Nurse bedside shift report implementation handbook

ORIGINAL ARTICLE

A quantitative assessment of patient and nurse outcomes of bedside

nursing report implementation

Kari Sand-Jecklin and Jay Sherman

Aims and objectives. To quantify quantitative outcomes of a practice change to a

blended form of bedside nursing report.

Background. The literature identifies several benefits of bedside nursing shift

report. However, published studies have not adequately quantified outcomes

related to this process change, having either small or unreported sample sizes or

not testing for statistical significance.

Design. Quasi-experimental pre- and postimplementation design.

Methods. Seven medical-surgical units in a large university hospital implemented a

blend of recorded and bedside nursing report. Outcomes monitored included patient

and nursing satisfaction, patient falls, nursing overtime and medication errors.

Results. We found statistically significant improvements postimplementation in

four patient survey items specifically impacted by the change to bedside report.

Nursing perceptions of report were significantly improved in the areas of patient

safety and involvement in care and nurse accountability postimplementation.

However, there was a decline in nurse perception that report took a reasonable

amount of time after bedside report implementation; contrary to these percep-

tions, there was no significant increase in nurse overtime. Patient falls at shift

change decreased substantially after the implementation of bedside report. An

intervening variable during the study period invalidated the comparison of medi-

cation errors pre- and postintervention. There was some indication from both

patients and nurses that bedside report was not always consistently implemented.

Conclusions. Several positive outcomes were documented in relation to the imple-

mentation of a blended bedside shift report, with few drawbacks. Nurse attitudes

about report at the final data collection were more positive than at the initial po-

stimplementation data collection.

Relevance to clinical practice. If properly implemented, nursing bedside report can

result in improved patient and nursing satisfaction and patient safety outcomes. How-

ever, managers should involve staff nurses in the implementation process and con-

tinue to monitor consistency in report format as well as satisfaction with the process.

Key words: bedside shift report, nursing handover, nursing shift report, patient-

centred care, patient satisfaction

What does this paper contribute

to the wider global clinical

community?

• Previous nursing bedside report manuscripts have had very small or unreported sample sizes for patient and nursing bedside report surveys and have rarely attempted to calculate the statis- tical significance of their results.

• Our patient and nurse survey instruments examined a far greater number of factors/issues that are considered relevant to bedside nursing report than any other study of which we are cur- rently aware.

• We are also only the second pub- lished study to track changes in patient falls during the handover hour before and after implement- ing bedside report.

Accepted for publication: 25 January 2014

Authors: Kari Sand-Jecklin, EdD, MSN, RN, AHN-BC, Associate

Professor of Nursing, West Virginia University, Morgantown; WV,

Jay Sherman, CNRN, ME, Clinical Research Nurse, West Virginia

University Healthcare, Morgantown, WV, USA

Correspondence: Jay Sherman, Clinical Research Nurse, WVU Eye

Institute, 3rd Floor, P.O. Box 782, Morgantown, WV 26506, USA.

Telephone: +1 304 598 6128.

E-mail: shermanj@wvuhealthcare.com

© 2014 John Wiley & Sons Ltd 2854 Journal of Clinical Nursing, 23, 2854–2863, doi: 10.1111/jocn.12575

Introduction

Improving upon the effectiveness of communication is a

Joint Commission National Patient Safety Goal (JCAHO

2013). According to the Joint Commission (2011), one of

the factors leading to sentinel patient events is miscommuni-

cation. A significant percentage of a nurse’s communications

each day occurs during patient handoffs, and the safety of

the patient can be compromised at this time (Friesen et al.

2008). A survey of over half a million hospital staff found

that respondents rated the safety of patient handoffs second

lowest among 12 areas of patient safety (Sorra et al. 2012).

In a study concerning near miss incidents, nurses again iden-

tified patient handoffs as a factor (Ebright et al. 2004). In

recent years, bedside nursing handoffs have been presented

positively in the literature, with benefits such as improved

patient satisfaction, improved nurse communication and

shorter shift reports being identified. It was the goal of the

Medical Surgical Research Utilization Team at West Virginia

University to implement a change in practice to a blended

form of bedside nurse shift handoff, and to evaluate this new

format in terms of patient and nurse satisfaction as well as

impact on patient safety.

Background

The literature on nursing bedside report is focused in two

general areas. The first focus area is the process of imple-

menting bedside report, either describing the experiences

related to implementation or explaining how other organi-

sations could implement this change. The second area of

focus is improving the process of bedside report, often

through observation and identifying common themes, or by

describing how others may improve their own reporting

process. Unfortunately, although there is strong consistency

in the suggested strategies for the implementation of bed-

side report, there is a gap in the literature in terms of docu-

menting quantitative patient and nurse outcomes

(Riesenberg et al. 2010, Novak & Fairchild 2012, Staggers

& Blaz 2012, Sherman et al. 2013). However, in the last

two years, several manuscripts have been published that in

some way quantified the potential outcomes of bedside

nursing report.

Identified benefits of bedside report

Numerous benefits of bedside nursing report have been

reported, with remarkably few drawbacks identified. The

most often reported benefit (identified by nine individual

manuscripts) is that patients are better informed (Searson

2000, Anderson & Mangino 2006, Laws & Amato 2010,

Tidwell et al. 2011, Maxson et al. 2012, Rush 2012, Tho-

mas & Donohue-Porter 2012, Wakefield et al. 2012, Sand-

Jecklin & Sherman 2013). However, several of these manu-

scripts did not report sample size or statistical significance

(Anderson & Mangino 2006, Laws & Amato 2010, Tho-

mas & Donohue-Porter 2012, Rush 2012, Wakefield et al.

2012), and others (Searson 2000, Maxson et al. 2012) were

based on small sample sizes. The study reported by Sand-

Jecklin and Sherman (2013) did find significant improve-

ments in patient information as a result of bedside report

using a large sample size of 302 patients/families preimple-

mentation and 250 postimplementation.

The second most often reported benefit of moving nurs-

ing report to the bedside is related to general improvements

in patient satisfaction. Improvements in patient satisfaction

are a primary goal of nursing practice changes. Radtke

(2013) and Reinbeck and Fitzsimons (2013) reported

improvements in patient responses to the Hospital Con-

sumer Assessment of Healthcare Providers and Systems sur-

vey (HCAHPS). However, such general changes in patient

satisfaction could be affected by many uncontrolled vari-

ables in addition to the implementation of bedside report.

Additional studies have found improvements in general

patient satisfaction with the practice change, but did not

report sample sizes (Willis 2010, Thomas & Donohue-Por-

ter 2012, Cairns & Dudjak 2013), or presented only quali-

tative impressions (Trossman 2009).

Increased patient involvement in their care is another

reported benefit of bedside shift report. Sand-Jecklin and

Sherman (2013) found a significant improvement in nurse

perceptions of patient involvement in care based on com-

parisons of 148 nurses at baseline and 98 nurses after the

implementation of bedside nursing shift report. Other stud-

ies reporting this outcome either did not report sample size

or had very small sample sizes or data that did not lend

itself to quantitative analysis (Searson 2000, Kelly 2005,

Anderson & Mangino 2006, Cairns & Dudjak’s 2013).

Several positive nurse-related outcomes have also been

associated with bedside shift report. Improved nurse team-

work is one of these reported outcomes. Unfortunately, the

studies reporting this did not report sample size or signifi-

cance (Anderson & Mangino 2006, Laws & Amato 2010,

Thomas & Donohue-Porter 2012), had a small sample size

(Tidwell et al. 2011) or were based on qualitative impres-

sions (Trossman 2009). An increase in nursing accountabil-

ity as a result of bedside shift report was noted by

a number of researchers (Anderson & Mangino 2006,

Laws & Amato 2010, Maxson et al. 2012, Thomas &

Donohue-Porter 2012, Sand-Jecklin & Sherman 2013),

© 2014 John Wiley & Sons Ltd Journal of Clinical Nursing, 23, 2854–2863 2855

Original article Quantitative assessment of bedside nursing report

with Sand-Jecklin and Sherman reporting statistically signif-

icant increase in nurse perception of report-promoting

accountability. Increased report accuracy was also identified

as an outcome (Kelly 2005, Anderson & Mangino 2006,

Thomas & Donohue-Porter 2012, Cairns & Dudjak 2013),

as was an improvement in patient safety (Cahill 1998,

Chaboyer et al. 2009, Trossman 2009, Laws & Amato

2010), although studies reporting these results were based

on unreported or very small sample sizes. Additionally, the

safety improvements were based on the perceptions of nurs-

ing staff, rather than direct patient safety data. However, in

a South Australian study on bedside handover outcomes,

Bradley and Mott (2012) reported a reduction in patient

safety incidents (burns, medication errors, skin tears and

falls) after implementing a bedside nursing report.

Additional benefits of bedside nurse report that have been

mentioned in the literature include improved nurse–patient

relationship (Searson 2000, Anderson & Mangino 2006,

Thomas & Donohue-Porter 2012), increased mentoring

opportunities (Trossman 2009), increased nurse ability to

answer physicians’ questions at the beginning of the shift

(Anderson & Mangino 2006, Maxson et al. 2012), general

improvement in nurse satisfaction with report (Tidwell et al.

2011, Evans et al. 2012), reduction in patient discharge

times due to improvement in patient education (Chaboyer

et al. 2009), better task prioritising at the beginning of shift

(Federwisch 2007), a decrease in falls (Athwal et al. 2009),

improvements in nurse friendliness and attitude and more

prompt response to patient calls (Wakefield et al. 2012), and

a decrease in patient call light use (Cairns & Dudjak 2013).

It should be noted again that of the above-mentioned manu-

scripts, only Tidwell et al. (2011) and Maxson et al. (2012)

reported statistically significant results, albeit both with

small sample sizes and with Tidwell’s study being performed

on a paediatric unit and therefore not as generalisable. Addi-

tionally, the Athwal et al. study (2009) contained a very

small sample size, Evans et al. (2012) did not report the

study sample size and Federwisch (2007) had a qualitative

study design.

Drawbacks of bedside report

Few negative outcomes have been reported related to the

implementation of bedside nurse report. Most studies

reporting negative outcomes are either qualitative in nature

or are based on unreported or small sample sizes. Privacy

has been voiced as a concern by nurses (Anderson & Mangi-

no 2006, Caruso 2007, Laws & Amato 2010) and a very

small number of patients (Timonen & Sihvonen 2000).

Some patients have found report redundancy tiring (Cahill

1998, Caruso 2007), have disliked the use of medical jargon

(Cahill 1998, Searson 2000) or have felt anxious from

repeatedly hearing about their condition (Timonen & Sihvo-

nen 2000). Sand-Jecklin and Sherman (2013) reported

nurses’ perceptions of reduced report efficiency and effec-

tiveness, and increased stress associated with report after the

implementation of a blended format of nursing shift report.

Finally, there is the question of report length. Of the nine

manuscripts reporting on this, seven found that bedside

report took less time (Anderson & Mangino 2006, Caruso

2007, Athwal et al. 2009, Tidwell et al. 2011, Bradley &

Mott 2012, Evans et al. 2012, Cairns & Dudjak 2013).

Howell (1994) reported that half of surveyed nurses

thought it took longer and half did not. Sand-Jecklin and

Sherman reported that although a significant number of

nurses perceived that bedside report took more time, actual

overtime data indicated there was no significant difference

between baseline and postimplementation overtime.

Of the 13 papers that give specifics about the bedside

reporting process implemented, nine used some type of

‘blended’ reporting process. Anderson and Mangino (2006),

Athwal et al. (2009) and Laws and Amato (2010) com-

bined a written report with the bedside report. Howell

(1994), Caruso (2007), Chaboyer et al. (2009) and Rein-

beck and Fitzsimons (2013) reported that nurses discussed

information they deemed to be sensitive privately, away

from the patient bedside. Federwisch (2007) and Trossman

(2009) described a group meeting with all of the nurses

before the off-going nurse would meet with the oncoming

nurse at the bedside. Only, Tidwell et al. (2011), Bradley

and Mott (2012), Thomas and Donohue-Porter (2012) and

Wakefield et al. (2012) reported that the entire report took

place at the bedside.

Bedside nursing report has increased greatly in popularity

recently. In fact, in just the last two years, the literature has

approximately doubled in size. These studies have been

almost universally positive, but unfortunately have suffered

from small or even unreported sample sizes. Additionally,

only in the last two years have studies begun to calculate

the significance of their results. What evidence there is does

suggest that a blended report (with part at the bedside)

may lead to beneficial results for both patients and nurses,

but more evidence is needed.

Methods

Baseline data and instrumentation

After internal review board approval for the study was

obtained, we collected baseline data related to nurse percep-

© 2014 John Wiley & Sons Ltd 2856 Journal of Clinical Nursing, 23, 2854–2863

K Sand-Jecklin and J Sherman

tions about the shift report process and patient perceptions

about nursing care. The ‘Patient Views on Nursing Care’

patient survey tool was adapted from the Larrabee ‘Patient

Judgments of Nursing Care’ instrument with permission

from the author (Larrabee et al. 1995). Instrument revisions

were based on the literature that indicated potential

changes in patient perceptions with the implementation of

bedside report. The patient survey had 17 items dealing

with the following nurse behaviours: treating the patient

kindly and with respect, listening to the patient, informing

the patient about their care, teaching so that the patient

could understand, working with other nurses, passing along

information from shift to shift, including the patient in

report discussions and keeping the patient’s health informa-

tion private (Sand-Jecklin & Sherman 2013). All items had

a five-point Likert-type response option, with five indicating

excellent care and one indicating poor care. Overall instru-

ment reliability according to Cronbach’s a was 0�96, and interitem correlations ranged from 0�49–0�80. We distrib- uted anonymous patient surveys, along with a cover letter

to a convenience sample of patients who had been hospita-

lised for at least 48 hours and were scheduled for discharge

from the medical surgical units on multiple days during the

month of baseline data collection. Family members were

encouraged to complete the survey if patients were unable

to complete it themselves, but only one survey was pro-

vided to each patient or family member. Patients were given

an envelope in which to seal their completed or blank sur-

vey forms prior to returning them to the researcher. Surveys

were returned to the researcher in a sealed envelope to pro-

tect confidentiality.

Nurse perceptions of shift report were collected via an

online survey. The ‘Nursing Assessment of Shift Report’

survey was based on a review of the literature, focusing on

nurse-identified benefits and pitfalls of bedside report. The

instrument was reviewed by an instrument develop expert

as well as nurse managers, staff nurses from the medical-

surgical units being studied and revised based on feedback.

The 17-item nursing survey contained items such as per-

ceived efficiency and effectiveness of report; perceptions of

report helping to identify recent changes in patient status

and promote patient safety; whether they felt that report

promoted patient involvement in care; the influence of

report on nurse mentoring, teamwork and accountability;

and perceptions of whether report provided all information

needed for patient care (Sand-Jecklin & Sherman 2013).

Item response items were in Likert-type format with five

agreement options (strongly agree to strongly disagree).

Demographic items asking about nurse age, number of

years in nursing, education and typical shift worked were

also included in the instrument. Instrument reliability

(Cronbach’s a) was 0�90, with interitem correlations rang- ing from 0�20–0�71. Fliers announcing the survey were posted on the medical-

surgical units of the university hospital, and all nurses

working on the units received an email that asked them to

complete the survey, by clicking on the included web link.

Baseline data for both patients and nurses were collected

during the same month.

We also collected baseline data on patient falls during

shift change, medication errors and nurse overtime during

the same month-long period. Only patient falls occurring

during the hours of shift change (7–8 am, 2–3 pm, 7–8 pm,

11 pm–12 midnight) were included in data collection, as

falls occurring at other times during the day would not be

directly related to the shift report process. Nursing overtime

was measured via employee time records. Nine staff nurses

per unit were selected for monitoring of work-time records,

ensuring a balance of nurses based on nursing experience.

Overtime minutes for 10 shifts in the month were calcu-

lated.

Implementation of the practice change

Prior to the practice change, nurses at this large mid-Atlan-

tic university hospital listened to a recorded patient report

prior to shift change. As discussed in the background sec-

tion of this paper, the majority of published papers imple-

mented a ‘blended’ recorded and bedside shift report. As

this seems to be the format that is the least redundant for

the patients and also that allows for private discussion of

any issues that may not be appropriate for the patient to

hear at that time, we decided to do likewise. In making this

move, the focus of the recorded portion of report (using the

Situation, Background, Assessment, Recommendation for-

mat) was to be on new issues and abnormal patient assess-

ment findings. The bedside component of report was to

include request for permission to conduct report at the bed-

side; introductions; discussion of the plan of care; visualisa-

tion of patient incisions, drains and lines; pain assessment;

and review of any potential safety issues. We developed an

educational video for nurses, including guidelines and

examples of bedside shift report, and also distributed

printed guidelines for both bedside and recorded report

(Sand-Jecklin & Sherman 2013).

After nurse education, bedside nursing report was imple-

mented across the seven medical-surgical units at the facility.

During the first days of implementation, clinical preceptors

and nurse managers were present to facilitate the change

and guide staff nurses in the report process. We distributed

© 2014 John Wiley & Sons Ltd Journal of Clinical Nursing, 23, 2854–2863 2857

Original article Quantitative assessment of bedside nursing report

a brief evaluation survey to nurses’ unit mailboxes one

month after the practice change occurred, to learn about

nurse perceptions of the new blended report format and to

identify the need for practice change reinforcement. The

survey asked what was going well with the new report pro-

cess, what was not going well and what suggestions the

nurse had for improving the report process.

At three months postpractice change, we obtained

patients and nurse satisfaction data following the same pro-

cess that was used at baseline data collection. One narrative

question was added to the Patient Views on Nursing Care

survey for postimplementation data collection: ‘Please tell

us how you felt about the nurse-to-nurse shift report at

your bedside’. Patient fall, medication error and nurse over-

time data were also collected.

Based on the initial postimplementation data, several

actions were taken to improve the consistency of use of the

blended shift report format. An ‘Improving Bedside Report’

tip sheet was distributed by the research team to all medical-

surgical nurses, and posters related to making bedside shift

report successful were placed on the study units. In addition,

managers and clinical preceptors periodically observed nurs-

ing staff during both recorded and bedside report, providing

immediate one-on-one feedback related to the process. New

medical record updates (including a summary screen

designed for use in bedside report) and documentation

guidelines were introduced relating to patient plan of care,

and guidelines for incorporating patient plan of care into

bedside report were also distributed. We hoped that these

additional interventions would address some of the identified

issues with report efficiency and inconsistency.

Final postimplementation data were collected 13 months

after the implementation of bedside shift report. The data

collection process was identical to that used at baseline and

three-month postimplementation data collection periods.

Data analysis included ANOVA comparisons of pre- and po-

stimplementation patient and nurse survey responses, with

descriptive analysis of medication errors and patient falls.

Repeated measure comparisons were made between base-

line and the two postimplementation data points for nurse

overtime, and descriptive analysis with thematic coding was

completed for the patient narrative comments and the nar-

rative nurse survey.

Results

Patient survey data

The Patient Views on Nursing Care survey was completed

by 233 patients at baseline data collection, 157 patients at

three-month postimplementation data gathering, and 154

patients at 13-month postimplementation data gathering.

Family members completed 70 baseline surveys, 72 (three)-

month postimplementation surveys, and 53 (13)-month po-

stimplementation surveys. Satisfaction with nursing care

was high both at baseline and before and after the imple-

mentation of bedside report, with all item means being at

least 4�2 of five points on all three surveys. Prior to completing ANOVA comparisons between all pre-

and postimplementation responses, we filtered out the fam-

ily survey responses, and family members may not have

been present with the patient at the time of nursing shift

reports; thus, their responses may not reflect the impact of

the change to bedside nursing report. ANOVA revealed signif-

icant differences for the items ‘made sure I knew who my

nurse was’ and ‘encourage to be involved in care’, with

responses at the 13-month postimplementation data collec-

tion being significantly more positive than at baseline for

both items, using Dunnett T-3 post hoc comparisons. Addi-

tionally, we found significant differences in patient

responses to the items ‘include in shift report discussion’

and ‘pass along important information from shift to shift’.

Post hoc testing did not demonstrate specific differences

between the data collection points; however, both postim-

plementation means were higher than baseline (see Table 1

for analysis results).

Analysis of patient narrative comments on the postimple-

mentation surveys indicated that most comments were glob-

ally positive (good care, caring nurses, professional, etc).

However, the next most common response on both surveys

(representing 10 and 18% of total responses) was that bed-

side report was not used, was used inconsistently or con-

sisted of only an introduction of the oncoming nurse. The

third most common response was that the patient felt

informed and had good explanations as a result of bedside

report (8% of responses to the three-month postimplemen-

tation survey and 10% of responses at 13 months postim-

plementation). Other patient responses related to bedside

report were positive, with only one patient in each survey

indicating concerns about privacy during bedside report.

See Table 2 for a summary of patient comments.

Nurse survey data

The baseline nurse perception survey was completed by 148

nurses, 98 completed the three-month postimplementation

survey, and 54 completed the 13-month postimplementation

survey. There was nurse representation from each of the

seven targeted units, and all work shifts among the survey

respondents. The most common age range of respondents

© 2014 John Wiley & Sons Ltd 2858 Journal of Clinical Nursing, 23, 2854–2863

K Sand-Jecklin and J Sherman

was 22–34 years old, while mean years in nursing ranged

from 10�2–10�5. The most commonly held current degree was the BSN for all surveys. There were no significant dif-

ferences in respondent demographics between the baseline

and the two postimplementation surveys.

ANOVA indicated a significant difference in nurse responses

to several survey questions. For items ‘the current system is

an effective means of communication’, ‘the current system

is an efficient means of communication’ and ‘report is rela-

tively stress-free’, baseline responses were significantly more

positive than the three-month postimplementation

responses, but not the 13-month postimplementation

responses, indicating that nurses’ responses rebounded to

baseline data at the last data collection point. Nurse

responses to the items ‘the current system helps assure

accountability’ and ‘the current system promotes patient

involvement in care’ were significantly more positive in

both postimplementation surveys in comparison with base-

line. Responses to ‘report helps prevent patient safety prob-

lems’ were significantly more positive at 13 months

postimplementation than both baseline and three months

postimplementation. Finally, nurse perceptions that ‘report

is done in a reasonable amount of time’ were significantly

more positive at baseline than at both postimplementation

surveys (see Table 3).

Patient and nurse outcome measures

The number of patient falls during shift change for all units

decreased from 20 preimplementation to 13 at three

months postimplementation and 4 at 13 months postimple-

mentation. Documented medication errors decreased from

20 preimplementation to 10 at three months postimplemen-

tation. However, between the 3- and 13-month postimple-

mentation data collection periods, the hospital implemented

a new patient incident reporting system, which required

documentation of ‘near-miss’ medication errors, errors in

Table 2 Patient narrative responses related to bedside report

3 Months

postimplementation

(%)

13 Months

postimplementation

(%)

Globally positive

comments

(nurses nice, caring,

professional)

106 (42) 93 (48)

Bedside report

not used, used

inconsistently or

only for introductions

24 (10) 34 (18)

Felt informed, good

explanations

20 (8) 19 (10)

Comments about

specific nurses, not

related to bedside

report

9 (4) 15 (8)

Good or improved

communication

9 (4) 6 (3)

Introduced next shift 7 (3) 10 (5)

Report works well 6 (2) 8 (4)

Table 1 Patient Views on Nursing Care survey

Survey item

Baseline

3 Months

postimplementation

13 Months

postimplementation

M (SD) M (SD) M (SD) F (df) P

Made sure I knew who my nurse was 4�56 (0�74) 4�71 (0�64) 4�76 (0�54) 4�48 (2, 537) 0�012 Treat me with respect 4�64 (0�69) 4�76 (0�61) 4�76 (0�57) 2�26 0�11 Help me feel comfortable 4�60 (0�75) 4�67 (0�71) 4�65 (0�67) 0�55 0�58 Treat in a polite and friendly way 4�69 (0�68) 4�76 (0�62) 4�73 (0�57) 0�68 0�51 Listen carefully without interrupting 4�57 (0�79) 4�66 (0�68) 4�68 (0�62) 1�33 0�27 Tell me what I need to know about tests/procedures 4�39 (0�96) 4�47 (0�85) 4�55 (0�74) 1�56 0�21 Tell about plans for discharge 4�19 (1�10) 4�35 (1�00) 4�41 (0�90) 1�99 0�14 Ask if I have questions or concerns 4�49 (0�86) 4�59 (0�79) 4�61 (0�70) 1�36 0�26 Answer questions and concerns 4�55 (0�83) 4�57 (0�76) 4�62 (0�73) 0�38 0�69 Encourage me to be involved in care 4�36 (0�93) 4�47 (0�92) 4�59 (0�74) 2�90 0�056 Work with me to meet my needs 4�46 (0�87) 4�58 (0�76) 4�61 (0�73) 1�89 0�15 Teach in a way I could understand 4�46 (0�88) 4�54 (0�84) 4�62 (0�71) 1�76 0�17 Make sure I understand what I need to do about health 4�43 (0�84) 4�50 (0�86) 4�62 (0�71) 2�55 0�08 Nurses work well together 4�59 (0�72) 4�65 (0�74) 4�71 (0�64) 1�35 0�26 Communicated important information shift to shift 4�40 (0�92) 4�61 (0�73) 4�60 (0�73) 3�62 (2, 515) 0�027 Included in shift report discussion 4�00 (1�24) 4�31 (1�10) 4�29 (1�09) 3�18 (2, 448) 0�042 Keep health information private 4�62 (0�75) 4�70 (0�65) 4�74 (0�59) 1�20 0�30

© 2014 John Wiley & Sons Ltd Journal of Clinical Nursing, 23, 2854–2863 2859

Original article Quantitative assessment of bedside nursing report

drawing medication peak/trough levels, medications missing

from patient drawers and other medication events. Thus,

no valid comparison could be made between the three data

collection points after the final 13-month postimplementa-

tion data collection. Nurse overtime data comparisons indi-

cated no significant change in overtime between baseline

and either of the postimplementation data collection peri-

ods, either for overtime as a whole or for overtime on indi-

vidual nursing units. Thus, overtime data do not parallel

nurse perceptions that bedside report is more time consum-

ing than the previous recorded report format.

Discussion

Several positive outcomes have been documented as a result

of implementation of a blended form of recorded and bed-

side report at this large university hospital. Patients per-

ceived better nurse-to-nurse communication, more patient

involvement in care, more involvement in shift report and

staff making sure the patient knew who his/her nurse was.

The changes in patient perceptions on the items reflecting

these issues together with the lack of change of response to

the more broad or general survey items would seem to indi-

cate the direct influence of bedside report on patient per-

ceptions. These findings reflect the reports of the previous

studies (Searson 2000, Kelly 2005, Anderson & Mangino

2006, Cairns & Dudjak 2013). In addition, patient falls at

shift change were reduced after the implementation of bed-

side report, and medication errors were found to be

decreased at three months postimplementation of the new

reporting system. These findings are important, as patient

safety is a critical aspect of quality patient care.

Nurses perceived increased nurse accountability,

increased patient involvement in care and increased preven-

tion of patient safety problems as a result of implementa-

tion of bedside nursing report. These perceptions are also

reflected in other publications (Cahill 1998, Anderson &

Mangino 2006, Chaboyer et al. 2009, Trossman 2009,

Table 3 Nurse perceptions of report format

Survey item

Preimplementation

3 Months

postimplementation

13 Months

postimplementation

M (SD) M (SD) M (SD) F (df) P

Report is effective means

of communication

4�04 (0�56) 3�61 (0�99) 3�98 (0�71) 10�04 (2, 297) 0�000

Report is efficient means of

communication

3�89 (0�76) 3�32 (1�13) 3�78 (0�83) 11�78 (2, 294) 0�000

Report helps identify changes

in patient condition

3�64 (0�87) 3�78 (0�88) 3�91 (0�65) 2�31 0�10

Report helps assure accountability 3�43 (0�98) 3�81 (0�94) 3�85 (0�79) 6�46 (2, 296) 0�002 System ensures professional report 3�80 (0�77) 3�62 (0�86) 3�87 (0�58) 2�27 0�11 Report is relatively stress-free 3�63 (0�85) 3�02 (1�05) 3�48 (0�84) 13�18 (2, 297) 0�000 Report gives opportunities

for mentoring

3�55 (0�88) 3�64 (0�89) 3�80 (0�81) 1�56 0�21

Report promotes patient involvement

in care

2�64 (0�96) 3�66 (0�92) 3�81 (0�85) 50�74 (2, 297) 0�000

Report prevents delays in patient care

and discharge

3�40 (0�96) 3�10 (1�09) 3�24 (0�80) 2�75 0�07

Report helps prevent patient safety

problems

3�41 (0�91) 3�60 (0�87) 3�93 (0�61) 7�49 (2, 297) 0�001

I feel adequately informed after report 3�59 (0�81) 3�46 (0�95) 3�78 (0�69) 2�51 0�08 I feel informed about patient plan of

care after report

3�54 (0�83) 3�47 (0�86) 3�69 (0�75) 1�19 0�31

I feel informed about patient discharge

plan after report

3�15 (0�96) 3�12 (1�00) 3�22 (0�92) 0�19 0�83

I feel informed about patient teaching

needs after report

3�11 (0�99) 3�17 (0�93) 3�33 (0�91) 1�03 0�36

Report is completed in a reasonable time 3�69 (0�86) 3�08 (1�16) 3�24 (1�16) 11�22 (2, 297) 0�000 Nurses on the unit keep patients

informed about care

3�80 (0�73) 3�76 (0�66) 3�90 (0�59) 0�86 0�43

There is good teamwork between

shifts on the unit

3�92 (0�81) 3�79 (0�71) 3�83 (0�95) 0�84 0�43

© 2014 John Wiley & Sons Ltd 2860 Journal of Clinical Nursing, 23, 2854–2863

K Sand-Jecklin and J Sherman

Laws & Amato 2010, Maxson et al. 2012, Thomas &

Donohue-Porter 2012). The rebounding of nurses’ percep-

tions about the effectiveness, efficiency and stressfulness of

report to approximately baseline levels at the 13-month po-

stimplementation data collection point would seem to indi-

cate that it may take longer than three months for nurses

to become comfortable with the practice of bedside report.

To our knowledge, no other studies have monitored out-

comes from a change to bedside nurse report for an

extended period of time. Thus, these findings are significant

in terms of providing quantitative support for continued

monitoring of the implementation and outcomes of bedside

report for at least a year postimplementation.

On the less positive side, nurses had a lower level of

agreement with the statement that shift report was com-

pleted in a reasonable amount of time at both postimple-

mentation data collection points. In contrast to this

perception, data on nurse overtime demonstrated no signifi-

cant difference between baseline and either of the postimple-

mentation data collection points. Potential explanations for

these conflicting findings may be that nurses developed effi-

ciencies in areas other than bedside report, in order to be

able to leave work on time, or that the inconsistencies in

implementation of bedside report contributed to the percep-

tion that it took longer than a reasonable amount of time.

The majority of other studies monitoring report time indi-

cated that bedside report took a shorter amount of time than

prior forms of report, (Howell 1994, Anderson & Mangino

2006, Caruso 2007, Athwal et al. 2009, Tidwell et al. 2011,

Bradley & Mott 2012, Evans et al. 2012, Cairns & Dudjak

2013, Sand-Jecklin & Sherman 2013). This continues to be

an area in which more monitoring is needed.

An area of concern in the study findings is that both

patients and nurses reported some inconsistencies in bedside

reporting after the practice change was implemented,

despite additional interventions between the 3- and 13-

month data collection periods focused on standardising the

reporting process and supporting staff in implementation of

bedside report. In review of the implementation process,

the research team realised that it might have been more

helpful to gather a larger group of change champions from

all units and shifts to create a ‘critical mass’ of nursing staff

that were in support of bedside report and demonstrated

effective reporting processes.

Conclusions

Our patient survey and nursing instruments found several

positive outcomes in relation to the implementation of a

blended bedside shift report. Almost all of the 34 survey

items indicated some improvement from baseline to

13 months postimplementation; however, the change was

not significant for the majority of items. Nurse attitudes sig-

nificantly rebounded on many issues from the three months

postsurvey to the 13 months postsurvey. There was a

decrease in falls at shift change. The only significantly nega-

tive outcome was nursing perception of the length of

report, but this was not supported by overtime data. Over

time, there may have been an increasing inconsistency in

the performance of the blended bedside shift report.

Limitations

One of the identified study limitations was related to partici-

pant sampling; we used a convenience sample of medical-

surgical patients scheduled for discharge and all nurses

whose home unit was a medical-surgical unit. The patient

and nurse respondents may not have fully represented the

total population of patients and nurses on the study units.

Additionally, as the nurse survey did not collect identifiers

and no limitations were imposed on the number of surveys

submitted from any one computer ISP address, it is possible

that nurses may have completed more than one survey either

during the baseline or the two postimplementation data col-

lection times. Both patients and nurses reported some incon-

sistencies in the use of the blended bedside reporting

process, but we did not measure the degree or frequency of

these inconsistencies. Our recommendation to others mea-

suring the outcomes related to the implementation of bed-

side report would be to include one or more items in both

the patient and nurse surveys that would be able to quantify

any inconsistencies in implementation. Finally, a practice

change unrelated to bedside report (implementation of a

new medication error reporting system), impacted the data

collected for this study, making full comparison of medica-

tion error data impossible. This did not affect the collection

of our patient falls data in any way though.

Relevance to clinical practice

Based on the findings of this practice change evaluation

study, we suggest that a blended form of recorded and bed-

side shift report may improve patient perceptions of commu-

nication among nurses, patient involvement in care and

patient safety, as well as nurse perceptions of accountability

and promotion of patient safety, without significantly

impacting nurse overtime. A blended report mechanism may

also impact the frequency of medication errors and patient

falls at shift change. However, this blended report format

may be perceived by nursing staff as less efficient than a

© 2014 John Wiley & Sons Ltd Journal of Clinical Nursing, 23, 2854–2863 2861

Original article Quantitative assessment of bedside nursing report

totally recorded report format, particularly within the first

few months after implementation. As with all practice

changes, it is important to address perceived barriers to the

new practice behaviour, to continue to reinforce appropriate

behaviour and to periodically monitor process and outcome

variables. Monitoring should continue for at least a year po-

stimplementation of the practice change. It may also be help-

ful to have several change champions on each shift to

promote and support the move to bedside report, in order to

quickly attain a critical mass of nurses who are implement-

ing the process as it was envisioned. Additional studies on

quantifiable outcomes of a blended recorded and bedside

shift report process are warranted in all areas/specialties of

acute care facilities, in order to provide additional documen-

tation of ‘best practices’ in terms of nursing shift report.

Acknowledgements

The authors wish to express their appreciation to the fol-

lowing Medical Surgical Research Team Members for

their participation in the literature review process: Chris-

tine Daniels, MSN, MBA, RN, NE-BC; Samantha Rich-

ards, MSN, MBA, RN; Holly Mattingly, BSN, MBA,

RN; Sharon Tylka, BSN, RN; Ella Grimm, BSN, RN,

NE-BC; Nancy Stelzer, MSN, RN, NE-BC; Rhonda Ham-

ilton, BSN, RN, ONC; Katy Hall, BSN, RN, ONC; Jen-

nifer Johnson, BSN, RN, CNRN; Traci Ashcraft, BSN,

RN, BC; Susan Heiskell, MSN, RN, BC and Dr. Stacey

Culp.

Disclosure

The authors have confirmed that all authors meet the IC-

MJE criteria for authorship credit (www.icmje.org/ethi-

cal_1author.html), as follows: (1) substantial contributions

to conception and design of, or acquisition of data or

analysis and interpretation of data, (2) drafting the article

or revising it critically for important intellectual content,

and (3) final approval of the version to be published.

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