Transition to bedside shift reporting

[BRoBSN]

I'd like my unit to transition to bedside shift reporting. My staff is adamantly against it. I think it will help our pt satisfaction scores! Does anyone have any suggestions/experiences as to what did or did not work? We don't overlap shifts, so I anticipate some issues with OT? HR is working with me on this one. I'll take any ideas I can get! Thanks!

[Tweety, BSN, RN]

It definitely makes shift change take longer. Most of our patients like it.

The thing is to be consistent and hold people accountable. Otherwise they will give report outside of the room and then go into the room and say "this is your next nurse" and then leave. I have seen, and still see after a few years, disobedience of the rule of doing bedside report.

One of the objections is your can't say some things you want to say, like your impressions they are drug seeking, or the are a pain in the butt. That can simply be said outside of the room.

We first had training with simulated reports that we all had to go through. Management, prior to Covid, would have to audit a certain number of shift change reports a month.

Our patients seem to like it. I like it because you can include the patient and sometimes get some clarification on things. Also, just last night we went in for bedside report and found the patient climbing out of bed.

[HiddencatBSN, BSN]

4 hours ago, BRoBSN said:

I'd like my unit to transition to bedside shift reporting. My staff is adamantly against it. I think it will help our pt satisfaction scores! Does anyone have any suggestions/experiences as to what did or did not work? We don't overlap shifts, so I anticipate some issues with OT? HR is working with me on this one. I'll take any ideas I can get! Thanks!

I’ve worked at many places where bedside report is required and everyone hates it and no one actually does it. Like ever. The way it would always work is management would decide to monitor and we’d find places other than the RN station to give report and maybe do a few reports at bedside under duress and then as soon as management stopped babysitting report we’d go back to away from bedside.

In my experience bedside report takes much longer, there’s often additional information you don’t want to impart in front of the patient so have to follow up outside the room, the patient interrupts and has requests.

Also- with your covid patients this seems like an especially obnoxious time to start bedside report with the additional time needed for donning isolation.

I don’t mind a bedside introduction (my shift is done, this is HiddencatRN, she’ll be caring for you now) but 6 hospitals and 10 years and I’ve never known anyone to be willingly compliant with this requirement.

[JKL33]

Being consistent with a brief check-in with the patient and two nurses at shift change, the introduction of the next nurse and saying good-bye (for the off-going nurse) is a great idea.

I am not sure that the bedside report accomplishes a ton more than what could be accomplished with ^ the above.

It sounds good. Reality is less stellar.

I'm sorry but I do think it's sad when managers are very gung-ho about a particular thing and suddenly everyone is supposed to drop everything to perfect this one thing...but the baseline problems are just too big to ever be conquered (or, are simply deemed unimportant)--I'm talking about things like staffing well enough for nurses to have a chance to feel that they have actually provided real care. I find it highly offensive that something like bedside report (a trend, an experiment that is going to fix patient satisfaction) is important enough to pay somebody to police/watch/monitor RNs and any other length it takes to implement it...then everybody goes back to their offices while people struggle all day.

I also think bedside report is annoying because it's another one of those "appearances" things. You are expending great effort to hopefully manipulate how patients feel about something. I think they'd feel pretty good if they were afforded appropriate care and attention throughout their episode of nursing care.

8 hours ago, Tweety said:

Also, just last night we went in for bedside report and found the patient climbing out of bed.

Coincidence. Sorry. ? The patient down the hall could have just as well been climbing out of bed while the two were tied up in a room for 10 minutes. ?

[Nunya, BSN]

It will probably help your patient satisfaction scores but it sure won't help your staff satisfaction scores. And what does it mean when you say HR is working with you on OT? Staff gets OT pay if they work OT, period.

[RNperdiem, RN]

If there is a lof of staff pushback, there is probably good reason for it.

[BRoBSN]

I am in complete agreement with all of you! I really don't have a choice in the matter. I have been "strongly urged" to begin the process...….last year! I have been dragging my feet because of everything you all have said! I only asked because I'm looking for ways to make this transition as painless as possible. That is the only reason I posted this. Sorry if I offended anyone. I'm between a rock and a hard place.

[Tweety, BSN, RN]

No it doesn't deal with nurse satisfaction or staffing issues, or all of the other myriad of problems of nursing. I think it's just an evidenced based practice regarding one issue. I do wish management was as attuned to nurse satisfaction as they are customer service scores.

I also like being held accountable and holding another nurse accountable. If the patient is climbing out of bed, incontinent, or has a dry IV bag, missed a medication, or the patient is in pain or has a request, we can deal with it before the prior shift leaves.

[Nurse SMS, MSN, RN]

I am in the minority here in that I loved bedside shift report. One of my biggest challenges as a bedside nurse was when a nurse would perpetuate a problem with the patient that was more due to stress, personality conflict or prejudice than my personal judgement would have seen. These are the things that tend to get shared and overshared to the point that it can impact patient stay.

Most patients enjoyed hearing shift report because they then felt like they know everything that we know. It also lowered the tendency for call lights to ring during shift change.

It is unpopular with staff because it means a level of transparency many aren't comfortable with, can become pretty odious from a time standpoint. Coaching on how to deal with bathroom requests, breakfast requests, medication requests and the like can be helpful for this. I always started bedside shift report with telling the patient what we were doing, the importance of saving any questions for the end and that the tech would be rounding on them shortly went a long way toward helping with these time management challenges.

I am a big proponent of hourly rounding too - something that staff has never loved either. Good luck with your new project!

[HiddencatBSN, BSN]

12 minutes ago, Nurse SMS said:

One of my biggest challenges as a bedside nurse was when a nurse would perpetuate a problem with the patient that was more due to stress, personality conflict or prejudice than my personal judgement would have seen. These are the things that tend to get shared and overshared to the point that it can impact patient stay.

I can see how this happens but I also think there's a bit of a workplace culture aspect about it too- I want to know if a nurse has had an issue with a patient and then I can try to change my approach or at least not be surprised when the patient gives me a hard time about xyz. I know the nurses I work with too and know their personalities and challenges so know if one of them is reporting a particular issue or bad interaction with the patient, I can take it in that context.

[Nurse SMS, MSN, RN]

14 minutes ago, HiddencatBSN said:

I can see how this happens but I also think there's a bit of a workplace culture aspect about it too- I want to know if a nurse has had an issue with a patient and then I can try to change my approach or at least not be surprised when the patient gives me a hard time about xyz. I know the nurses I work with too and know their personalities and challenges so know if one of them is reporting a particular issue or bad interaction with the patient, I can take it in that context.

Definitely, though I usually found if there was a patient's specific preference that was triggering to the patient, they never minded it being brought up in front of them. In fact, they found it comforting to know they would not have to go through trying to explain it or change it all over again with each change in caregiver.

"Mrs. X has a strong preference for having her vitals done only at the same time as her medication, so that she can get at least four hour stretches of sleep. We have been accommodating her on that and it seems to help a lot. She has Ativan PRN if she's having trouble coping tonight."

That kind of stuff, without going into the details of her throwing things or yelling or whatever....

[DavidFR, BSN, MSN, RN]

Let's be honest, some patients are difficult and you need privacy to dicuss inappropriate behaviour. Some patients are stressed out and hearing their treatments and problems repeated at the bedside 2 to 3 times a day isn't going to help them. I've worked in units where we've tried it. It never worked. We never got off on time as it dragged on for ever. It's one of those bright ideas that sounds wonderful in theory, so patient inclusive etc. but in reality it's fraught with problems.

My advice - forget it.