Megan Brooks

May 10, 2013

A change of venue for the change-of-shift report had an "immediate and dramatic" effect for nursing staff and patients on a medical oncology unit at the Community Medical Center in Toms River, New Jersey, Donna Reinbeck, MSN, OCN, the unit's director of patient care, told Medscape Medical News.

Moving the shift report from the nurses' station to the bedside has "saved us time and allowed patients to participate in their care," Reinbeck noted.

The bedside shift report has also improved staff relationships. "There were sometimes feelings of, 'the night shift left this for me to do or the day shift didn't do that.' That all ended with bedside shift reports. It seemed to create a more cohesive working environment and mutual respect between the staff," she said.

Reinbeck recently shared her experience with the bedside shift report at the Oncology Nursing Society 38th Annual Congress in Washington, DC.

The Institute of Medicine's 2001 report, Crossing the Quality Chasm, listed patient-centered care as 1 of 6 overarching aims for improving the healthcare system. Patient-centered care can be defined as healthcare through the eyes of the patient, and is often measured by patient experience surveys such as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS).

"Improving the patient experience involves changing the current culture of the way nurses practice and communicate with each other and with their patients," Reinbeck noted.

 
Our HCAHPS scores weren't that great and we were looking for a way to improve them.
 

Historically, she explained, nursing shift-to-shift reports have taken place at a central nursing station, and they can be long, incomplete, and fraught with interruptions. In addition, they happen without patient involvement, which can lead to errors and confusion about treatments, diagnoses, and medications.

Moving shift reports to the bedside improves transparency between the healthcare team and the patient, Reinbeck said. The patients are able to hear exactly what their plan of care entails and are free to add any pertinent information.

What sparked the idea of the beside shift report? Honestly, Reinbeck said, "our HCAHPS scores weren't that great and we were looking for a way to improve them."

To get started, all nurses on the unit attended an educational session to learn about the bedside shift report. A standardized tool based on the Situation, Background, Assessment, and Recommendation (SBAR) communication structure was developed to encompass all items expected to be reviewed at the change of shift. Meetings were held to discuss issues and concerns related to patient confidentiality, physician buy-in, and the hand-off.

"I had all kinds of push back and concerns from staff," Reinbeck admitted, "but we addressed all of their concerns and came up with answers before getting started."

She said she was "floored and excited" when she saw how much the HCAHPS scores improved in all 4 communication domains after implementation of the bedside shift report.

Table: Median HCAHPS Scores Before and After Bedside Shift Reports

Domain Before After % Change
Communication with nurses 74.0 80.0 8.0
Nurses treat with courtesy, respect 83.0 91.0 10.0
Nurses listen carefully 66.5 71.0 7.0
Nurses explain in a way you understand 64.0 71.0 11.0

 

These results show that nursing staff is building relationships with patients and effectively engaging patients in their care, Reinbeck said.

Staff satisfaction and perceptions of hand-off communication also improved with bedside shift reports. "We noticed that there was a lot of mentoring going on at the bedside; a lot of the younger nurses said they liked the fact that they could see what the older, more experienced nurses were talking about," Reinbeck said.

The beside shift report is now standard on Reinbeck's unit, and some of the other units at her hospital are also trying it, she said. "It's simple and easy to implement, but I really think the key was addressing staff concerns prior to implementing it and getting staff engaged that really helped," Reinbeck said.

Staff Satisfaction and Buy-In

The bedside shift report is not new to Gabriela Kaplan, RN, AOCN, adjunct faculty at Trinitas School of Nursing in Elizabeth, New Jersey. "We started bedside reports at the Memorial Sloan-Kettering Cancer Center in 1978; 35 years later, it seems to be a new concept. It's like that song — everything old is new again."

Kaplan said the bedside report has "tons of advantages. The biggest one is that the offgoing nurse and the oncoming nurse are both looking at the same thing at the same time in real time. Doing shift reports in the nurses' station is not effective. Everybody should be doing the bedside report."

This research did not receive outside funding. The authors and Ms. Kaplan have disclosed no relevant financial relationships.

Oncology Nursing Society (ONS) 38th Annual Congress. Poster 112830. Presented April 26, 2013.

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