A few hospitals I've worked at have started to implement bedside shift report. I dislike it. There is information that I don't feel comfortable sharing in front of the patient because 1) it may make them unnecessarily concerned 2) it may insult them 3) they'll ask questions which would interrupt the flow of report. It seems that to play along with management, RNs will stand near the bedside but report out of earshot from the patient.
Variations I do like include forms of rounding together on each patient after report to check that the patient is alive, that tubes/wires/drains are labeled and present as described, or to clarify any complex parts of report.
But giving the entire report AT the bedside I think is nonsense. I've wanted to ask management WHY they think this is important. It's not mandated by JCAHO and yet management feels very proud to implement this as a "quality improvement" project. So what are you improving exactly? Well... I looked it up and research appears to say that the benefit of bedside shift report is to make THE PATIENT feel more empowered/involved/part of the diagnostic process. They are given an opportunity to ask questions and voice concerns which is supposedly going to make their care better or seem better.
I feel that throughout my day and especially during assessments, I give my patients ample opportunity to be involved in their care. This new interaction is just a disruption to the excellent care I already DO provide. I feel like I'm starting to sound like the heartless RN who just wants to get through with her day but I'd like to think that's not me.
I think of shift report as sacred. It is an exchange that requires high-level communication and attention to transmit vital information. I take this bedside reporting idea as another encroachment on our practice in the name of "patient satisfaction". I hear about bedside charting. What's left? Should all our communication with doctors and various practitioners be projected through the patient's speakerphone?
Part of my facilities policy is to walk around with the next shift and give report. I do not like giving bedside report for the reasons you mentioned. I like report at the desk, and then we do a quick walk to make sure everything is as it should be. There definatly is a purpose for it though. Once I did not do a walk and found my pt dead, very very dead. ( he was palliative) but that should have been nights problem not mine. I got "well if you had gone around as per policy....." from my manager. Now I am very careful to.
Great summary! Your description is pretty much how I have developed my bedside report routine. When bedside report was first rolled out we received education classes that detailed how to conduct report in this manner and gave us an opportunity to role play different scenarios. Some of the scenarios included difficult patients and/or difficult family members. Each year since we review the process. It has been evolutionary and we have done some fine tuning over the years. For the most part we are all used to it now and it is no big deal.
I find it interesting that some of the comments mention discussing certain details outside of the room. The patient still hears. A couple of years ago a friend of mine (who is an ICU nurse) was hospitalized for a week and she mentioned that she loved when the nurses came in and performed the entire report at her bedside. She also mentioned how frustrating it was to see and hear nurses who gave the report in the hall outside of her room.
It is important to learn how to discuss the difficult topics in front of and with the patient. For example if the patient is drug seeking and has a narcotic dependency this is no surprise to the patient. Why shouldn't we discuss this in front of them? If we don't they will continue to think they are fooling everyone. These are the very things we should be discussing with them and in front of them. Of course there are appropriate and inappropriate ways of doing so. One time we had a patient in the ICU who was married, but also had a girlfriend. Unfortunately the wife and girlfriend ended up coming in for a visit at the same time. Long story short things got ugly and security had to break things up. The girlfriend was instructed not to return. The stress of the situation affected the patient and was included in bedside report. The report went something like this,"Mr. Doe has been pretty anxious this afternoon. His wife and another female visitor engaged in an argument. The female visitor has been instructed not to return to the hospital. Mr. Doe agrees that this is a good idea. Our main goal for this evening is to provide a calm environment to prevent further anxiety to Mr. Doe."
Other comments have discussed the patient or family member that interrupts too much or asks to many questions. There is nothing wrong with controlling the conversation from the outset by clearly stating, "We are going to take five minutes for report. We will give you a couple of minutes if you have any questions. Beyond that we will need to discuss things in detail later after we have seen and reported on all of the other patients." This has worked for me. If the patient or family begins to elaborate or ask a series of questions I reiterate that I will address the questions or concerns as soon as I can after report has been completed on everyone. This usually works for me.
Believe it or not nurses have come to like bedside report as well as patients. If your reading this and not a fan of bedside report, hang in there in there! This is a skill that requires practice and if you continue to practice it will get easier and you may actually begin to find that you enjoy it. (No I am not in management. I'm a bedside nurse just like you.) ;-)
We have always done that on my unit and it never made me feel comfortable at all. Other patients can hear. I feel like one nurse goes around to do walking rounds before the next shift does report and check to make sure everyone is ok should be enough. I was in my ER once and they did walking rounds and I heard my report loud and clear from outside the door and it made me uncomfortable to know so can others.
A few months ago we went to bedside reporting. I was apprehensive at first, but we were firmly informed it was NOT going away so we had better make it work. Now most of the staff prefer the bedside reporting because it is actually quicker than sitting at the nurses station. There is less visiting about non-patient related stuff, and actually fewer interruptions. As far as "rooms full of people" we ask everyone to step out (spouses too!) and then ask the patient if they want anyone let back in to hear report (all our rooms are private, so no roommates). We have yet to have anyone get upset about this. The thing I like best about bedside report is that the patient is right there, so I can show and sometimes get a second opinion on something. One thing that we have found key to making sure report goes smooth with few interruptions is the hourly rounding. By making my last set of rounds in the hour before report starts to tell the patient "in about an hour we are going to start rounding do you have to pee, need something for pain" etc. report is not interrupted by these things. It also gives the patient a chance to say whether or not they want report in the room, some don't and that's their right. Just be sure to cover your tail with management and write on the nurses notes "patient states he does not want bedside report done in his room this am". Once you get a system down, it does flow nicely. It just takes practice and patience!
It won't go away and they are starting to write up those resisting it. I like it. There are a few things I share privately but patients LOVE this form of reporting...so it's here to stay
I work in psych, and since you can expect patients to go balistic if you use a word they don't like such as "psychotic" or a diagnosis they disagree with, or god knows how many other things. So in psych we managed to make it mostly written with a 'look at the faces, meet the people' component so managment is still happy.
We still do written shift summary , Bedside is more a Plan for the day , plan for the stay, trace lines, make sure safety checks are in place and introduce the new staff and also a nice time for 'closing' the day with the leaving staff. You don't have share everything about pt behavior ect......that would go in shift summary and could be discussed ahead of time. the goal is to make sure that patients are kept well informed of expected consults, testing, and other things pertinent to their recovery. I don't know why people are so resistent to this. I love this form of report. when i first started where i worked it wasn't being done very often and it did feel like a hassle but now that its being forced......its becoming a part of our culture and it really is not a big deal. Most of the info you given in your written report the bedside report is really quick and a overview.....not a big deal at all. we tend to get the same pts back and so those reports are even quicker...just a plan for the day and letting the pt know who will be caring for them that night.
We have always done bedside report in our unit and most of the peds areas. We have up to 6 kids in each pod, so we are used to it I guess. If there is a lot of sensitive stuff that needs to be discussed we do it away from the patient or in the hall. We always go to the bedside for a general report and to trace lines and check labels on lines, feeds, etc. But, according to Joint Commission the family has a right to hear nursing report and be involved (ok, we know how that goes, but it is what it is) and to do an SBAR and face to face. You will get used to it.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
We got chastised for not giving a "full" report even if you're handing off back and forth to the same nurse multiple days in a row. "Mr. X has a history of blahblahblah." "Yes, I know that. In fact I told YOU that 12 hours ago."
Another fine example of not really "knowing" how things function at the bedside level.....I'm sorry.
I'm still a student, so most of what I've seen is a combination of bedside report and "station" report. I've seen nurses who just flat refuse to do bedside report. I can see the arguments both ways, and when I get a job, I'll do whatever the policy is. So I'm not complaining about the policy, but I'd like to share something I've observed:
Bedside report takes a lot longer. Not per patient, there are actually some time savings I see there. BUT, I've noticed that they don't hand off the same 4 (or 5 or 6 or whatever) patients from nurse A to nurse B. Nurse B has to find out the 2 or 3 different nurses who have cared for the patients s/he is getting (Nurse A, C, and D) and wait for whichever of them finishes first with Nurses E, F, G, H and I - get report from that nurse, then wait for the next one to get through. It's a goat ropin' as we say here in Texas. I've seen shift report take an hour because of all the combinations of offgoing and oncoming nurses who have to get together in the patients' rooms. If Management is serious about initiatives like this, they need to get real about the OT that will ensue.
Specializes in Ambulatory Surgery, Ophthalmology, Tele.
I feel awkward during bedside report. It's 7 am and lets have 20 nurses all talking at the same time. Some patients look at you like they would rather be sleeping then hearing you discuss their bowel movement schedule. I prefer to sit at the nurses station, then go see the patient after.
Daisy_08, BSN, RN
597 Posts
Part of my facilities policy is to walk around with the next shift and give report. I do not like giving bedside report for the reasons you mentioned. I like report at the desk, and then we do a quick walk to make sure everything is as it should be. There definatly is a purpose for it though. Once I did not do a walk and found my pt dead, very very dead. ( he was palliative) but that should have been nights problem not mine. I got "well if you had gone around as per policy....." from my manager. Now I am very careful to.