Bedside Nursing Shortage

Bedside Nursing Shortage

Section D

Bedside Nursing Handoff

Change-of-shift report is the time when responsibility and accountability for the care of a patient is transferred from one nurse to another. The communication that ensues during this process is linked to both patient safety and continuity of care giving. Additionally, this reporting method was implemented to empower patients to participate in their plan of care, reduce errors from oversight, and to allow visualization of the patient's condition at shift change. A team of nurses and technicians were assembled to research and implement a plan of action for initiating bedside reporting. Patients filled out surveys before discharge regarding bedside reporting, which allowed for measurement of success and patient satisfaction.

Implementation Plan

The staff were challenged by the executive team to continuously look for ways to improve patient safety. Some nurses had voiced concerns about change of shift report—that it was too long and often contained extraneous information. In an effort to improve patient handoffs between shifts and the desire to increase patient involvement in care, the staff decided to change the way shift reports were done, by bringing report to the bedside. Bedside reporting was implemented through several steps. Initially a committee of two RNs, the flight commander, and one medical technician was formed. The committee researched bedside reporting, implementation strategies and results from studies of bedside reporting initiatives. An implementation plan was agreed upon which included an educational session with all staff members regarding the process of bedside reporting, expectations, the need to educate patients and an implementation date.

Performance was measured in five areas to include: patient informed of bedside report,

completion at every shift change, presence of nursing team (RN and Medical Technician,) patient involvement in report, and patient understanding of report and plan of care. Data from patients was anonymously collected over two months.

Bedside reporting was successfully implemented and is on-going. The initiative increased overall patient and staff satisfaction with improved hand-off reports due to the involvement of the patient. Changes from a group style verbal report without patient input was replaced with a team report--including the patient as a member of the team--given right at the bedside. The use of a standardized report sheet allowed for a quick reference regarding patient condition and any additional notes for the oncoming shifts. Having the patient involved in change of shift report was found to be most valuable by the staff. Bedside reporting can literally be a lifesaver; it prevented the need for resuscitation of one patient due to identification of an asthma patient was decompensating.

Staff resistance to change was the largest problem that was incurred. Resistance was overcome by education, allowing an adjustment period, and strict enforcement of expectations regarding bedside reporting and staff accountability. Also, an exception to the rule was allowed if the nurse and patient felt bedside reporting would not be beneficial, for example, if the patient was sleeping and did not want to be disturbed. In this case, verbal report would be accomplished in a private location instead of ...