Studer Group "Bedside Shift Report SM"

[DVorahRN, BSN, RN]

Our facility introduced the concept of Bedside Shift Report^SM as proposed by the Studer Group a few years ago. Frankly, I think they did a poor job of introducing it and an even worse job of training us (yes, scripts and role play feel silly, but it does give you a starting point -- something my hospital skipped over completely).

My unit has really had a difficult time with implementing this process as we find it takes far more time to give report this way, and off-going shift RNs are inevitably leaving late. One of the challenges is that the patient decides that "as long as you are here" they need to go to the bathroom, get pain medicine, get nausea medicine, get a warm blanket, get ice water/coffee/food, etc. Obviously some of these needs can easily be met by ancillary staff, however, since there are 2 RNs at bedside, the RNs have to do it right then. This eats into the time available for report on the remaining patients. And if you are giving report to/getting report from multiple nurses, an awful lot of time can pass.

Our unit management is really cracking down on us to do it every patient, every shift, and it is causing a lot of push-back and stress. Has anyone who is using this program found a way for it to work smoothly, without making shift report last forever?

[klone, MSN, RN]

Bedside report is not new, and not a unique idea of Studer (although I'm a big fan of his and love his book "Hardwiring Excellence").

The thing is that you need to make it clear to patients that this time is not for nursing care, but to introduce the incoming nurse to the patient and clarify that day's goals with everyone, and to allow the off-going nurse, who has been taking such good care of you, to get out on time. Reassure that patient that you're aware of his needs and you will be back just as soon as shift report is over to address them.

And with the implementation of bedside shift report, your charge nurse has to adjust her normal routine of scheduling to accommodate this by trying to match up as many patients and nurses as possible. I would say that she should do her best to make sure that the off-going nurse doesn't have to give report to more than 2 nurses.

[NotMyProblem MSN, ASN, BSN, MSN, LPN, RN]

Absolutely not! We've been doing this for some time (4 years), and all of the issues you stated are still going on! In addition, we have to get the first set of vitals after we complete report on all patients (a suggestion to do it during report since we're here), was forbidden by management. Needless to say, it has been reflected several times in the satisfaction survey about a "great nurse lost points with me in the end because there were two of them in my room at shift change and they told me to press my call button instead of them helping me to the bathroom".

My stance is this: since the techs do nothing from 7pm-11pm (I don't know about days), just dividede that pay among us nurses for those hours and have them work from 11p-7am. Maybe the cut in hours/pay for them will make them get off their rears and do their jobs.

[HouTx, BSN, MSN, EdD]

Imagine that. The 'wise ones' who originally designed the process didn't really have a clue about the dynamics of actual patient care. How unexpected and rare .

From what I have seen, this always happens... report morphs into mini-case consultations (with the patient participating), room tidying, filling patient requests, etc.... usually takes twice as long as before. I have seen some 'wise' managers make sure that techs are also present during the bedside report. When requests are made, the tech steps in so that the RNs can focus on report. But it doesn't help when the patient/family chimes in and wants to enter into the discussion. Oh well, I guess we can chalk that up to patient education, right?

[iluvivt, BSN, RN]

You know how are nurses got around it?.They do it outside the room to start.ehere the patient and family cant' see fir the most part. Then they do go in together and the incoming nurse is introduced and they look at whatever they need to look at and on to the next. It does not totally eliminate the I need to use the restroom and other requests but it does cut down on them...They need to ask the people (nurses who are doing the job) what works once for them. We usually have the best ideas We can try diffetent things until we get it perfect but if you are told what to do it will eventsl k y change into some form that works. That is what I have seen in every unit forced to give report this way. ..they do a modified version of it. Personally I would not want that if I was a patient.You have so little privacy and your room is like grand central. .why make it worse! I would be happy just conversing with my nurse and doctor...I would not need or want the production.

[macfar28]

I find bed side reporting disastrous. Yes, in theory, it sounds wonderful but in reality, not so much. Working in psych and substance abuse there are things that we need to say outside of ear shot of the patient (I'm sure in other areas of nursing too...just speaking for myself). We also don't have private rooms so how would you like for me to respect privacy during bed side report???

[Karou]

When the, "while you're here..." Starts during bedside report I usually tell the patient, "okay one of will get to it just as soon as we are finished giving report on the rest of our patients". I make it clear that this is time for report. If it is a PRN medication request then the off going nurse usually offers to medicate after report is finished. If it is a bathroom request then I do go ahead and do that. That is one need that I do not want a patient to have to wait for.

Some units have the PCT's answering all the call lights while nurses do report, then the oncoming nurses give report to the oncoming PCT's. PCT's do not give report to each other. It's nice because the nurses aren't as interrupted during report and then they collaborate with PCT's at the beginning of shift.

[blondy2061h, MSN, RN]

They've been trying to get us to do it for a few months and nurses just aren't doing it. Management can't be there all the time and it's just not happening when they're not there. Our patients get interrupted sleep all night. Between 0600 when nights makes their last rounds and 0800 when days makes their first rounds patients can often get two solid hours of sleep, and now you want us to go in there at 0700? Neither the nurses nor the patients want it.

[OhioCCRN, MSN, NP]

Urgh! I hated the mini consultations during bedside report with the families chiming in and contradicting everything! Thank goodness for ICU where we kick out the families and can give a nice thorough report without additional drama

[Red Kryptonite]

My stance is this: since the techs do nothing from 7pm-11pm

Wait.....what? Just where is this fantasy hospital/facility where I can sit around and do nothing for 1/3 of my shift?

I too have found that bedside report can turn disastrous because it's like a Pavlovian response for the patients to need to use the bathroom once staff walks into their room.

[sistrmoon, BSN, RN]

One of our units is doing bedside report and hasn't had a patient fall in over 100 days. Their satisfaction scores have gone up and pressure ulcer rates down too. So I know it's coming for us. But I'm wondering how it works in practice. Seems like it would be awkward. And HIPAA?

[Lennonninja, MSN, APRN, NP]

One of our units is doing bedside report and hasn't had a patient fall in over 100 days. Their satisfaction scores have gone up and pressure ulcer rates down too. So I know it's coming for us. But I'm wondering how it works in practice. Seems like it would be awkward. And HIPAA?

It CAN be super awkward at times. I think it generally works well in the ICU but med/surg nurses just have too many patients to make it feasible, and I've had personal experience with this. Med/Surg report with bedside report could take over an hour It rarely takes more than 30 minutes to do bedside report in the ICU and we're expected to give an extremely detailed report.