Nurses Are Advocates And Protectors For Their Patients

In every profession there are changes that propel how tasks are done; nursing is no stranger to this. One of the biggest changes that have come into nursing’s daily events is how report hand-offs are being done. Gone are the days of taped report that each off going nurse must tape about each patient and the oncoming nurse must listen to. Nurses are now being encouraged to move their report to the bedside, in front of the patient (Trossman, 2007). It is very important to know how this can affect the patient and even the nurse’s schedule. With every change, there are positives and negatives that can finalize the decision to keep or forego

The health care institution has been considering a wide array of solutions to improving the quality of patient care within the facility, and it is now believed that a suitable course of action is represented by the improvement of the nurse reporting at the bed of the patient, at the change of the shifts. This strategy is beginning to draw more attention within the medical community, but it has yet to be fully adopted by the health care institutions.

The hand over process of communication between nurses to nurses is done with the intention of transferring essential information for safe, and patient centered care. Traditionally, this shift report has been done away from the patient’s bedside, at the nurse’s station, or other place like staff’s room. In addition, the shift report used to be delivered through audio recording of the patient’s information. These reporting mechanisms did not include face-to-face reporting of the patient information, nor involvement of patient. Therefore, information regarding the patient’s care was not shared with the patient, leaving them out of his/her own care plan. Recent studies and development of Patient Centered Care Philosophy have challenged this belief of giving a report away from the patient. Tan (2015) said, “Shift report must not only be restricted in nurse to nurse communication, but it must involve patients as the recipients of care” (p. 1). Incorporating the patient into the end of shift report is essential for providing patient centered care and patient satisfaction. Nurses at the St Jude Medical center in the acute in-patient rehabilitation unit are not exceptional. Most of the end of the shift report between nurses are still done away from the patient. Aim of this paper is to make a change in the work place, which is the process of giving end of shift report at the bedside incorporating patient and families in the acute in-patient rehabilitation unit at St Jude Medical

Currently at the hospital I work in does not require bedside reporting in high acuity areas such as the emergency department. The current practice is to first identify the nurse for the assignment you are relieving, which often times can be multiple nurses. This often leads to very brief exchange of patient information so that each nurse can get to the next person and start care or leave for the day. Due to the nature of an emergency department, patient population is extremely diverse yielding reports regarding patients of different ages, diagnoses, and acuity. Couple the diverse nature of clients with the brief interactions between nurses to communicate what is presumed important regarding patient care while attempting to maintain privacy all with the distractions of a busy nursing station and it is likely some piece of information may be missed or overlooked.

Traditionally, nursing shift-to-shift reports were organized methods of communication between only the oncoming and leaving nurse, designated to a location such as the central nursing station or nook of a hallway. Shift reports can be considered the foundation of how the day is going to plan out because it introduces the patient, diagnoses, complications, medications, consults, upcoming test and the entire plan of care. These reports are full of complicated and vital information and while set in certain locations that are vulnerable to interruptions, such as the nursing station, medical errors and miscommunication are more likely to be made. The Joint Commission’s 2009 and 2010 National Patient Safety Goals (Joint Commission, 2015) included two patient safety standards, first to encourage patients to be involved in their health care plan and second, to implement a standardized communication process for handoff reports between providers. Soon after in 2013, The Agency for Healthcare Research and Quality under the United States Department of Health and Human Services introduced a set of strategies to improve patient engagement along with safety and quality in patient care. Within these strategies the new method of nurse bedside shift report was developed, which suggests nurses to conduct shift-to-shift reports at bedside in the room of each patient, rather than out of the room. The benefits of this new method were

Bedside reporting involves giving information or a report to the oncoming nurse in the presence of a patient. This method gives the patient an opportunity to ask questions and get clarification regarding his or her care. Bedside reporting increases patient satisfaction, quality of healthcare and nurse-to-nurse responsibility. Hospitals need to design a better handoff process that can easily reduce patient risks and increase patients’ involvement in their care. Emergency rooms shift reports usually take place at the nursing station of every patient care area. The departing nurse gives information verbally to the oncoming shift. Therefore,

Bedside shift reporting, is it necessary? Baker (2010) states that is has its benefits, from patient safety, increased patient involvement and staff teamwork, ownership and accountability.” (Baker, 2010) To promote stronger engagement, Agency for Healthcare Research and Quality developed the Guide to Patient and Family Engagement in Hospital Quality and Safety for bedside reporting. (AHRQ, 2013)

Interdepartmental communication and medical errors have both been proven as causes of harm to patients in health care settings. When there are gaps in communications between nurses changing shifts or patient transitions from one department to another, medical errors can occur and cause harm to patients. Even though there has been improvement in recognition of these problems and actions taken to reduce communication gaps and medical errors, there still needs to be more work, especially in individual facilities.

Bedside report has also become a critical component to maintain patient safety. In the past nurses would give hand off report at the nurse’s station, leaving their patients alone. This time frame has proven to be when the majority of sentinel events occurred, such as falls (Ofori-Atta, J., 2014). Bedside report keeps patients involved in their care and reduces the risk of errors in communication between nurses and maintains patient

Communication between nurses at report change is essential. The next nurse needs the most important information whether it is as Situation-Background-Assessment-Recommendation (SBAR) that the Institute for Healthcare Improvement (n.d.) outlines to use or in another form. The case of Rio Grande Regional Hospital Inc v. Villarreal discusses how one nurse breached the standard of care because the record reflects that from the time Hermes was given the double-edged razor until he died neither Nurse Bergado nor any other nurse checked to see how Hermes was doing in the bathroom” (Find Law for Legal Professionals, 2016). At Baylor Scott & White at All Saints, we have a policy that each patient is rounded on physically every hour.

Change of shift in the nursing profession is unique (Caruso, 2007). Information is transferred between nurses verbally and through written communication. In many facilities shift report from one shift to another involved sitting down and getting all your orders from a caredex and then talking with the previous nurse face to face going over pertinent information regarding their patients. This type of report usually happens in a report room or sometimes in the hallways or other common

Evidence also supports that bedside shift reporting is financially beneficial for staff nurses and nursing management. The average report time is significantly decreased from an average of 45 minutes to 29 minutes (Gregory, et al., 2014). This reduces overtime and saves hospitals money. Nurses’ satisfaction is improved because they get to end their shift on time. They get to proceed with shift report more quickly, with fewer distractions and in real time (when compared with writing or recording report). Increase in nursing satisfaction reduces turn over and, once again, saves hospitals money (Gregory, et al., 2014).

The solutions to these problems are often expected from outside the medical field, but the quality and efficiency of the medical act can also be improved from the internal environment. In such a setting then, the current project proposes the improvement of bedside reporting by nurses at the change of shifts.

Errors pervade in our lives whether it is our home, in our workplace, or in our society. The effects of healthcare errors have impacted all our lives either directly or indirectly. Patient safety and quality care are at the core of healthcare system which strongly depends upon nurses. “To achieve goals in patient safety and quality, thereby improve healthcare, nurses must assume the leadership role. Nurses need to ensure that they and other healthcare providers center healthcare on patients and their families. Even though the quality and safety of healthcare is heavily influenced by the complex nature

Nurses work in a challenge work setting; therefore, nurses must recognize the current issues of the facility and health care system as well as comprehend and utilize the optimal advocacy strategies to be successful and accountable professionals. American Nurse Association (ANA) provides five resources for workforce advocacy programs which include: