Changing Nursing Reporting from Nurse Station to Bedside
The role of effective communication during patient handoff cannot be underestimated. This is according to Williams (2018), who indicates that effective communication is profound in ensuring quality and safety of patient care. Over the last many years, barriers, as well as problems associated with patient handoffs, have raised a lot of debates among scholars, medical practitioners, and policymakers. As posited by Kerr, Lu, and McKinlay (2013), for hospitalized patients, shift handoffs between outgoing and incoming nurses need to include critical information related to the plan of care of patients. This notwithstanding, conventional methods of shift report have not fully addressed this aspect, leading to increased medication errors and conflicts among nurses. When it comes to my organization, these problems have been presented by the use of shift reporting at the nursing station. With this understanding, there is a substantial need to adopt bedside shift reporting in my organization for the aim of addressing the communication issues that come with shift reporting at the nursing station. This capstone project is therefore dedicated to provide a justification for the implementation of shift reporting in my organization from the nursing station to bedside.
Description of the Issue or Problem
Communication has since time immemorial been regarded as one of the most essential components of the nursing role. As such, Cairns, Dudjak, Hoffmann, and Lorenz (2013) have stressed that various aspects of patient care typically call for thorough as well as complete reporting of procedures, conditions, medications, and follow up. Inadequate reporting may lead to a wide range of adverse events that are related to lack of fundamental patient information needed from professional communication. In particular, shift reporting in most healthcare organization has presented potential gaps in nursing communication. This, as a result, has resulted to medical errors, which have a detrimental impact on the health outcomes of the patients. Despite the fact that many healthcare organizations have over the last couple of years been adopting reporting procedures as well as handoff at the bedside, some have continued to undertake shift reporting at the nursing station.
According to Bradley and Mott (2014), effective and transparent communication between nurses during a change of shift is considered vital when it comes to ensuring safe, effective, and quality patient care. This notwithstanding, a plethora of past studies has affirmed that lack of effective communication and collaboration among nurses are among the leading causes of patient harm in most of the healthcare facilities across the country. Communications between nurses typically occur during the shift handoff report. This is usually between incoming and outgoing nurses. The process of shift handoff report occurs when the outgoing nurses transfer essential patient information to the incoming nurses. This information is normally related to new medication orders, lab results, as well as new recommendations from the physicians. This information may also encompass any changes related to the condition of the patient. As such, Gregory, Tan, Tilrico, Edwardson, and Gamm (2014) stress that it is pertinent that transfer of such information to be accurate, complete, as well as consistent. However, the quality of information transferred to the incoming nurses by outgoing nurses is highly dependent on the method of shift reporting used.
In relation to my place of work, shift handoffs usually occur at the nurse’s station, which is away from the patient. In most of the times, shift handoffs do not start on the stipulated owing to the fact that most of the nurses at the station discuss a lot of issues that are not related to the patients. Further, during handoffs, the nurses socialize a lot. Consequently, the process of transferring critical patient information from the incoming nurses to ongoing nurses is in most cases rushed. This, as a result, makes it challenging for the incoming nurses to provide the required level of care to the patients.
Further, in the nurse’ station, incoming nurses usually waste a lot of time before attending the patients. This, as a result, affects the patient’s outcomes as some patients may require close attention all the time. From this point of view, it is deducible that shift handoffs in my place of work lack consistency and accuracy. This is frustrating, not only to the patients. but also to the newly hired nurses.
Conflicts have also been emerging in my place of work owing to the lack of adequate communication during shift handoffs. Taking this into consideration, orders of new physicians such as a change in dosage and lab results are sometimes not communicated clearly between the incoming and outgoing nurses. This, in turn, results in serious medication errors that have detrimental impacts on the health status of the patients. When such issues arise, nurses start blaming each other leading to conflicts. These conflicts affect their productivity to a huge extent, which in turn affects the way patient care is given the organization. Nurses in the organization have also occasionally reported that they sometimes find gastronomy tubes, dislodged catheters, and oxygen tubes at the patient bedsides. Other nurses have reported to find a patient in severe distress. All these are discovered after the shift handoffs at the station. These factors, as emphasized by Williams (2018) can hugely contribute to safety concerns as well as errors that can have significant impacts on the wellness and wellbeing of the patients. When nurses blame each other over such incidences, conflict and tension are created among them. These factors explain why the rate of nursing turnover in the facility over the last many years has remained high. As such, most of the newly hired nurses typically resign prematurely owing to conflicts as well as lack of adequate support from the senior nurses. Additionally, premature resignation among newly hired nurses occurs due to miscommunication during the shift hand-offs.
In an attempt to address the aforementioned challenges associated with shift handoffs at the nurse ’s in my place of work, various past interventions have been implemented. These include tape-recorded handovers and written handover. In relation to tape-recorded handover, it entails the use of taped records, where the ongoing nurses record information related to the patients. This method was effective in transferring information from ongoing nurses to incoming nurses, it was faced by a myriad of challenges. Specifically, if an interruption occurred during reporting, the nurses had to make a note on the recorder from where it left off. This led to confusion on the side of incoming nurses. At times, tape recorders would break, which would result to patient rerecording each patient report. Due to these challenges, this intervention did not work for the organization, and thus the nurses had to go back to the normal handoffs at the nurse’s station.
When it comes to the intervention of written handoffs, it entails the use of record sheets, where outgoing nurses fill the sheets with patient information. The use of record sheets in my organization proved accurate as well as less time-consuming. However, the issue of illegibility was evident in various occasions resulting in medication errors. As such, this intervention was deemed unfit for the organization.
Based on the information provided problem, failure to address the issue of shift handoffs at the nurse’s station will present the organization with various issues. More specifically, the organization will continue to have miscommunication issues, which are likely to result to medication errors. Additionally, the organization will also continue experiencing conflicts among nurses, which in turn will fuel the occurrence of other issues such as increased rate of nursing turnover. According to Gregory et al. (2014), the conventional methods of shift handoffs at the nursing station may result in lack of addressing various challenges that may be discovered through providing rounds at the bedside. Therefore, adoption of bedside reporting my place of work can go a long way in enhancing positive patient outcomes.
The issue of nursing reporting at the nursing station affects various stakeholders. These include nurses, patients, and hospital management. In relation to nurses, shift handoffs at the nursing station usually affect their productivity. Precisely, it has been established that nurses usually waste a lot of time at their nursing station as the ongoing nurses transfer client information to the outgoing going nurses. Additionally, with shift handoffs at the nursing station, conflicts are prevalent particularly due to ineffective communication. These conflicts in return lower their morale and ultimately their productivity. Conflicts may also result to nurses failing to work together as a team. When such happens, it implies that organizational goals and objectives cannot be achieved effectively and efficiently.
In relation to patients, Cairns et al. (2013) have argued that the level of care patients receive in a particular facility is highly dependent on how nurses collaborative and communicate. Therefore, for the case of my organization, given the fact that shift handoffs at the nursing station usually result in poor communication and collaboration, it implies that patient care is compromised to a huge degree. In view of Mardis et al. (2016), shift handoffs at the nursing station do not allow patients to be involved actively in their own care. This means that patients become routinely unaware of the care plans, changes, progress, as well as discharge plans. When communication is shift handoffs are not done at the bedside, it increases anxiety among the patients, as they may feel as if there are not part of the health team when it comes to making critical decisions.
When it comes to the organizational management, shift handoffs at the nursing station make the organization to incur a lot of operational costs. Specifically, as aforementioned conflicts that due to issues of shift handoffs at the nursing station have increased the rate of nursing turnover in the organization. When the nurses resign prematurely, the organization has to spend a lot on hiring and training new nurses. This has a detrimental impact on the financial well-being of the organization.
Nurse Role and Responsibility
The role of nurses in addressing the issue of shift handoffs at the nursing station cannot be overlooked. Taking this into consideration, nurses have a critical role to play when it comes to addressing the problem of shift handoffs at the nursing station. Kerr et al. (2013) stress that it is the role of the nurse to ensure that the patients receive the best available care. Therefore, in this case, given the fact that shift handoffs at the nursing station present significant barriers to the provision of effective healthcare, it is the role of nurses to provide feasible solutions to the problem.
When it comes to nurse responsibility, Gregory et al. (2014) assert that nursing is considered a fundamental social responsibility that is irreplaceable. As such, nurses are considered agents of change when it comes to the implementation changes in the social context. In relation to the issues of shift handoffs at the nursing station, nurses have the responsibility of implementing changes that may result to better patient outcomes. In this context, it would entail implementation of bedside shift reporting, which has been found to help in overcome these problems.
Description of the Initiative
In order to overcome the issues presented by shift handoffs at the nursing station in my organization, bedside shift reports (BSR) have been recommended in this project. According to Mardis et al. (2016), bedside shift reporting is a fairly new concept in most organizations, not only in the US, but also in other countries across the world. This is despite the fact that it has been around for the rest four decades. This has been echoed by Bradley and Mott (2014), who explain that nursing reporting has over the last couple of years metamorphosed, moving from the nursing station to the patient’s bedside. Gregory et al. (2014) stress that this move has been designed for the purpose of improving safety as well as giving patients a better and deeper understanding of their condition together with their treatment plans.
Cairns et al. (2013) have described bedside shift reporting as the handoff report between the incoming and outgoing nurses that take place at the bedside. This, as a result, makes patients important components of the care delivery process. According to Jeffs et al. (2013), communication with the patients together with their families on matters related to patients’ health, aspects of care, services, and treatment is considered a fundamental characteristic of a holistic healthcare. Taking this into account, the primary objective of the bedside shift reporting is to help in ensuring that there are safe handoffs of care between nurses through involving the patients and their families. Various traditional methods of shift reporting have not allowed patients to be actively involved in the communication of critical information. This aspect has been the driving force of implementation of bedside shift reporting in most healthcare facilities across the country.
Over the last couple of years, there has been increasingly easier access to the internet. This in turn has given patients substantial medical information that they were not exposed to previously. Consequently, they gain a lot of knowledge, which makes it possible for them to make informed decisions regarding their care. As emphasized by Kerr et al. (2013), this knowledge has prompted a substantial change to a more collaborative model of care as opposed to the physicians have exclusive rights in regards to how the care of the patients should be managed. With bedside shift reporting, nurses are able to address some of the efficiencies associated with the conventional methods of reporting such as verbal and taped verbal shift report.
Owing to the fact that nurses are typically considered as the first line of defense in relation to patient safety, bedside shift reporting is regarded as a pertinent part of the care plan. As such, in accordance to the assertion of Mardis et al. (2016), nurses are accountable for all communications that occur during a handoff. It is during this time that nurses can verify the patient’s history, findings of physical assessment, as well plan of care including, but not limited to medications. During this time, the patients have the opportunity of asking questions related to their health. In light of this, it is with no doubt that implementing bedside shift reporting in the organization will be vital to a huge extent.
Implementation of the bedside shift reporting in the organization will involve various steps. The first step as suggested by Jeffs et al. (2013) will involve implementing the project on a small scale using a small unity as a pilot. This will play a profound role in helping the clinicians in learning what works and what does not. Once the healthcare organization has identified the target of improvement, the next phase will be letting the nurse buy-in the idea. This will make feel as if they are a crucial part of the organization. The patients, as well as their families, also need to be informed about the implementation of the bedside shift reporting. This will make them prepared for the change of shift reporting, particularly when it comes to sharing the ideas on the same. Further, all the nurses in the organization should be trained on critical elements of the bedside shift reporting such as using the same language and thanking the patient at the end. Through presenting a consistent message, Williams (2018) posits that trust is built with the patient and the family.
Implementation of the proposed initiative will have substantial impacts on the organization. Precisely, the outcomes of the proposed initiative will positively impact the patients as well as nurses. Firstly, implementation of bedside shift reporting in the organization will lead to increase patient safety. As espoused by Radtke (2013), nursing care typically entails ensuring that patients are safe all the time. Conducting bedside shift reporting has been found by various quantitative schools of thoughts to enhance patient outcomes. For instance, a study conducted by Jeffs et al. (2013) found out that bedside shift reporting prevents adverse events including a rapid response in case the patient condition has deteriorated. Bedside shift reporting plays a vital role in ensuring that outgoing nurses give correct information to the incoming nurses through visualizing the patient. This, in turn, helps in reducing possible medication errors. In support of this, a study conducted by Bradley and Mott (2014) revealed that the implementation of bedside shift reporting helps in decreasing medication errors by about 80 percent. The same study also found that bedside shift reporting helps in reducing patient falls by close to 100 percent. From this point of view, it can be deduced that bedside shift reporting helps in ensuring patient safety, which ultimately result to enhanced patient outcomes.
Patient satisfaction has also been associated with bedside shift reporting. In light of this, Radtke (2013) has indicated that communication with patients and their families during bedside shift reporting helps greatly in improving the overall experience. In most healthcare facilities, patient satisfaction is considered fundamental, as it determines the possibilities of patients coming back in the future. A study conducted by Mardis et al. (2016) found out that most patients like meeting their nurses as well as being involved in the plan of care. This study further found that bedside shift reporting usually decreases the perception that the team members of the healthcare team are hiding something. Therefore, with bedside shift reporting, patients feel that they are in safe hands, which enhances their satisfaction. Most of the patients in the 21st century are able to easily access their information from the internet related to their health status and hospitalization (Small & Fitzpatrick, 2017). Therefore, they always want a more collaborative approach in their care for the purpose of being kept informed about their current condition as well as treatments plans. Through such, they are able to achieve maximum satisfaction. This is only possible through implementation of bedside shift reporting.
Nurse satisfaction has also been linked to bedside shift reporting. A myriad of studies has confirmed that nurses who complete bedside shift reporting usually have a higher satisfaction. Bedside shift reporting improves communication between the nurses and the patients. This, in turn, improves awareness of immediate needs and concerns of the patients. Results from a study by Ofori-Atta, Binienda, and Chalupka (2015) showed that nurses typically feel more prepared immediately after handoff to discuss various patient issues with physicians and other healthcare practitioners. According to Jeffs et al. (2013), one of the main drawbacks of bedside shift reporting is that nurses feel that bit takes more time. Additionally, some forms of discussions regarding the patient cannot happen at the bedside. Nevertheless, this has been termed as an individual perception owing to the fact that evidence does not support this dissatisfaction. In fact, a study by Kerr et al. (2013) found out that the implementation of bedside shift reporting decreases overtime hours per nurse due to the fact that the report takes less time. Walsh, Messmer, Hetzler, O’Brien, and Winningham (2018) have stressed that bedside shift reporting enhances the satisfaction of nurses through increasing efficiency of reports, enhancing teamwork among nurses, increasing nurse accountability, as well as enhancing mentorship among nurses. Through such, nurses feel motivated to work, which in turn increases their productivity. Ultimately, positive patient outcomes are realized to a considerable degree.
One of the nursing theories that can be used in the implementation of bedside shift reporting in my organization is the Lewin’s Change Theory. This theory was developed for the purpose of understanding the change process. The Lewin’s Change Theory involves three main stages of change implementation. These are unfreezing, change, and refreezing (Cumming, Bridgman, and Brown, 2016). These stages must be completed in order for the purpose of ensuring that change is implemented successfully. Therefore, through utilizing this theory in my organization, changing reporting from the nursing station to bedside will be enhanced considerably.
In the unfreezing stage, it is the first stage of change and it entails preparing the organization to accept that change is fundamental. According to Erakovich and Anderson (2013), the main aspect in this stage is developing a convincing message explaining the existing ways of doing things cannot continue. Therefore, when it comes to my organization, there is a substantial to prepare the staff for the change of handoffs. This would entail letting them know the challenges that are presented by the handoffs at the nursing station including miscommunication and time wastage. Therefore, there is need to let them know that implementation of the bedside shift reporting would go a long way in addressing these issues.
When it comes to the change stage, Ofori-Atta et al. (2015) assert that it is the phases where the actual change occurs in regards to nursing practice. As such, recognizing and acknowledging that change is typically chaotic and difficult is a fundamental part of the change process. Cumming et al. (2016) have posited that this stage calls for the creating of a detailed place of action and engaging various stakeholders in trying out the proposed change. A study by Erakovich and Anderson (2013) revealed that nurses are usually more likely to comply with the proposed change if they are integrated into the decision-making process. Understanding individual roles is also considered pertinent in ensuring that implementation of the proposed change is successful. In my organization, in the implementation of bedside shift reporting, there is a substantial need to provide nurses with the training before the implementation. Further, in line with the assertion of Cumming et al. (2016), it would be pertinent for the nurses to get continued support, education, and guidance until they are fully familiar with the of the bedside shift reporting process. Prior to the actual implementation of the project, a two of three trial runs would be conducted. This would slowly introduce the nurses to the of bedside shift reporting, thus ensuring a smooth transition. During the of bedside shift reporting trial run, the nurses would have the opportunity of asking questions as well as providing suggestions for improvement. Erakovich and Anderson (2013) have indicated that the change stage is usually the most difficult stage among the involved participants. This is due to the fact that it requires to continue coaching alongside clear communication to avoid losing sight of the proposed change. As such, through this stage, it is pertinent to identify recognize and identify potential barriers that can compromise successful implementation of the project.
Lastly, in regards to the refreezing stage, it entails establishing the change as the norm in the organization (Cumming et al., 2016). Therefore, in relation to the bedside shift reporting in my organization, this stage would entail understanding that BSR is the newly accepted practice in the organization. From this point of view, continued staff education, support, and guidance are required in order to ensure that all nurses recognize bedside shift reporting as the new norm. Additionally, nurses need to be provided with positive enforcement with the aim of making them remain active in the implementation of the bedside shift reporting. At this stage, it is crucial to constantly remind the nurses the benefits that come with the implementation of bedside shift reporting. This will play a profound role in ensuring that they do not go back to the old methods of shift hand-offs. Still, in this stage, ongoing assessments will be required for the purpose of identifying barriers as well as providing suggestions for improvement. This in turn will help hugely in making necessarily modifications to suit the organizational needs. The nurse manager in the organization also need to constantly monitor the nurses to ensure that they comply with the requirements of the bedside shift reporting.
Implications for Nursing and Healthcare
Change of handoffs from the nursing station to bedside shift reporting in my organization will to a huge extent advance nursing and healthcare practice and nursing leadership.
Nursing and Healthcare Practice
Change of handoffs from the nursing station to bedside shift reporting will advance nursing and healthcare practice in various ways. Firstly, it will result improve patients outcomes owing to the fact that patients will be given an opportunity of taking part in their own care. Given the fact that bedside shift reporting will improve communication among nurses as well as between the patients and the nurses, it is with no doubt that fundamental information will be shared. Such information will play a key part in determining the best plan of care that should be given to the patients. Ultimately, their overall well-being will be enhanced. Secondly, with the implementation of bedside shift reporting, healthcare will be advanced through increasing patient safety. As aforementioned, bedside shift reporting usually ensures that there is effective communication which in turn helps reducing cases of medication errors.
Bedside shift reporting will also advance healthcare through increasing nursing satisfaction. This, in turn, will help in increasing the overall productivity of nurses. Lastly, bedside shift reporting will help in reducing operational costs significantly. This is due to the fact that bedside shift reporting will lead to reduced nurses turnover, meaning the organization will not have to incur additional costs recruiting and selecting new nurses. Besides, with bedside shift reporting, it implies that overtime hours will be minimized, which will further reduce operational costs.
Implementation of bedside shift reporting will also advance nursing leadership in a myriad of ways. Firstly, through bedside shift reporting, nurses will develop teamwork skills, which is considered crucial in nursing leadership. According to Walsh et al. (2018), bedside shift reporting makes it possible for nurses to work together towards achieving specific patient needs. This enhances teamwork. Secondly, bedside shift reporting advances communication skills of nurses. This is due to the fact that they have to make communication with the patients, as well as with other nurses. In line with Small and Fitzpatrick (2017), effective communication is considered imperative in nursing leadership
With bedside shift reporting, collaboration skills are enhanced substantially. As such, nurses are able to collaborate with one another on various issues related to patient needs. Additionally, with bedside shift reporting, nurses are able to collaborate with patients as well as physicians. It is through this collaboration that they are able to achieve significant outcomes when it comes to the needs of the patients. Lastly, with implementation of bedside shift reporting, nursing leadership is advanced through embracing change. According to Marshall and Broome (2016) change within an organization is usually inevitable. Therefore, through the implementation of this initiative, nursing leaders can develop ways of embracing changed within the organization. This, as a result, can result in better patient outcomes.
Conclusively, it has been established from this paper that shift handoffs at the nursing station in my organization have presented substantial challenges. These are related to poor communication, which in turn leads to medication errors and conflicts, and ultimately leading to reduced patient outcomes. From this point of view, this paper has established that bedside shift reporting can help the organization in overcoming these challenges. Through such, there will be improved communication, enhanced patient satisfaction, enhanced patient nurse satisfaction, and reduced operational costs. Lewin’s change theory will play a critical role in the implementation of this initiative.
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