Common reasons against in-room report
And potential responses
It is not always easy to get people to change behaviors. Nathan Rozeboom, RN, MPH, CCRN, a nurse manager at Harborview Medical Center in Seattle, experienced that when he tried to get nurses on a neuro intensive care unit to start giving report in the room with patients and their families. There was always a reason why some nurses just couldn't do it.
But with the most common excuses, there is also a good comeback, and Rozeboom says he has learned from his last try at bedside reporting how to answer the nurses who spout these lines the next time around.
- "We can't because of HIPAA!" In an effort to maintain patient privacy, if you think someone is actively eavesdropping, lower your voice, turn your back, or ask them not to, he says.
- "The family is a pain!" Have a little compassion, he says. They are worried, tired, scared. And possibly a pain. If they have a lot of questions and comments, explain that you need to finish report and shift change. Tell them that as soon as you are done, you will come back to listen and answer. Have a pad of paper and pen available for family members so they can jot questions and notes down in your absence.
- "It slows down report!" Actually, research shows it is faster to do bedside reporting because there is less diversion among the reporters — no coffee cups, no discussion about the latest episode of The Walking Dead or Scandal. (For more recent research on the benefits of bedside report, see box page 39.) It is all about the patient.
- "The patient has isolation precautions so I can't take any paper out of the room!" Actually, Rozeboom had infection control specialists explain to nurses that if you put what you are writing on right back in your pocket, you can, indeed, take it out of a room with isolation precautions without fear of infecting the wider world.
- "The patient has dementia or is a psych patient and report agitates them!" This is perhaps the only common complaint that has some validity, Rozeboom says. While some nurses complain about the awkwardness of reporting with demented patients, that is not when there is a problem. It is when patients are agitated, start to shout and thrash, or say irrelevant things that makes it difficult for the two nurses to communicate. In those instances, you can take report outside the door of the room. But you still have to do those safety checks in the room — that can't be done anywhere else. And keeping report near the patient is a good way to stay on task and focused.