Transition to bedside shift reporting

HiddencatBSN, BSN · Jul 29, 2020

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, BSN · Jul 29, 2020

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.

JKL33 · Jul 30, 2020

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.

Nunya, BSN · Jul 30, 2020

On 7/29/2020 at 9:24 AM, Nurse SMS said:
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.

Since you're stuck and essentially being forced to do this I think this is a good idea. You have to get across nicely to the patient that report time isn't a time to ask for things and have one nurse leave to get it. Report time is for report and asking questions about care ONLY. Excluding emergencies of course, and they can ask for pain meds but they need to be told it'll be a few minutes. No one ever died from pain. And someone else suggested changing med times around so if you give report at 7 there aren't lots of routine meds due at 8. But I would also have the nurses keep track of exactly how long report takes at the bedside, and have them start now recording how long it takes before initiation of this. And then you can figure out how much OT they're getting....I would also develop a staff satisfaction survey to be given after a month or 2, with one of the questions being what amounts of time are they spending giving a private report on things they don't want to say in front of the patient? Because there WILL be things they want to pass on and not say. And of course you're going to have to figure out what to do about visitors...stay or leave? And even if the patient is OK with them staying do you want to have to entertain THEIR questions? And if they decide to leave there's the one or 2 minutes waiting while they leave (saying goodbye etc) which isn't much if it's one visitor but if there's a couple...

I think if there are nurses on the fence about staying on the unit or leaving this might just push them over the fence...into a new job. Good luck!

BRoBSN · Jul 30, 2020

Thanks! These are my concerns as well! It's very difficult to try to present something positive when I'm not really on board with it myself! But, as I said, I really don't have too much of a choice so I hope to present it with a focus on increasing patient/family involvement / satisfaction. When I initially talked about bedside shift report, a year ago, I was presently surprised with the number of positive responses I got from my staff. Hopefully this positive attitude remains and "rubs off" on the negative Nellies!! We shall see ?

JKL33 · Jul 30, 2020

Go for it with reasonable expectations. Have an actual plan for how you are going to address the most likely difficulties your staff will face in actually doing this. IME that is a critical juncture, that's where everything falls apart because too many people who want to implement the change just want it done and they want someone else to absorb the 100% foreseeable difficulties, impracticalities and actual impossibilities with no additional provisions, allowances or resources. This is why I have begun referring to such things as fantasies.

1 hour ago, BRoBSN said:
negative Nellies

Tip: ^Another thing to be avoided if you want others' cooperation. To save everyone's eyeballs I cut out a huge couple of paragraphs about the topic of those labeled "negative nellies." I'll suffice it to say don't make the mistake of misjudging people and don't label them, either; the first will be your downfall and the latter is simply unnecessary and unprofessional.

Instead, come up real solutions and options that will make your change-attempt more likely to succeed.

1) What will staff do if they get sidetracked with questions and requests during report? Have an answer.

2) Come up with options for scenarios where it is best for two professionals to speak on a professional level. If you hired professionals, then let them use their professional judgment about this. Speak privately to outliers who use this as an excuse not to participate in bedside report rather than treating an entire group of adults like pre-schoolers from the get-go.

3) Come up with what you are going to do if this reporting process ends up taking longer than traditional report, and what you are going to do if OT is being incurred due to your company's preferred nursing process.

4) Be prepared to communicate your company's preferred process to physicians and all other interested parties (including patients and their visitors/loved ones), with the expectation that unnecessary interruptions are to be minimized.

5) Make sure your techs are overlapped and all ready to answer call lights during nursing report. Decide what you're going to do about the techs and their reports that they find useful--will you eliminate this, or can they sit in the NS where they can see call lights and give their report while being ready to answer lights? How will you handle it if the number of call lights really interrupts the techs' report time?

6) Don't go crazy with a list of things that are to be accomplished during this time. If you want bedside report with the patient, then let it be about that. It is not about checking and passing judgment about a coworker's work or fixing every problem under the sun or filling out more papers or flowsheets or audits of any kind.

Every single one of these suggestions are things that administration would, should, and must do if they want to be taken seriously with regard to the importance of the change they are advocating. Otherwise it's just game-playing and your staff will rightfully resent that.

Best of luck (sincerely)! ?

Tweety, BSN, RN · Jul 31, 2020

On 7/29/2020 at 5:59 PM, HiddencatBSN said:
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.

Am I missing something? Are bedside shift report advocates saying you should omit sharing essential information about a patient such as violent tendencies and throwing things?

A simple "before we do bedside report, let me say he throws things...or whatever". Would suffice.

HiddencatBSN, BSN · Jul 31, 2020

4 minutes ago, Tweety said:
Am I missing something? Are bedside shift report advocates saying you should omit sharing essential information about a patient such as violent tendencies and throwing things?
A simple "before we do bedside report, let me say he throws things...or whatever". Would suffice.

The post I quoted gave an example of euphemizing violent patient behavior in bedside report as anxiety and difficulty coping so yes, you are missing something.

HiddencatBSN, BSN · Jul 31, 2020

8 minutes ago, Tweety said:
Am I missing something? Are bedside shift report advocates saying you should omit sharing essential information about a patient such as violent tendencies and throwing things?
A simple "before we do bedside report, let me say he throws things...or whatever". Would suffice.

From the post:

”’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....”

Tweety, BSN, RN · Jul 31, 2020

4 minutes ago, HiddencatBSN said:
From the post:
”’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....”

Gotcha. Kind of went over my head.

I took it the nurse was saying what one might say in front of the patient during bedside report, not necessary that the facts that the patient throws things would not be told to the oncoming nurse.

HiddencatBSN, BSN · Jul 31, 2020

2 hours ago, Tweety said:
Gotcha. Kind of went over my head.
I took it the nurse was saying what one might say in front of the patient during bedside report, not necessary that the facts that the patient throws things would not be told to the oncoming nurse.

I guess my main complaint is- when I do my initial rounding and assessment I include a recap and update for the patient. I think rounding is a great tool and a quick bedside introduction and handoff is great, but for report I want to be able to focus on the report, and getting that info quickly. In the ER shift handoff is usually brief and problem focused so bedside makes it take much, much longer than it typically does and there’s often stuff that hasn’t been addressed with the patient yet because we’re waiting on the doctors to give official results and my population frequently has things we don’t address in front of the patient (peds, so for example we never discuss a sexual assault case in front of the prepubescent child because repetition can give them the sense that they are giving incorrect answers and potentially influence their disclosure).

OUxPhys, BSN, RN · Jul 31, 2020

My old job tried to enforce it and the staff would find ways around it. Same thing at my current job. Sure, bedside report is good for the pt's who are pleasant and don't have a lot going on. It is not good for your heavy pt's and pt's who are a PITA. As one poster said sometimes report for certain pt's needs to be done in private. Some pt's also don't like staff coming in at 7AM every morning to hear report. There have been times where report was given and the pt actually corrects the nurse giving report because the pt was informed of an update my the MD or team yet the nurse is still left in the dark. That's a bad look that happens too often.

If there is a big staff pushback then I would back off the bedside reporting.