I work on a med surg unit that specializes in the acute care of the elderly. Our management has tried 15 times in the past to roll out bedside reporting on our unit and has met resistance each and every time. They are implementing it again the end of this month. I have volunteered to help find ways to get more nurses involved and to hopefully give bedside report an honest shot. I would appreciate any tips from people who have had bedside reporting implemented on your units.
A couple of things we have thought of:
A script or a list of things that can be discussed in the room.
Having management and super users for a week spend shift change in the hallways to help with the process. offering encouragement and tips.
And lastly figuring a way out to honestly track if bedside report is being completed and the shift that has the highest percentage wins a pizza party or something similar.
Tried 15 times unsuccessfully? What part of "this clearly ain't working" is unclear? It's not the lack of pizza... just saying.
Here are my issues with it. Spoiler alert: none of these issues are solved with pizza.
Shift overlap is 30 minutes; you should expect report to take 30 min or less. Nurses should NOT be expected to stay longer than our scheduled shift for routine issues. I'm not talking about the code or unstable admit at change of shift. I'm talking about basic report -- it happens without fail, BID/TID, every. single. day. I DO NOT agree to routinely staying over, and no other nurse should either.
The LTACH I used to work in very rarely kept assignments consistent between days and nocs. So between my 4-5 pts, I could be receiving/giving report to/from 2 or 3 RNs. That is hard enough to complete in 30 minutes, with all of us near the nurse's station... how much time is wasted with nurses trying to find each other in pt rooms?? More time than I am willing to give.
Many med-surg floors have even larger pt assignments. If it can't be done in 30 minutes with 4 pts, what makes anyone with a lick of sense think it could work with 7 or 8?
Like it or not, there are things that shouldn't be said RIGHT THEN. Would YOU mention the 18 yr old's penile discharge or the drugs of abuse he tested positive for? Would YOU mention the pregnant fiancee who didn't survive the MVC, when the pt didn't know yet? (True story -- pt had just been extubated, and his sister wanted him to hear it from her vs hospital staff, and she wanted the chaplain present.) I certainly hope not... therefore communicating sensitive info would require EXTRA time in a more private area.
We are professionals. We are perfectly capable of communicating with our colleagues without a manager breathing down our necks... er, I mean "offering encouragement and tips."
Your staff is telling you something with those 15 unsuccessful roll-outs. You should be listening to them, and accepting that their barriers might just be reasonable. Not insult them by offering them pizza to go with the Kool Aid.
I am still unsure of how I feel about bedside reporting as I have not seen it in full effect. I went to a panel conversation about it at a conference once where all the nurses that participated raved about it.
I think the main reasons I would see our staff resisting would be:
*Not wanting to wake sleeping patients. We have a sometimes volatile group of elderly people.
*Needing to get report from multiple nurses on the off going shift.
*Some nurses just talk too long and report already takes way too long to complete.
These are all reasons I would also resist.
I guess in my mind I would visualize bedside reporting as a shortened hallway report as we do now and then a quick rounding on patients so that eyes are on before the off going shift leaves.
Thank you. Let me point out that I am not management, I just happened to be standing in for the charge nurse the day that management came by to talk numbers and graphs. I did point out to them at the time that if they were to be the ones patrolling the hallway it is going to make everyone uncomfortable. I think my next place is to look for evidence in the negative.
I think that a valid idea would be our report as we do now and then a safety bedside check/doorway if patients are sleeping. Our hospital is currently focused on patient satisfaction scores and not staff satisfaction or safety. And the more comments I am reading from those of you with experience makes me think that this will be unsafe and is going to increase the incremental overtime that they are always trying to cut down on.
I think that this week I will time my reports and see how long they take on average and then do an attempt at bedside reporting to compare. I think that maybe if I show that there will be an increase in overtime pay we can try and get this pushed away again.
Please keep commenting.
I only mentioned pizza party because that seems to be the only way we are rewarded for anything. And I couldn't think of an alternative on the fly.
(and a pony ride would be so much better! But my EVS staff would kill me!!)
What is prompting the initiative to roll out bedside reporting? Is there any area that has been identified for info not getting communicated or is it "customer service". Would there be another aspect to approach the problem from. If someone has been tried 15 times...
We don't do bedside report where I work - for all the reasons other posters mentioned.
Scripting - I'm so not a fan. But all the nurses I work with have adopted the same basic format, although everyone does it differently. My point being, specific points of info get passed along. The same with our narrative charting, we have a list of info to be included. As long it is all there, it's all good - different people organize it differently.
Typically most of us do a "drive by" after report is completed to do a safety check on each patient, introduce ourselves etc. But I could see the benefit of both nurses performing this together.
Good luck with this project. I'm not management but I've undertaken some projects where I worked, and ended up learning a lot.
Thank you. Let me point out that I am not management, I just happened to be standing in for the charge nurse the day that management came by to talk numbers and graphs. I did point out to them at the time that if they were to be the ones patrolling the hallway it is going to make everyone uncomfortable. I think my next place is to look for evidence in the negative.
I think that a valid idea would be our report as we do now and then a safety bedside check/doorway if patients are sleeping. Our hospital is currently focused on patient satisfaction scores and not staff satisfaction or safety. And the more comments I am reading from those of you with experience makes me think that this will be unsafe and is going to increase the incremental overtime that they are always trying to cut down on.
I think that this week I will time my reports and see how long they take on average and then do an attempt at bedside reporting to compare. I think that maybe if I show that there will be an increase in overtime pay we can try and get this pushed away again.
Please keep commenting.
I only mentioned pizza party because that seems to be the only way we are rewarded for anything. And I couldn't think of an alternative on the fly.
(and a pony ride would be so much better! But my EVS staff would kill me!!)
Sounds like you were chosen as the token RN in management's relentless pursuit of forcing bedside report because of the mistaken belief it will raise patient satisfaction. Let's be reasonable, patient acuity is higher than ever, it only makes sense to be able to sit and give report where there are no distractions. When you do bedside report you are more like an actor standing there trying to engage the patient who will inevitably take that moment to need to go to the bathroom or want something to drink. So instead of concentrating on the report staff will find themselves catering to customer service. It is distracting, disrespectful and a waste of time.
It is one thing to get the report first and then do a meet and greet and quick handoff with the patient, that is the only thing that makes sense, but management won't see that in their insistence that this will somehow raise patient staffing scores.
All I can say is good luck and if 15 times failed, 16 won't change things either! Why don't they listen to the nurses and stop trying to coerce them even to the point of scripting! We are not at McDonalds!
At my old hospital our supervisors often had to be in the numbers so we would be giving report to them. We had one who was, I guess, trying to model it for us so she was right next to the bed near the head with the other nurse right beside her. I used say that she would climb in to bed with them if she could!
Tried 15 times unsuccessfully? What part of "this clearly ain't working" is unclear? It's not the lack of pizza... just saying.
Here are my issues with it. Spoiler alert: none of these issues are solved with pizza.
Shift overlap is 30 minutes; you should expect report to take 30 min or less. Nurses should NOT be expected to stay longer than our scheduled shift for routine issues. I'm not talking about the code or unstable admit at change of shift. I'm talking about basic report -- it happens without fail, BID/TID, every. single. day. I DO NOT agree to routinely staying over, and no other nurse should either.
The LTACH I used to work in very rarely kept assignments consistent between days and nocs. So between my 4-5 pts, I could be receiving/giving report to/from 2 or 3 RNs. That is hard enough to complete in 30 minutes, with all of us near the nurse's station... how much time is wasted with nurses trying to find each other in pt rooms?? More time than I am willing to give.
Many med-surg floors have even larger pt assignments. If it can't be done in 30 minutes with 4 pts, what makes anyone with a lick of sense think it could work with 7 or 8?
Like it or not, there are things that shouldn't be said RIGHT THEN. Would YOU mention the 18 yr old's penile discharge or the drugs of abuse he tested positive for? Would YOU mention the pregnant fiancee who didn't survive the MVC, when the pt didn't know yet? (True story -- pt had just been extubated, and his sister wanted him to hear it from her vs hospital staff, and she wanted the chaplain present.) I certainly hope not... therefore communicating sensitive info would require EXTRA time in a more private area.
We are professionals. We are perfectly capable of communicating with our colleagues without a manager breathing down our necks... er, I mean "offering encouragement and tips."
Your staff is telling you something with those 15 unsuccessful roll-outs. You should be listening to them, and accepting that their barriers might just be reasonable. Not insult them by offering them pizza to go with the Kool Aid.
Thank you. Let me point out that I am not management, I just happened to be standing in for the charge nurse the day that management came by to talk numbers and graphs. I did point out to them at the time that if they were to be the ones patrolling the hallway it is going to make everyone uncomfortable. I think my next place is to look for evidence in the negative.
I think that a valid idea would be our report as we do now and then a safety bedside check/doorway if patients are sleeping. Our hospital is currently focused on patient satisfaction scores and not staff satisfaction or safety. And the more comments I am reading from those of you with experience makes me think that this will be unsafe and is going to increase the incremental overtime that they are always trying to cut down on.
I think that this week I will time my reports and see how long they take on average and then do an attempt at bedside reporting to compare. I think that maybe if I show that there will be an increase in overtime pay we can try and get this pushed away again.
Please keep commenting.
I only mentioned pizza party because that seems to be the only way we are rewarded for anything. And I couldn't think of an alternative on the fly.
(and a pony ride would be so much better! But my EVS staff would kill me!!)
Here's the thing:
Yes, there is some theoretical positive aspect to the idea of patients seeing that we are passing on appropriate information about their hospitalization. It shows that we are working as a team for their benefit.
The problem is that bedside report will never be a one-script-fits-all scenario (and by that I don't literally mean "script," I mean the patient's story just isn't a nice, easy-to-wrap-up, straightforward hospital visit). NEVER! And, for those TNTC situations where things are complicated (either medically, socially, or otherwise) then this little show just doesn't work.
More random thoughts:
- I have no problems with the introduction of the next staff member. I was doing that for years before it became mandatory. I've seen quite a few of my coworkers doing it over the years, too. It's just a courteous thing to do, both for your patient and for the oncoming staff member.
- The problem with this "complete bedside reporting" idea is that it is meant to show the patient our teamwork and to involve them in their care, but given the other overall business goals, it is ironic to pull something like this when everyone then must run their a$$ off for the rest of the day, feeling like they don't have time to attend to patients' needs the way they would like to, with good listening and therapeutic communication, etc. So...in short: Bedside reporting ends up being a big old show being put on in "bandaid" fashion.
- We get it; a lot of report information that traditionally hasn't been shared with the patient, should be. This is not the way to do it. What would be better would be time throughout the day/night to maintain a better ongoing communication with the patient.
-Psychotic: The number of things that suddenly and mysteriously don't need to be passed on in report any more when places are hell-bent that this must work (at all costs): "NO! You don't need to review all the labs during this time - the oncoming nurse can check those in the computer for him/herself!" I get the idea that quite a few people feel that this dog-and-pony show (not to be confused with the reward pony, above) is a perfectly fine substitute for REAL REPORT! How nuts is that?? We don't need to actually give a prudent report any more, we just need the patients to see us smiling and involving them! Everything else is in the computer! (I didn't make up the quote about labs, I heard it as an instruction to staff).
Here.I.Stand, BSN, RN
5,047 Posts
Tried 15 times unsuccessfully? What part of "this clearly ain't working" is unclear? It's not the lack of pizza... just saying.
Here are my issues with it. Spoiler alert: none of these issues are solved with pizza.
Shift overlap is 30 minutes; you should expect report to take 30 min or less. Nurses should NOT be expected to stay longer than our scheduled shift for routine issues. I'm not talking about the code or unstable admit at change of shift. I'm talking about basic report -- it happens without fail, BID/TID, every. single. day. I DO NOT agree to routinely staying over, and no other nurse should either.
The LTACH I used to work in very rarely kept assignments consistent between days and nocs. So between my 4-5 pts, I could be receiving/giving report to/from 2 or 3 RNs. That is hard enough to complete in 30 minutes, with all of us near the nurse's station... how much time is wasted with nurses trying to find each other in pt rooms?? More time than I am willing to give.
Many med-surg floors have even larger pt assignments. If it can't be done in 30 minutes with 4 pts, what makes anyone with a lick of sense think it could work with 7 or 8?
Like it or not, there are things that shouldn't be said RIGHT THEN. Would YOU mention the 18 yr old's penile discharge or the drugs of abuse he tested positive for? Would YOU mention the pregnant fiancee who didn't survive the MVC, when the pt didn't know yet? (True story -- pt had just been extubated, and his sister wanted him to hear it from her vs hospital staff, and she wanted the chaplain present.) I certainly hope not... therefore communicating sensitive info would require EXTRA time in a more private area.
We are professionals. We are perfectly capable of communicating with our colleagues without a manager breathing down our necks... er, I mean "offering encouragement and tips."
Your staff is telling you something with those 15 unsuccessful roll-outs. You should be listening to them, and accepting that their barriers might just be reasonable. Not insult them by offering them pizza to go with the Kool Aid.
Just saying.