Shift-to-shift report in front of patient and family

classicdame, MSN, EdD · Aug 6, 2012

agree. It is difficult, although I have experienced too much gossip and social issues being discussed when pt/family are not around. We have a checklist for our staff to takes notes on while getting report. Hopefully, we will get to the point where that is not needed. Hope others can share with you so both of us can learn from your post.

yuzzamatuzz · Aug 6, 2012

We're supposed to do bedside report at my hospital, but it hardly ever is done unless my nurse manager or the DON is around. Most people don't like it. Like you said, there are some things you can't say in front of the family. On one hand, it keeps the family in the loop and also lets them know that you know what is going on as well. When you have more complicated patients it helps clarify things with the next nurse (you can show them all the drains, pumps, dressings, etc.). Pretty much anything medical I feel comfortable saying in front of the family. I agree with the above poster that there is too much gossip when the family is not around. However, there are a lot of social things that I just would not want to say in front of my patients. For example, I work in pediatrics and we have a lot of ACS cases and social issues. I think it jeopardizes my personal safety to let the parent know that I am the person who filed the ACS case and why. Discussing family dynamics in front of the family is obviously not appropriate and would jeopardize future nurse-patient relationships. You can't say in front of the family "I spent an hour discussing with mom her child's new diagnosis...and she says she understands but I just don't think she gets it yet." While giving bedside report, I leave out social stuff and anything else I feel uncomfortable saying...you can share that when you get back to the nursing station. When receiving bedside report I try not to put the oncoming nurse on the spot and ask questions she may not know the answer to... those questions are better asked at the nursing station.

Piglet08 · Aug 6, 2012

I am all in favor of a bedside assessment together at change of shift, and of course some "report" information will go with that. I just don't see how I can do report as a performance in front of the family. That's what it would have to be, a performance.

Yeah, there's the family dynamics issues that might be a problem. There's also complex medical issues that the family might not be ready to hear about. When I'm speaking to patient and/or family about some aspect of care, I'm assessing their comprehension as I speak, and adjusting accordingly. In report, I'm adjusting to the nurse I'm talking to, too - is this someone who's been around the block and seen this before, or someone who needs to know what to watch out for? And if it's someone who has to know what to watch out for, when I say that in front of the family, isn't that going to decrease their confidence in the oncoming nurse? I'm frustrated, because I think there's variables that just aren't compatible.

If admin's edict were to complete a bedside head-to-toe and introductions during report, I'd say, no problem, great. So far what I've been doing is a report at the desk with the chart, and then another one at bedside. I don't know if that's going to fly if higher-ups see me in action. Honestly, at the end of a long night I find it hard to remember, without paper in front of me, the patient's name, age, diagnosis and primary MD. To the family, that's going to sound like I'm a "bad nurse". I don't think I am. Just, after being up all night, I'm exhausted. And maybe it's a bit of stage fright. I am confident in myself as a nurse but not as an actress playing a nurse.

nurse2033, MSN, RN · Aug 6, 2012

I agree, they can be awkward. You can't always speak freely in front of patient and family. Where I used to work they tried to start this but we ignored it. You end up having to do two reports, one sanitized, one real. There are a few studies which say it is better but I'm not convinced. You can't reference the chart while at bedside and there are multiple interruptions. I would sic your educator on this to research the best method.

Piglet08 · Aug 6, 2012

"Speaking freely" is out of the question. I need to achieve "speaking intelligently" and it's a work in progress:rolleyes:

Nursingluv101 · Aug 6, 2012

I hate bed side report. I understand introducing the next nurse to the patient but that's about it.

turnforthenurse, MSN, NP · Aug 6, 2012

We are supposed to do bedside report at my facility and for awhile management said that they will come around in the mornings (along with the nursing supervisors) to make sure it is being done. No one ever did it and eventually management just stopped trying. I think the only unit where bedside report is done is in the ICU, tbh. On my unit, if we have a more complicated patient or if I want to verify something with the oncoming nurse (such as a drip setting or to look at a dressing) we will go to the bedside but not give a full report.

It can be awkward and yes, there are some things that probably shouldn't be said in front of the patient...as nurse2033 said, you end up having to give two reports. That takes time and then report ends up taking an entire hour or more and then you end up with a bunch of employees in overtime.

Sun0408, ASN, RN · Aug 6, 2012

We have done bedside reporting for a few years now. It is awkward at first. Do you have a kardex to give report. That will help a lot... I don't see it as acting or a performance;it is no different than what you do at the nurses station. The pt is there, the family maybe there, either way the information is the same.. Name, DX, MD, allergies, IV access, fluids, up coming tests etc... Sensitive information can be told outside the room, like a DX of HIV, hep C, CA that is not known to the pt or family yet.. Do your report like you always have, after a while the pt/family will not even care what you are doing or saying. Soon it will be second nature and not a performance at all..

We take the kardex and the chart in the room, go over both at the same time, a real time saver :)

Piglet08 · Aug 6, 2012

I am sure I'll get into the swing of it eventually. I'm not a dinosaur. I can do this. I will keep repeating this to myself.

MJB2010 · Aug 6, 2012

My biggest issue with bedside report is that there are a few people I work with that seem completely unaware of what is NOT appropriate to say in front of a patient or their entire family. Don't squabble over policies, how many patients you have tonight etc. Also please leave out the stuff the patient is unaware of, test results the DR has not discussed, mental health issues, and embarrassing things. Also you need to be aware of WHO is in the room, is this their neighbor from 2 years ago or their immediate family? The might not want to hear about bowel movements in front of some guests.

Ruby Vee, BSN · Aug 6, 2012

we do it at the bedside computer, not facing the family and in low enough tones that they can't hear unless they're standing right on top of us. if a family member tries to stand right on top of us while we're exchanging report, they are politely asked to step out of the room. we also use enough acronyms and jargon that they probably wouldn't understand most of what we were saying anyway -- which is my biggest problem with bedside report. they hear it, don't understand it, and then we spend extra time trying to explain to them that normal lab values are nothing to worry about, etc. i see the value of being able to go over wounds, drains, etc. with the oncoming shift, but getting the family involved with report always slows things wayyyyy down!