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Anauja Bell
Being a health care professional entails many different responsibilities and expectiations.
Between caring for patients, providing education, and facilitating emotional support, the job of
nurses and other support staff members is essential. It is imparitive to ensure that the
professionals in these roles understand the immensity of importance that they have in patient care
and the vast room for potential errors. Many hospital errors stem directly from lack of
communication or knowledge of patient condition. To prevent these issues, many facilities have
started to promote the practice of bedside shift report. By definition, bedside shift report is a
report given during shift change between the oncoming nurse and the offgoing nurse that occurs
Background
Within the last several years, many health systems have adopted bedside shift report to
promote effective communication, patient safety, and patient involvement in care. Through
research, observation and discussion with the unit manager on a neuroscience unit, it has been
reported that staff compliance towards adopting bedside shift report has been low. To promote
higher staff compliance with bedside shift report, patient and professional benefits were
discussed with the unit. This issue was chosen due to the large amount of studies and evidence
based research that supports the use of bedside shift report in the healthcare setting. In most all
cases this method has been seen as beneficial. This issue is relevant to the Step-Down
Neuroscience unit because much like many other facilites and units, implementing a new shift
towards a practice can be difficult in promoting compliance. With compliance from all staff
Identifying Issue
Management on the neuroscience unit has noticed that staff often continues with
alternative methods of reporting despite the suggestion to follow the implemented policy of
bedside reporting. Upon discussion with the unit manager, a gap analysis regarding the thoughts
towards bedside shift report outcomes was deemed to be the most effective way to assess the
reasons for noncompliance. Three questions were generated and addressed to ten staff members
on the unit. When asked the question “do you feel bedside shift report promotes patient safety?”
100% of staff said yes. When asked the question, “do you feel bedside shift report is beneficial to
you as a medical professional?”, 60% said yes it is benificial to them and 40% said no it is not
beneficial. When asked “do you feel like bed side shift report promotes patient satisfaction
outcomes overall?”, 40% said yes it improves outcomes and 60% said it does not improve
outcomes. This information was directly obtained from the patient support technicians and the
One of the largest drives in evidence based practice regarding bedside shift report is
moving towards patient centered care. As discussed by Baker, patient experiences have now
been heavily rated on score cards and general systems called Hospital Consumer Assessment of
Healthcare Providers and Systems (HCAHPS) to promote patient voice in standards of care
(2014). But despite the generalized questionnaires and their results, facilites have still seen a
struggle in implementing effective patient and family centered care models (Baker 2014). Many
of these issues stem from not knowing the proper components for implementing these care
models and shifting clinical mindesets to be patient focused versus treatment focused (Baker
2014). Many of the barriers presented based on patient reports were: respect for patient
MANAGING CHANGE TOWARDS BEDSIDE SHIFT REPORT 4
preferences, values and needs; providing education and appropriate information; coordinating
and integrating care and services; emotional and physical comfort; involvement and education
provided to families and caregivers; discharge transitions; and access to continuing care (Baker
2014).
One way discussed to improve patient centered care was through a three step process
suggested by Hall and Romp through a presentation at Kentucky One Health Center. Hall and
Romp suggested that nurses start by addressing the patient’s needs prior to shift change through
rounding and addressing the five p’s: plan, potty, position, possesions (2014). Secondly, they
suggested that the offgoiong nurse take managing up techniques for the oncoming nurse (Hall
and Romp, 2014). These actions include making sure all the medications required for a shift
were given or successfully rescheduled, making sure patient is repositioned and comfortable, as
well as making sure patient enviornment is clean and in order. Thirdly, they suggest that
offgoing nurses are sure to update the white board and discuss the patient’s current condition and
plan of care (Hall and Romp, 2014). With use of the whiteboard and discussion of plans anyone
in the patient’s room has access to knowledge of the care plan and goals provided for the day.
From implementation of these practices, Hall and Romp were able to provide a comparison of
pre and post HCAHPS. It was shown that there was an overall increase in HCAHPS scores from
73% to 83% in likelihood to recommend the facility, from 79% to 83% in providing clear
communication, from 62% to 77% in prompt bathroom assistance and 70% to 85% in pain
controlled this amount to this amount in these categories (Hall and Romp 2014).
Another large topics discussed in regards to bedside shift report is patient safety. Studies
have shown an overall improvement in patient safety related to many aspects for those units and
facilities that participate in bedside shift report. According to researchers Gregory, Tan, Tilrico,
MANAGING CHANGE TOWARDS BEDSIDE SHIFT REPORT 5
Edwardson and Gamm, many of the patient perspective articles focus on the improvement of
care understanding and patient empowerement due to the ability to directly ask questions about
their care and receive answers in real time with two professionals present, while others report
that patient benefit relies directly upon the ability to receive more prompt delivery of care
(2014). Also doing the report in front the of patients allows them to ask questions that may not
have been clarified on the previous shift (Jeffs, Acott, Simpson, Campbell, Irwin, Lo, Cardoso
2013). Other studies suggest that participants feel that bedside shift reporting allowed for an
opportunity for nurses to check and clarify information (Jeffs, et. al 2013). From this practice,
nurses and patients were able to find, intercept, correct and review potential and actual errors in
Nurses also described that they were able to prioritize their care more effectly and
efficiently when using bedside shift report (Jeffs, et. al 2013). As a nurse, having the ability to
lay eyes and quickly do assessments on their patients during report allowed them to be able to
see who was in the most critical condition and in need of the most instant care (Jeffs, et. Al,
Through bedside shift report, nurses were also able to compare baseline assessments
between when they were the oncoming nurse and when they are the offgoing nurse (Gregory,
Tan, Tilrico, Edwardson, and Gamm 2014) . Oncoming nurses were able to assess the enviornent
for cleanliness, intravenous lines, fluids, wounds sites, and chest tube drainage systems to ensure
everything was in working order and where it should be (Gregory, et. al, 2014). This led to a
higher level of accountability and the information needed to know what tasks should be done
Through research it has been shown that the overarching theme and largest benefit for
centralized shift reports were given in a nurses station, in an alcove or within empty rooms,
which did not allow for patient participation and left many holes in report (Radtke 2013) . Many
nurses have voiced frustration in regards to the lack of information being shared during these
types of reports (Radtke 2013). It is said that nurses tend to feel like they are behind before they
even begin their shift due to the gaps and unexpected findings upon first entering the patient’s
room (Radtke 2013). Nurses often are presented with questions before even seeing their patients,
messy rooms, skipped medications with no explanation, soiled dressings, and I.V. fluids set at
According to Reinbeck and Fitzsimons, the most effective communication tool is SBAR.
SBAR stands for situation, background, assessment, and recommendation. When describing
situation, the offgoing nurse would introduce the oncoming nurse (Ofori-Atta, Binienda, and
Chalupka 2015). This would allow for the oncoming nurse to greet the patient, address the
patient’s name, verifying their wristband with name and date of birth, hear the diagnosis and
update the patient information board (Ofori-Atta, et al 2015). During the background phase
nurses are able to directly involve the patients. In this phase nurses exchange brief but pertinent
information regarding the patient’s health history, comorbidities and events leading to
hospitalization, and how long the patient is expected to stay in the facility (Ofori-Atta, et al
2015). Nurses should ask the patient to first hear the information being discussed, then further
their knowledge if needed by asking quesions at the end (Ofori-Atta, et al 2015). The next phase
would be assessment. This is where nurses conduct a full review of systems to the next nurse
MANAGING CHANGE TOWARDS BEDSIDE SHIFT REPORT 7
being sure to include pertinent information about vital signs, tubes, invasive lines, surgical
drains, urinary catheters, and venous access devices (Ofori-Atta, et al 2015). This is also the
section where nurses observe the I.V. sites, the medication pumps, the infusion rates, and address
patient’s about whether they are experiencing any pain (Ofori-Atta, et al 2015). The next step
would be recommendation. This is where the offgoing nurse relays information regarding the
patient’s cultural and communication needs, pending orders, goals and plans of care (Ofori-Atta,
et al 2015). At the end of SBAR the patient should again be asked if they have any questions or
With the shift towards bedside rounding, many nurses and hospital staff were concerned
with the potential increase in time for patient hand-off (Reinbeck and Fitzsimmons 2013). In
studies conducted by Reinbeck and Fitzsimmons, it was shown that interruptions from
physicians, interpersonal team members and phone calls were greatly reduced in comparison to
the former practice of reporting (2013). It was also shown that time was actually reduced due to
the streamlined effect of SBAR (Reinbeck and Fitzsimmons 2013). Nurses were also
appreciative for being able to visualize all of their patients within the first 30 minutes of their
shift (Reinbeck and Fitzsimmons 2013). Another positive aspect of bedside shift reporting was
building nurse-nurse dyatic relationships such as increased socialization by sharing stories and
mentoring, coaching and networking opportunities (Reinbeck and Fitzsimmons 2013). Although
this seems like a minute aspect, nurses having the ability to overcome feelings of discomfort,
express feellings of stress, and exchange thoughts on patient care led to an increase in employee
satisfaction rate as well as reduction in costs to healthcare facilites from less paid overtime and
legal costs related to falls and medication errors (Reinbeck and Fitzsimmons 2013).
MANAGING CHANGE TOWARDS BEDSIDE SHIFT REPORT 8
Although many benefits, there are still oppositional barriers to bedside shift reporting.
Often times bedside shift report happens very early in the morning and this become diruptive to
patients who are attempting rest (Radtke 2013). Patients can become agitated with the practice
and constant interruption and even request that the reporting in their room cease entirely (Radtke
2013).This also becomes an issue for patients who are unresponsive, or unable to participate due
to cognitive or sensory limitations (Radtke 2013). Another issue that nurses run into with bedside
rounding is disclosing information that has not been discussed between the patient and the
healthcare provider (Radtke 2013). This can be troublesome due to the lack of detailed
explanation the nurse can give about the next steps in care, as well as the potential inability to
give a clear answer about when the physician will next be available to see the patient. This can
potentially increase patient anxiety. Many nurses have also stated that they may feel skeptical
discussing certain issues in the medical records in front of the pateints such as certain infectious
disorders to alert drug abuse and psychosocial issues (Radtke 2013). Confidentiality is one of the
largest concerns regarding bedside shift report (Radtke 2013). Often times patients may be in a
semi-private room or are in the room with family members or friends and it can be an
uncomfortable situation for the patient and the nurse to ask certain individuals to be dismissed
(Radtke 2013). Patients over 18 years old can decide whether they would like their family
members or friends to have knowledge of their condition and medical records (Radtke 2013).
This becomes a privacy issue when revealing certain test results, disease processes, and plans for
treatment (Radtke 2013). Finally, there is often the issue of staff compliance. Like with any
practice or policy change, staff can be resistent in participation (Radtke 2013). This poses a
safety issue for patients and can increase staff tension for those who do want to properly
This evidence is all very impactful in regards to the issues faced in the Neurosceince
Step-Down unit. It goes in depth to why the unit should continue to adopt the new policy of
bedside shift rounding and work towards adherence. It also addresses the issues and reasons why
staff may be resistent to adopting the policy. This infornation can now be compiled and
formulated to directly address the obstacles that the neuroscience unit faces regarding
compliance with bedside shift report by promoting the research behind how it promotes patient
Recommendations
Based on the evidence found regarding bedside shift report, it has been concluded that
this practice can lead to many positive outcomes for the patients as well as the nursing staff. It
has been shown that by continuing to ask patient opinions on care allows for progress towards a
successful model of patient centered care. This can be implemented by using the “background”
phase of SBAR to allow patients and family members to ask questions and address concerns.
This will allow the patients on the unit to feel heard and have a sense of autonomy within their
care plan. Through research it has also been shown that bedside shift report will increase patient
safety. This can be implemented by using the “assessment” phase of SBAR to do a two person
skin check, I.V fluid check, and relaying pertinent information about vital signs, tubes, invasive
lines, surgical drains, urinary catheters, and venous access devices. The next research based
recommendation is for nurses to increase communication for overall better outcomes. Based on
the information found, increased communication leads to improvement in all areas of healthcare.
Nurses and technicians should ensure to adopt the format of reporting through SBAR and make
sure they are delivering this information at the bedside. Using this system will allow them to
MANAGING CHANGE TOWARDS BEDSIDE SHIFT REPORT 10
avoid any gaps in information and hold each oncoming and offgoing nurse accountable for
patient’s current state when they are transferred to the next caregiver.
This will change the staff practices and patient outcomes in many positive ways. This
will lead to improved HCAHPS scores for the unit. It will also lead to increased staff morale
from the ability to address feelings and concerns to one another. This will improve time
management because of the structured delivery system, which allows for a smoother transition
from shift to shift. It will also increase patient and family education from listening to the SBAR
transaction. This practice will decrease falls due to the presence of two people being in the room
for assistance as well as decrease the rate of pressure ulcers faced by the unit from doing a four
eyed skin check. There also will be a reduction in medication errors from having two
There are many approaches in how this practice can be implemented. By addressing the
reasons staff does not want to participate, management can formulate a plan to address staff
concerns. After adressing these issues, meetings can be set to make a system to change the
outstanding concerns and make the system flow more smoothly specified to the unit. Once the
issues are addressed a plan is made to improve compliance, a follow up gap analysis with the
same three questions, “do you feel bedside shift report promotes patient safety?”, “do you feel
bedside shift report is beneficial to you as a medical professional?”, and “do you feel like bed
side shift report promotes patient satisfaction outcomes overall?”, should be implemented. The
results should be compared and contrasted to the results obtained prior to implementation and an
increase in safety promotion, benefience, and patient satisfaction should be noted. Management
should also implement a penalty for consistent noncompliance with bedside shift report, unless it
MANAGING CHANGE TOWARDS BEDSIDE SHIFT REPORT 11
is a patient specific issue. These recommendations will be delivered to the unit through brochure
The details discussed in the brochure include why bedside shift rounding is beneficial,
oppositional barriers to the practice, the results from the gap analysis from the staff, statistics
This deliverable will be left in the break room for staff to obtain as they please and will also be
presented and passed out throughout three shifts during morning and night huddle. During the
presentation, a positive approach to the situation will be taken. The discussion will be centered
on how staff can improve their compliance with bedside shift report and what the positive
outcomes are related to patients and staff members when they are compliant.
MANAGING CHANGE TOWARDS BEDSIDE SHIFT REPORT 12
References
Baker, G. R. (2014). Evidence boost: a review of research highlighting how patient engagement
contributes to improved care. Canadian Foundation for Healthcare Improvement
Gregory, S., Tan, D., Tilrico, M., Edwardson, N., & Gamm, L. (2014). Bedside shift reports:
what does the evidence say?. Journal of Nursing Administration, 44(10), 541-545.
Hall, K., Romp, C. Bedside Shift Report: A Pilot Evidence Base Practice Project. Poster session
presented at: Kentucky One Health; 2014; Louisville, KT
Jeffs, L., Acott, A., Simpson, E., Campbell, H., Irwin, T., Lo, J., ... & Cardoso, R. (2013). The
value of bedside shift reporting enhancing nurse surveillance, accountability, and patient
safety. Journal of nursing care quality, 28(3), 226-232.
Ofori-Atta, J., Binienda, M., & Chalupka, S. (2015). Bedside shift report: Implications for patient
safety and quality of care. Nursing2018, 45(8), 1-4
Radtke, K. (2013). Improving patient satisfaction with nursing communication using bedside
shift report. Clinical Nurse Specialist, 27(1), 19-25.
Reinbeck, D. M., & Fitzsimons, V. (2013). Improving the patient experience through bedside
shift report. Nursing management, 44(2), 16-17.