Reimplementing bedside shift report at a community hospital

Bedside shift report aids in the development of employee teamwork, ownership, and accountability, and has been shown to increase nurse satisfaction.1 It allows for the rapid determination of a patient’s condition, surroundings, and treatment, which facilitates identification of medication errors, prevents patient falls, and provides the opportunity for nurses to recognize a change in a patient’s clinical status.2 Moving shift report to the bedside promotes effective communication between patients and caregivers through transparency and open dialogue. Promotion of patient involvement in their own care plan enforces selfefficacy and adherence to treatment. The goal of bedside shift report is to help improve the patient experience and ensure safe handoff of care between nurses by involving the patient and family.3 To improve the patient experience, we must change the way nurses practice and communicate with each other and their patients.4 One of the ways to change nursing culture is to introduce different techniques to communicate patient-specific care at shift change. By reporting at the bedside in the presence of the patient, a culture shift can occur. The purpose of this project was to use a quality improvement process to reintroduce bedside shift reporting at a 294-bed community hospital in eastern North Carolina. The hospital consists of two medical-surgical units, a telemetry unit, an ICU, an ED, women and children’s services, and a labor and delivery suite. It employs 1,100 staff members, 250 of who are RNs. Standard practice at this facility included nurse-to-nurse shift report at the nurses’ station or in a conference room away from the bedside. Although bedside shift report had been introduced 2 years prior, the implementation failed. To better understand the reasons for the failure, clinical nurses and staff development specialists involved with the initial implementation were informally interviewed. It became apparent that the cause of the failure was multifaceted: inadequate staff education, lack of buy-in by nursing staff and leadership, and lack of accountability and supervision from nursing leadership. Education about bedside shift reporting provided to clinical nurses was substandard; nurses reported a lack of understanding of the benefits and rationale. Because clinical nurses didn’t understand the reason for the change, there was resistance to adopt the new method of patient handoff. Follow-up hadn’t been carried out effectively and there was a lack of buy-in by not only clinical nurses, but also directors, unit managers, and supervisors who were responsible for ensuring the nurses’ participation. Without leadership holding clinical nurses accountable for implementation of bedside shift report, they slowly reverted to the previous behavior of giving report at the nurses’ station.