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Transition to bedside shift reporting

BRoBSN BRoBSN (New) New Nurse

BRoBSN specializes in ICU.

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 specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

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 specializes in Peds ED.

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.

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. 😉

Edited by JKL33

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.

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

BRoBSN specializes in ICU.

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 specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

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.  

Edited by Tweety

Nurse SMS specializes in Critical Care; Cardiac; Professional Development.

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 specializes in Peds ED.

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 specializes in Critical Care; Cardiac; Professional Development.

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 specializes in Oncology, ID, Hepatology, Occy Health.

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.

HiddencatBSN specializes in Peds ED.

7 hours ago, Nurse SMS said:

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....

Oh my the patient throwing things when upset is essential information to pass on! Not sharing that “having trouble coping” means “engaging in behavior that might harm staff or others nearby” is a huge miss on report. 

HiddencatBSN specializes in Peds ED.

Like seriously I’d feel way more concerned about following a nurse who failed to tell me room whatever was having escalating behavior and throwing things today and now has PO ativan to try to prevent anxiety from turning in to dangerous behavior than the nurse who said “they’re reporting pain, I paged the team twice and still don’t have orders” or “they literally just pulled out their IV at 1855 and have 2000 iv antibiotics due” and then went home. 

OP, if you do have to go to bedside report, please consider your facilities routine dosing schedule. A report that takes 45 minutes (and leads to multiple patient requests that are now on my internal “get done”timer) and 0800/2000 meds do on a 0700/1900 shift change schedule is a huge failure setup for the oncoming nurse. Maybe the logistics of having to change routine dosing times plus all the incremental overtime your nurses WILL work will be enough to change the powers that be’s mind.

12 hours 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.

Interesting. I do know exactly what you mean, but there's simply no way that I would consider this even in my top 50 biggest challenges as a bedside nurse. First, I know who is speaking/reporting to me and that helps me judge the portrayal I'm being given. Secondly, I don't care what anyone has said about a patient, my mission is to develop a healthy working rapport with my patient as fast as humanly possible.

 

12 hours ago, Nurse SMS said:

It is unpopular with staff because it means a level of transparency many aren't comfortable with

Kind of...but not exactly. My thoughts (might get some disagreement/flack here) - 1) Nursing report is a utilitarian thing to me. It isn't a group feel-good session where, after 12 hours of running, we then challenge ourselves to come up with creatively pleasant ways to convey basic information so that it won't be misunderstood by a lay person. 2) I think there is a huge tendency to try so hard at this creative pleasantness that the reality is not well-conveyed 3) I don't think there is anything wrong/unethical about two professionals speaking to each other about the work they have been doing on a patient's behalf. The nursing report is my interaction with my coworker and theirs with me. I just think we are allowed to have/desire that. 🤷🏽‍♀️

Each nurse is free to review the patient's progress and plan of care with the patient and make a shift plan with the patient. That's what we should be doing. I don't know why it has to be rolled together with nursing report.

12 hours ago, Tweety said:

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.   

I just have never needed bedside shift report to handle these situations. If there are outlier nurses who leave everything in disarray, discuss the concern with them and if nothing changes they should be written up/reported. For everyone else, nursing is 24/7. If the IV bag is dry, hang up another one. If the patient's climbing out of bed, what?--that is not necessarily an accountability issue; it's much more likely to be something my coworker has been struggling with and now they need to go home and rest.  If the patient is (now) asking for pain medication, also not an accountability issue. One of the two of us will take care of it.  Where things like this have needed to be worked out between two nurses, I've never had any problem taking care of it without bedside report.

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