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?
How would this work with double rooms and the HIPAA regs??? Sheesh, folk are so nosey now! Just watch folk and try to be confidential at the nsg desk when the line resembles an ACME deli on Saturday morning!!! Now to give report at shift change with a room full of visitors to boot!
Folks ARE noisy! We do not have 2 pts per room on my unit, but some of the rooms (such as the ones in the corners) are very close to another room. I was taking care of a patient and she asked me, "is so and so still here? You know, the guy in 19." I said I had no idea and said I wasn't supposed to discuss other pts bc of privacy issues, and she said "I just overheard the nurses and docs and family members talking him and about him, blah blah blah...."
I loathe bedside report. I like to do a quick round with the off-going nurse to check things, such as IVs or something that might be complicated or something that should be verified (such as a dopamine gtt going at 5mcg/kg/min) but other than that, I prefer report out of the room. Management has been saying that bedside report is MANDATORY but I have yet to see anyone following that rule lol. They say we don't have to say ALL of the details of the patient, but still. I prefer not to do it at the bedside lol!
Hi!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.
That sounds just beautiful.
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."
I don't believe everyone can be trusted to handle those situations so tactfully.
I agree with you COMPLETELY. We are in the process of transitioning to this on my unit and I am not enthusiastic. Like you, I believe that report is for the NURSE, not the PATIENT. It is my time to get the low down on the whole situation (including social issues, which are very common on my unit), ask questions, etc. The patient/family has the opportunity to be involved in the POC by being present during rounds (which we encourage) or asking questions at, well, just about any other time. Also, I always discuss the POC with each patient/family at the start of my shift and encourage questions.
While I do like going over lines and drips at the bedside, I see several problems with this development. For example, when a family member rudely accused me of not knowing "how to take care" of the patient when I asked a clarification question of the departing RN during bedside report. Also, the time involved when we are constantly getting lectured about "incidental overtime." I work nights and often have to give report to multiple nurses on day shift because of the staffing differences. Also, will nurses traipsing around the unit and getting interrupted with questions from patients and family and whatever else comes up x multiple patients reduce OT??
Two years ago I was hospitalized for 3 days with a complicated ankle fracture, surgical repair, and PT. I LOATHED bedside reporting. Everyday I would have to ask the nurses to take report in the hall because I was actually trying to rest at 7 a.m. I did NOT want to be a part of my report and couldn't have given a rip what was said. I may be in the minority, but I hated it. And, I hate it as a nurse. My unit is small and we frequently care for each other's patients so I like group report where we can at least get an overview of the patients on the floor.
Two years ago I was hospitalized for 3 days with a complicated ankle fracture, surgical repair, and PT. I LOATHED bedside reporting. Everyday I would have to ask the nurses to take report in the hall because I was actually trying to rest at 7 a.m. I did NOT want to be a part of my report and couldn't have given a rip what was said. I may be in the minority, but I hated it. And, I hate it as a nurse. My unit is small and we frequently care for each other's patients so I like group report where we can at least get an overview of the patients on the floor.
That is how a lot of us feel, too. There are patients who are still sleeping at 0645-0700 and I don't want to disturb them a bedside report (especially after I kept them up all night!) and neither does the on-coming nurse.
I'm a fan of the model where you get report like normal and then go into the room with the previous nurse and take a look around, have the previous nurse introduce you to the patient, and do a ultra quick assessment of the patient and the environment. I really do think that goes a long way to make the patient appreciate the fact that the shifts do talk to each other and their concerns are being addressed and reported.
Doing the entire report at bedside seems dumb. And like people have said you'll either get interrupted, insult somebody, violate their privacy, or have to dumb things down.
I'm a fan of the model where you get report like normal and then go into the room with the previous nurse and take a look around, have the previous nurse introduce you to the patient, and do a ultra quick assessment of the patient and the environment. I really do think that goes a long way to make the patient appreciate the fact that the shifts do talk to each other and their concerns are being addressed and reported.
Doing the entire report at bedside seems dumb. And like people have said you'll either get interrupted, insult somebody, violate their privacy, or have to dumb things down.
This is pretty much how we're doing bedside report. Our main reports are written with verbal clarification of anything necessary. At the bedside, it's mainly a time to introduce the patient to the oncoming nurse, hit a few highlights (Jane is hoping to be discharged before noon; I put a call into the resident to see if we can got something for Megan's sore throat, etc.)--not because these things weren't covered with the other nurse already, but to show the patient that communication has really taken place.
I ask patients during the night what they want if they are asleep. Should we wake them or just let them be. It helps to know that.
I do think the introductory part of bedside reporting has been a good thing. I also think that trying to do the entire report is unrealistic, and it can inhibiting to the nurses and overwhelming to the patients. It's also not the best use of time, IMO. Unless you're handing off your exact assignment to a single nurse, it can be quite a logistical stretch to meet with everyone who needs you while they're trying to track down a few others.
The introduction and the quick eyeballing of lines and IVs and such doesn't take very long, and the patients seem to like it, as long as we didn't wake them. But doing it all at the bedside seems like providing a 16-lb turkey when a Cornish game hen would have sufficed.
This is when it's great to have administrative folks that have (and are willing to exercise) some common sense.
Specializes in Orthopedic, LTC, STR, Med-Surg, Tele.
I don't understand why it's necessary to go look for things that "may have been missed" on the previous shift. The way we do it now, we get a verbal nurse-to-nurse report, then I go around quickly to all my patients, introduce myself, either do a full assessment or a quick once-over, and then figure out what my priorities are. I bring my report sheet with me, so if I look and see, oh he's supposed to be getting LR not NS!! I can figure it out. Guess how often that happens though??? ..... NEVER.
I think bedside report is probably awesome in ICU, or some place with a high acuity and low patient load. HowEVER our floor is pretty much the opposite. And our patients are already educated, informed consumers of healthcare. We are supposed to start doing bedside report soon, and I'm dreading it. I feel like I will give two reports: the Disney version of report for the patient, and then the REAL report to the oncoming RN, so as not to upset/scare the patient.
I think some nurses see it as a chance to "catch" the off-going nurse having missed something. When I go into a room and see something was missed, I fix it. I've got 12 hours to do so. The IV is bad? We'll change it out. Some like to go in the room though, see the ID band has fallen off (pretty frequent with peds patients) and expect you to go and print off another one and put it on the patient before you leave. Does it take long? No. But really, how much easier would it be for the oncoming to just take it with them the next time they go in there?
Basically, it's become a way for the lazy to find even more work to avoid doing. And for the self-righteous to find things to complain about.
We've been doing bedside report for 8 months or so now, and I really like it. You get a feel for what information needs to be given at the nurses' station, but for the most part, I like to get all of my report at the bedside. No more walking in at 7:20 to a patient that looks completely different than what was described in report. No more hearing "Pain was well controlled" only to have the pt tell me they've been begging for pain medication. No more hearing "The other nurse said I could get up by myself (from a high fall risk pt)" or "The day shift nurse said I could eat whatever I wanted (on an NPO pancreatitis pt)".
Less splitting and manipulation from the crazy pts, rooms are cleaner at shift change now, I've eyeballed all my pts by 7:15 and no one needs pain meds or the bathroom for the first little bit of my shift, and pts feel more aware of what's going on. It's been well received from our pts, staff has had to been pulled along kicking and screaming, but honestly, when pts tell you to your face how much they like the shift report, it's hard to gripe about it or resist too much.
We don't do shift report in double rooms (we only have a few); instead we do more of a meet/greet/"I updated your nurse on how your night went, do you have any questions?" type of bedside report.
We always ask visitors to step out for report; most of the time the pt says "Oh, they can stay, they know everything anyway." For our DPOAs and families I think it really gives them a great opportunity to stay updated.
If a pt is sleeping, we don't disturb them and we do shift report at the desk.
Report used to take 45 minutes or more; I'd hear all this unnecessary information and there would be too much chit chat. Now it typically takes less than 15 minutes for me to get report on all my pts. It gives me plenty of time to read all the H&Ps, check labs, and read the previous shift notes from nursing, PT, RT, etc before I start my rounds. I absolutely love it.
turnforthenurse, MSN, NP
3,364 Posts
Folks ARE noisy! We do not have 2 pts per room on my unit, but some of the rooms (such as the ones in the corners) are very close to another room. I was taking care of a patient and she asked me, "is so and so still here? You know, the guy in 19." I said I had no idea and said I wasn't supposed to discuss other pts bc of privacy issues, and she said "I just overheard the nurses and docs and family members talking him and about him, blah blah blah...."
I loathe bedside report. I like to do a quick round with the off-going nurse to check things, such as IVs or something that might be complicated or something that should be verified (such as a dopamine gtt going at 5mcg/kg/min) but other than that, I prefer report out of the room. Management has been saying that bedside report is MANDATORY but I have yet to see anyone following that rule lol. They say we don't have to say ALL of the details of the patient, but still. I prefer not to do it at the bedside lol!