Leadership DIMENSION

Where Do You Want to Give Report? Jennifer Spivey, RN

Traditionally, nurses have met in a conference room to give each other end-of-shift report. Many hospitals are now moving to bedside report. Which does the research support as best practice? What are the ethical and practical issues of each? This article answers those questions. Keywords: Best practice, Bedside report, End-of-shift report, Research [DIMENS CRIT CARE NURS. 2014;33(5):278/279]

‘‘Where do you want to give report?’’ is a common question heard in hospital step-down and intensive care units at the hours of 7 AM and 7 PM. Shift change is a critical time in patient care and safety while also presenting a financial challenge to organizations. Both shifts of nurses are simultaneously being paid while communicating essential information about their patients. The challenge with shift change is how to expedite the process without sacrificing patient safety through an incomplete report. Personally, a lengthy shift change at the start or end of my shift is frustrating. A prolonged shift change at the start of my shift encroaches on time needed for direct patient care. A longwinded change of shift at the end of my workday impedes my work-life balance because getting home late means less time with my family and less time for sleep in preparation for consecutive shifts. Shift change is a critical time for communicating and handing over patient care to the next nurse. The Joint Commission1 recognizes communication breakdown among health care providers as a leading cause of sentinel events, thus prompting the patient safety goal to improve effective handoff. Costly medical errors may result from an ineffective communication or a noncomprehensive shift report. Examination of the literature reveals what constitutes a comprehensive report as well as the benefits and consequences of different reporting styles and locations. Welsh et al2 examined factors that influenced exchanging shift report in their 2010 study. They analyzed nurses’ evaluations of different report styles. They identified facilitators of a good report as pertinent content, note-taking space, face-to-face information, and a check278

Dimensions of Critical Care Nursing

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list, guide, or structured form to follow for report. They also identified barriers to a good report as inadequate information, inconsistent quality, limited time for questions, equipment malfunction (tape recorder), insufficient preparation time, and interruptions.2 Benson and colleagues3 highlight that nurses’ most common concerns during shift change are the length of report and the time spent conveying it. There are multiple ways to convey information during shift report, and nurses utilize various combinations: written, verbal, and visual. Research suggests the method used to convey report can influence its length and accuracy and support face-to-face report as the most accurate because information can be clarified.4 When there is a popular push to exchange report at the bedside, one must consider how location affects shift handoff. Location of report adds the audience to consider, and the audience can influence and contribute to the information shared. Comparison of bedside report and report exchanged at the nurses’ station highlights the benefits of each. Consider report exchanged at the nurses’ station. It utilizes verbal and written framework for exchange as the oncoming nurse makes notes about her patients. Nurses sit at the nurses’ station reviewing the patient case while utilizing the electronic health record (EHR). Many perceive this framework to be time efficient and anecdotally cite that interruptions may be minimized away from direct patient care settings. It uses a face-to-face dialogue and allows for questioning and clarification, which increase the quality of information shared. This structure also protects patients and family members from being affected DOI: 10.1097/DCC.0000000000000064

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

Where Do You Want to Give Report?

by sensitive health history or poor prognosis.5 In 2013, Staggers and Blaz4 completed an extensive analysis of the literature on nursing shift-change reports. They suggest that away from patients and family members, shift-change report serves as more than just information exchange about patients, but as a time for nurses to support one another educationally, socially, and emotionally. What some may view as benefits to report exchanged at the nurses’ station, others view as a drawbacks. Report exchange at the nurses’ station can be lengthy because nurses may inject personal opinions about the patient, may try to justify their actions, or may use the report time to air frustrations from the day.6 Sharing report at the nurses’ station puts nurses in close proximity and increases socialization among nurses. More socialization equates to more time spent for shift change.5 Now consider bedside report that uses a verbal, written, and visual framework for information exchange and adds the patient or family member as a contributor. The nurses use the EHR to review the patient’s case at the bedside. In 2010, Nelson and Massey5 compared bedside and nurses’ station reports in a pilot study. Time needed for shift change was decreased with bedside reporting from an average of 66 minutes to 39 minutes. This reduction in time equated to a $73 000/year savings on the pilot unit. Patient satisfaction improves with bedside report because patients and family feel involved in their care.7 Bedside report also allows for a visual component of information gathering: the oncoming nurse can visually check intravenous sites, lines, and infusion rates.5 Bedside report improves professional communication; nurses can no longer be side-tracked by socialization or interjections of personal opinions or rationales of care.6 There are drawbacks, however, to bedside report. Reiley and Stengrevics8 note that many times bedside report duplicates what is already in the chart. One can gather almost all pertinent information from the EHR. Nurses are concerned with interruptions during report.2 According to Johnson and Cowin,6 interruptions at the bedside may lead to lost information. Nurses express concerns that exchanging reports at the bedside at 7 AM is an additional disturbance in patients’ sleep. One must also consider that nurses must step away from the bedside to share information on sensitive issues. Report at the bedside loses its ritualistic, socially supportive content.4 Despite the drawbacks of bedside report, research continues to support it as the most efficient method, and

hospitals continue to encourage its utilization as the most cost-effective method of report exchange. So why do nurses continue to use time-consuming, outdated practices of reporting at the nurses’ station? Do nurses fear losing the valued social, cultural, educational components of report tucked away from patients? Could nurses provide for these needs at a different time during the shift? Staggers and Blaz4 suggest the most important aspect to explore surrounding report is not how or where nurses share report, but what information they share. I believe the location of the report strongly influences the information shared. It is completely patient and family centered because reporting at the bedside eliminates the space for personal information sharing between nurses. During a time when patient care is transforming, nurses can implement changes in their practice to promote better patient care. Reporting at the bedside is a change that increases the efficacy of information sharing and decreases time and resources spent5 while improving patient care and satisfaction.7,9 Next time it’s 7 o’clock and you want to get out of work quickly while giving a thorough handoff report, think carefully about your reply to the question: ‘‘Where do you want to give report?’’

References 1. The Joint Commission. Hospital National Patient Safety Goal. 2014. www.jointcommission.org/standards_information/npsgs.aspx. Accessed February 2, 2014. 2. Welsh CA, Flanagan ME, Ebright P. Barriers and facilitators to nursing handoffs: Recommendations for redesign. Nurs Outlook. 2010;58:3. 3. Benson E, Rippin-Sisler C, Jabusch K, Keast S. Improving nursing shift-to-shift report. J Nurs Care Qual. 2007;22(1):80-84. 4. Staggers N, Blaz JW. Research on nursing handoffs for medical and surgical settings: an integrative review. J Adv Nurs. 2013;69:2. 5. Nelson BA, Massey R. Implementing an electronic change-ofshift report using transforming care at the bedside processes and methods. J Nurs Adm. 2010;40(4):162-168. 6. Johnson M, Cowin L. Nurses discuss bedside handover and using written handover sheets. J Nurs Manage. 2013;21(1):121-129. 7. Anderson CD, Mangino RR. Nurse shift report: who says you can’t talk in front of the patient? Nurs Adm Q. 2006;30(2):112-122. 8. Reiley PJ, Stengrevics SS. Change-of-shift report: put it in writing! Nurs Manag. 1989;20(9):54-56. 9. Tobiano G, Chaboyer W, McMurray A. Family members’ perceptions of the nursing bedside handover. J Clin Nurs. 2013; 22:1-2.

ABOUT THE AUTHOR Jennifer Spivey, RN, is CNII at Duke University Hospital. The author has disclosed that she has no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Address correspondence and reprint requests to: Jennifer Spivey, RN, 1403 Lees Chapel Rd, Sanford, NC 27330 ([email protected]).

September/October 2014

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

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Where do you want to give report?

Traditionally, nurses have met in a conference room to give each other end-of-shift report. Many hospitals are now moving to bedside report. Which doe...
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