wanted: thoughts on bedside reporting

mama_d, BSN, RN · Mar 11, 2011

I'll admit that I was one of those who had to be drug into bedside reporting kicking and screaming the whole way.

But now I'm a convert.

True, there are often times when discresion needs to be used, so it's not always a complete report at the bedside...and ALWAYS ask if it's OK to give report at the bedside. My standard line if there are visitors is "I see you have company, we'll just step out in the hall for report". That way the pt can say "Sure" or "Oh, it's OK" without being put in the unpleasant spot of getting in trouble with family members over refusing it.

I've come to enjoy the fact that I actually get to see my pts right off the bat, and if something comes up where I can't get back in their room at my normal rounding time I know they've at least seen my face already.

My max number of pts is 6, Ilm not at all sure how this would work once you hit the 7-8 range.

RNforLongTime · Mar 11, 2011

I don't think I'd like it because #1 what if your assigned relief nurse is late?? Then ya gotta wait for him or her to show up. Happened all the time at my last job...the day shifters would be walking on the unit at 7:15am when the shift starts at 7am. Sorry, since U can't be on time, you are getting a brief succinct report from me...bare minimum..you wanted to know more?? Oh well how about showing up ON TIME!!

I also don't think it's practical because what if you need to tell the oncoming nurse about how Mr so and so's famiy is a little more needy than others, or something like, they write EVERYTHING DOWN so watch what you say type thing....I like to be warned about patient family members like that and bedside rounds report wouldn't allow for that.

Riseupandnurse · Mar 11, 2011

I hate bedside reporting (which was really hallway reporting). After 8 to 12 hours of discharges and admits the patients of any given nurse tend to be spread up and down the very long hallway so "bunching them up" again means the nurse has to hook up with 2 or 3 other nurses, and there are bottlenecks and delays. Then then we are sitting ducks for any family members who need water, to tell you something about either their patient or themselves, however nonpressing, including the necessity to drop everything for a prolonged trip to the bathroom for the patient, etc. In addition, multiple physicians have us at their immediate beck and call (which I personally believe is the whole point behind administration moving to this form of report.)

We went from learning about all the patients in 20 to 30 minutes of a taped report to learning less information about 5 or 6 patients, and what we do learn takes 45 minutes at a minimum. Nobody, even the charge nurse, has an idea what is going on with anyone other than his or her own patients, so when problems arise during the shift or (God forbid this) any nurse wants to take a bathroom break, let along a lunch break, it is start from scratch with the report if the patients are to be safe while their own nurse is temporarily unavailable. It is inefficient, lengthy, and has resulted in less safety for the patients.

kygavin · Mar 11, 2011

I worked at a hospital with bedside reporting and Interdisciplinary rounds and it was great for communication between staff and great for patients and families. It also cut back on a lot of patient/family questions and concerns because they were kept up to date on everything that was happening. I was a new grad when I was there and it was very intimidating at first to give report in front of a bunch of people and present my patient at rounds but I quickly adjusted...

mama_d, BSN, RN · Mar 11, 2011

I wanted to add that it also increases accountability from one shift to the next, as well as give the opportunity to ask "Um, how lomg have they looked like that?" when a pt starts going downhill.

There have been a handful of times where the situation called for a "You helped cause this train wreck by ignoring XYZ, you're gonna stick around for a little bit and help me fix it."

And there have been several times where we went in and the day nurse said something along the lines of "Crap, he didn't look like that 45 minutes ago, I'll reassess and grab vitals if you page the doc." Totally eliminates those situations where you get delayed doing first rounds on a pt and then walk in to the room and the thought floats across your mind..."How long has his breathing sounded like Darth Vader?"

It is hard to adjust to. And there are still times when for whatever reason it's not practical, but on my floor at least it's the exception rather than the rule. Like when I walked into a rapid response on one of the pts I was getting a few weeks ago that lasted over 45 minutes...it was report at the nurses station and then a quick visit to the other pts together to introduce me.

Part of our process in implementing involved constant feedback from the floor to management as to what was working and what wasn't, along with suggestions on how to improve the flow. We were basically told that it was not an option, it was going to happen, but as it was such a big change management was willing to listen to us in regards to ideas for smoother implementation.

RNKPCE · Mar 11, 2011

We don't have direct hand off, that is all 6 of my patients go to nurse Jack. That is because we have a mix of 8 and 12 hour people, people want their patients back from the day before, or one assignment is too heavy etc. We already don't get out of report on time with normal one on one report.

What do you do when you start to do report and the family member tells you the patient is incontinent? Some of those clean ups take a long time. In a time where they are tightening up on overtime I can see bedside report only increasing it.

I can see going in and giving complex patients a walk thru with off going nurse, such as patients on drips such as heparin or people with complex dressing, or tubes. But do to the full report on every pt at the bedside doesn't seem like logistical possible in the time frame allotted for report. And like others have said what about the stuff such has the manipulative patient and stuff you have to pass onto another shift that you can't say in front of them.

mama_d, BSN, RN · Mar 11, 2011

If a non-urgent need on the pt or family's part needs to be addressed, I'll say something along the lines of "Jane and I need to finish the report process to ensure that we have a safe hand-off. Jenny will be your tech tonight, I'll let her know Betty needs to get cleaned up. As soon as I'm done with report, I'll check and if Jenny hasn't gotten a chance I'll take care of it. It should only be about a 15 minute wait." 90% of the time, it works without a problem.

rkitty198, BSN, RN · Mar 11, 2011

A few times I would recieve report from this one RN who would show the dressings, the tubes and would try telling me how to do stuff (like emptying the JP) that I already knew about. During the shift the patient called and wanted a "more competent" nurse because she said that the night shift RN had to show me how to do my job and she wasn't comfortable.

I think it can be a great tool, but one must be careful how report is given because it can make or break the patient/staff dynamic if not done tactfully.