, or in well-staffed, well-trained units with cooperative patients/families and controlled environment. Which are, in total, represent maybe some 10% of US care facilities. In all other 90% it is, at its best, time spent for the sake of satisfying some piece of paper and at the worst, totally dehumanizing action which brings more harm than good to everyone.

Specializes in Nurse Leader specializing in Labor & Delivery.
... which is:

- never there;

- in total denial for the last 10 years asking everyone when The Mother will be finally fix'ed up;

- partially there and asking you to wait for Cousine Mary who wants to speak, too, and will be there soon (you have to leave 7:35);

- holding on that last straw and do not let you go for half an hour; you have to do the same with your other 6 patients, and clock out at 7:35 latest or go see manager yet again;

- deep in anticipatory grief and only able to complain about every single little thing for now.

Then you wouldn't do it, other than simple bedside hand-off between nurses where they look at lines, pump settings, etc. which should be done 100% of the time for safety, anyway.

The purpose of bedside report is to allow the patient/family to be PARTICIPATORY in the patient's care plan. Obviously in situations where the patient and/or family can't or doesn't want to participate, it should be tailored accordingly.

Specializes in Critical care.
My facility supposedly went the way of bedside report years ago. Over the years it has evolved AWAY from the bedside. Instead, we give a computer-side report and finish up at the bedside to introduce the oncoming nurse to the patient, verify lines, tubes and dressings and elicit any immediate concerns. It works so much better this way! It improves quality of care as we review vital sign trends, medications and labs during the course of report. We can also glance at any relevant new orders, doctor's notes or test results. The oncoming nurse has a good idea of what is going on before she/he even enters the room to meet the patient. Moving away from bedside report has been an enormous step in improving patient care.

(However, we're forced to "pretend" when management is on the unit at report time. Our nurse manager is a genius at keeping upper management away from the ICU during report time, but sometimes one or two slip through.)

Your long and poorly constructed survey is in no way "fun". Perhaps constructing it as a survey, or a poll or a series of polls?

Bedside shift report greatly increases the time it takes to give report, and nurse to nurse shorthand is questioned and must be explained. Sensitive topics cannot be discussed in front of the patient/or family. There was a woman who was trying to keep her HIV status secret from her children, and the nurse just blurted it out during bedside report. It was well-documented that she wanted to keep it secret, but it just rolled right off someone's tongue who should have known better. The more people at the bedside, the more discussion there is. Maybe OK when you have only one patient in the ICU, but two patients in the ICU or six on the floor, and it's problematic.

In general, I think it's a bad idea that someone came up with to "increase patient satisfaction scores", which is as poor a metric as any I've seen to measure quality of care.

I agree with Ruby Vee. I am allowed to clock in 5 minutes before my shift starts. We have 30 minutes total to do morning safety huddle as a unit plus get report on 5 patients. There is just not enough time and many patients are sleeping still. We do report outside the room because there are "eyes" in the hospital and if we get caught doing it elsewhere we are written up (or at least that's the threat). We review orders (especially for continuous IV meds), pertinent doctor's notes, trends in vitals if needed, etc., we line trace (IVs, tubing- foleys, drains, chest tubes, etc.), then we have to review the tele monitor for events and adjust the alarm settings as needed (if pt is brady and known to be then we change the low alarm from 60 to 50 or whatever is safe and warranted to avoid alarm fatigue). If a patient has complex wounds we'll look at those together if possible. If the patinet is awake I'll introduce myself as I update the white board with the plan for the day, my name, the CNA's name, and the name of the doctor who will be rounding on them that day. When I'm giving report at night I always introduce the night nurse, tell the patient they are in great hands, ask if there's anything else we can do for them, and wish them the best in their recovery if I won't be back in or tell them to have a good night and that I'll see them in the morning.

I agree there are benefits to involving the patient and family, I just don't necessarily think report time is the best time to do so. I do many of the things Klone talks about during the day when I am updating the patient and the family during my shift. I will happily go over everything with the patient and the family when they ask for an update, I'll get their opinion, takes notes and pass along necessary info during report, etc.

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
... which is:

- never there;

- in total denial for the last 10 years asking everyone when The Mother will be finally fix'ed up;

- partially there and asking you to wait for Cousine Mary who wants to speak, too, and will be there soon (you have to leave 7:35);

- holding on that last straw and do not let you go for half an hour; you have to do the same with your other 6 patients, and clock out at 7:35 latest or go see manager yet again;

- deep in anticipatory grief and only able to complain about every single little thing for now.

Bedside reports, like too many "innovations" in modern American nursing, was concieved and brough to life by people who've never practiced nursing in real life in any capacity. If you take a look on that so- called "research" done to justify it, you'll see that it was all conducted in high-level academic centers. The problem is, the clientelle of said centers, and particularly specialty units, have nothing in common with one of critical rural access 25 total bed hospital in Tennessee or inner city facility in Bronx. If you read a bit more, you'll be surprised that many studies either do not mention ethnicity of subjects or have ethnicity gap as compared with demographics of surrounding area. The authors, not willing to grape with cultural, ethical and other problems, just pick up "typical" subjects for recruiting and, as a result, get data based on reactions of population which is overwhelmingly Caucasian, educated, US- born, outgoing, enjoys speaking about life with complete strangers, etc., so they love to "participate" in bedside report, especially if nurses are given additional time and other small insensitives because "it is a study". But it still has nothing at all to do with real life of a med/surg nurse who has 7 patients and 30 min, and already half dead after 12 hours running like crazy.

As things stand for now, bedside reports can be done as they were thought of in either boutique medicine like Cancer Centers of America, or in well-staffed, well-trained units with cooperative patients/families and controlled environment. Which are, in total, represent maybe some 10% of US care facilities. In all other 90% it is, at its best, time spent for the sake of satisfying some piece of paper and at the worst, totally dehumanizing action which brings more harm than good to everyone.

I know it's poor form to quote a long post in its entirety just to say something like "I agree", but this is such a well-reasoned indictment of bedside report that I couldn't begin to know where to start clipping. (Besides, my finger is too fat to be able to clip accurately on my phone.)

Bedside report seems to assume that all patients and their families understand what is discussed, and actually care about nurse to nurse report. In many cases, neither of those two things are true, and in the interest of getting out on time, no one has time to explain an entire report, even a focused report, to two or more angry family members of an angry patient who just want to suck up nursing time because they're bored sitting in the hospital but don't wish to leave because the hospital has heat, A/C, cable and internet, and all the free food you can mooch. Bedside report also assumes that patients and families can behave themselves for the time it takes to give/receive a bedside report, and that is often not the case, either.

And then there's bedside rounds, in a teaching hospital, which can take two hours per patient. That's probably enough time for the patient/family to get all of their legitimate questions answered. I've noticed that patient/family are far less likely to interrupt bedside ROUNDS with inane questions like "Why you TV don't have no remote except that one there?" And "What we having for supper tonight?". (Or maybe the attending physicians are just more adept and shooting those sorts of questions down with "the nurse will tell you that when we're all done here.")

I agree with Ruby Vee. I am allowed to clock in 5 minutes before my shift starts. We have 30 minutes total to do morning safety huddle as a unit plus get report on 5 patients. There is just not enough time and many patients are sleeping still. We do report outside the room because there are "eyes" in the hospital and if we get caught doing it elsewhere we are written up (or at least that's the threat). We review orders (especially for continuous IV meds), pertinent doctor's notes, trends in vitals if needed, etc., we line trace (IVs, tubing- foleys, drains, chest tubes, etc.), then we have to review the tele monitor for events and adjust the alarm settings as needed (if pt is brady and known to be then we change the low alarm from 60 to 50 or whatever is safe and warranted to avoid alarm fatigue). If a patient has complex wounds we'll look at those together if possible. If the patinet is awake I'll introduce myself as I update the white board with the plan for the day, my name, the CNA's name, and the name of the doctor who will be rounding on them that day. When I'm giving report at night I always introduce the night nurse, tell the patient they are in great hands, ask if there's anything else we can do for them, and wish them the best in their recovery if I won't be back in or tell them to have a good night and that I'll see them in the morning.

I agree there are benefits to involving the patient and family, I just don't necessarily think report time is the best time to do so. I do many of the things Klone talks about during the day when I am updating the patient and the family during my shift. I will happily go over everything with the patient and the family when they ask for an update, I'll get their opinion, takes notes and pass along necessary info during report, etc.

I agree. Report is for the transfer of information between professionals. If you have been doing your job, you have been teaching and updating and involving patients and families for a good deal of your shift, not just at the end of it. Someone described this a as a dog and pony show, and that is what it is...

Specializes in Psych ICU, addictions.
In psych a room full of people staring at a psychotic patient asking personal questions could absolutely be a detriment to their comfort level and everyone's safety.

Neverminding the psych patients who will start arguing with you about their diagnoses and symptoms because in their mind, they're NOT suffering from a psychiatric disorder and their perception of reality is just fine, thank you.

Plus the logistics of it. Patients are rarely in their room at change of shift unless it's NOC coming on, and then they're (hopefully) asleep. So should we pull patients out of milieu/groups/talking to the crows on the patio and drag them to their room for report? Go into their rooms at midnight and talk about them as they sleep and risk waking them? Then what about their roommates?

Or do report wherever they are...but then there's privacy issues to deal with then. I'm sure Patient X doesn't want everyone around them to know they have a history of schizophrenia, and oh yeah, they're Hep C positive. And I can't imagine how bedside report would work with a patient in 4-points.

I'm sure bedside report works well in a lot of specialties. I don't see it working out very well in psych. Perhaps there are places that they make it work, but they are rare exceptions and probably areas that are not very high acuity.

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