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.
References
Anderson C & Mangino R (2006) Nurse
shift report: who says you can’t talk
in front of the patient? Nursing
Administration Quarterly 30, 112–
122.
Athwal P, Fields W & Wagnell E (2009)
Standardization of change-of-shift
report. Journal of Nursing Care Qual-
ity 24, 143–147.
Bradley S & Mott S (2012) Handover: fas-
ter and safer? The Australian Journal
of Advanced Nursing 30, 23–32.
Cahill J (1998) Patient’s perception of bed-
side handovers. Journal of Clinical
Nursing 7, 351–359.
Cairns L & Dudjak L (2013) Utilizing bed-
side shift report to improve the effec-
tiveness of shift handoff. The Journal
of Nursing Administration 43, 160–
165.
Caruso E (2007) The evolution of nurse-
to-nurse bedside report on a medical-
surgical cardiology unit. Medsurg
Nursing 16, 17–22.
Chaboyer W, McMurray A, Johnson J,
Hardy L, Marianne W & Ying F
(2009) Bedside handover: quality
improvement strategy to ‘transform
care at the bedside’. Journal of Nurs-
ing Care Quality 24, 136–142.
Ebright PR, Urden L, Patterson E &
Chalko B (2004) Themes surrounding
novice nurse near-miss and adverse-
event situations. Journal of Nursing
Administration 34, 531–538.
Evans D, Grunawalt J, McClish D, Wood
W & Friese C (2012) Bedside shift-to-
shift nursing report: implementation
and outcomes. Medsurg Nursing 21,
281–284, 291.
Federwisch A (2007) Passing the baton:
bedside shift report ensures quality
handoff. Nurseweek (California) 20,
14.
Friesen M, White S & Byers J (2008)
Handoffs: implications for nurses. In
Advances in Patient Safety and Qual-
ity: An Evidence-Based Handbook for
Nurses (Hughes R ed.). Agency for
Healthcare Research and Quality,
Rockville, MD, pp. 208–216.
Howell M (1994) Confidentiality during
staff reports at the bedside. Nursing
Times 90, 44–45.
Joint Commission (2011) Testimonials.
Available at: http://www.jointcommis
sion.org/testimonials/default.aspx?Tes
timonialId=190 (accessed 18 July
2013).
Joint Commission (2013) National Patient
Safety Goals. Available at: http://www.
jointcommission.org/assets/1/18/NPSG_
Chapter_Jan2013_HAP.pdf (accessed
18 July 2013).
Kelly M (2005) Change from an office-
based to a walk-around handover sys-
tem. Nursing Times 101, 34–35.
Larrabee JH, Engle VH & Tolley EA
(1995) Predictors of patient-perceived
quality. Scandinavian Journal of Car-
ing Sciences 9, 153–164.
Laws D & Amato S (2010) Incorporating
bedside reporting into change-of-shift
report. Rehabilitation Nursing 35, 70–
74.
Maxson P, Derby K, Wrobleski D & Foss
D (2012) Bedside nurse-to-nurse hand-
off promotes patient safety. Medsurg
Nursing 21, 140–144.
Novak K & Fairchild R (2012) Bedside
reporting and SBAR: improving
patient communication and satisfac-
tion. Journal of Pediatric Nursing 27,
760–762.
Radtke K (2013) Improving patient satis-
faction with nursing communication
using bedside shift report. Clinical
Nurse Specialist 27, 19–25.
Reinbeck D & Fitzsimons V (2013)
Improving the patient experience
through bedside shift report. Nursing
Management 44, 16–17.
Riesenberg L, Leitzsch J & Cunningham J
(2010) Nursing handoffs: a systematic
review of the literature. American
Journal of Nursing 110, 24–34.
© 2014 John Wiley & Sons Ltd 2862 Journal of Clinical Nursing, 23, 2854–2863
K Sand-Jecklin and J Sherman
Rush S (2012) Bedside reporting: dynamic
dialogue. Nursing Management 43,
40–44.
Sand-Jecklin K& Sherman J (2013) Incorpo-
rating Bedside report into nursing hand-
off:evaluationofchange inpractice. Journal
of Nursing Care Quality28,186–194.
Searson F (2000) Introducing bedside
handovers: changing practice on a cor-
onary care unit. Educational Action
Research 8, 291–305.
Sherman J, Sand-Jecklin K & Johnson J
(2013) Investigating bedside report: a
synthesis of the literature. MedSurg
Nursing 22, 308–312.
Sorra J, Famolaro T, Dyer N, Nelson D &
Smith S. (2012) Chapter 5. Overall
results. In: Hospital Survey on Patient
Safety Culture: 2012 User Comparative
Database Report (prepared by
Westat, Rockville, MD, under con-
tract no. HHSA 290200710024C).
Agency for Healthcare Research and
Quality, Rockville, MD. AHRQ Publi-
cation 12-0017. Available at: http://
www.ahrq.gov/legacy/qual/hospsur
vey12/hosp12ch5.htm (accessed 18
July 2013).
Staggers N & Blaz J (2012) Research on
nursing handoffs for medical and sur-
gical settings: an integrative review.
Journal of Advanced Nursing 69,
247–262.
Thomas L & Donohue-Porter P (2012)
Blending evidence and innovation:
improving intershift handoffs in a
multihospital setting. Journal of Nurs-
ing Care Quality 27, 116–124.
Tidwell T, Edwards J, Snider E, Lindsey C,
Reed A, Scroggins I, Zarski C &
Brigance J (2011) A nursing pilot
study on bedside reporting to promote
best practice and patient/family-cen-
tered care. Journal of Neuroscience
Nursing 43, E1–E5.
Timonen L & Sihvonen M (2000) Patient
participation in bedside reporting on
surgical wards. Journal of Clinical
Nursing 9, 542–548.
Trossman S (2009) Shifting to the bedside
for report. The American Nurse 41,
7.
Wakefield D, Ragan R, Brandt J & Tregn-
ago M (2012) Making the transition
to nursing bedside shift reports. The
Joint Commission Journal on Quality
and Patient Safety 38, 243–254.
Willis P (2010) Bedside handoff: yes you
can and patients love it. Journal of
Vascular Nursing 28, 110.
The Journal of Clinical Nursing (JCN) is an international, peer reviewed journal that aims to promote a high standard of
clinically related scholarship which supports the practice and discipline of nursing.
For further information and full author guidelines, please visit JCN on the Wiley Online Library website: http://
wileyonlinelibrary.com/journal/jocn
Reasons to submit your paper to JCN: High-impact forum: one of the world’s most cited nursing journals, with an impact factor of 1�316 – ranked 21/101 (Nursing (Social Science)) and 25/103 Nursing (Science) in the 2012 Journal Citation Reports� (Thomson Reuters,
2012).
One of the most read nursing journals in the world: over 1�9 million full text accesses in 2011 and accessible in over 8000 libraries worldwide (including over 3500 in developing countries with free or low cost access).
Early View: fully citable online publication ahead of inclusion in an issue.
Fast and easy online submission: online submission at http://mc.manuscriptcentral.com/jcnur.
Positive publishing experience: rapid double-blind peer review with constructive feedback.
Online Open: the option to make your article freely and openly accessible to non-subscribers upon publication in Wiley
Online Library, as well as the option to deposit the article in your preferred archive.
© 2014 John Wiley & Sons Ltd Journal of Clinical Nursing, 23, 2854–2863 2863
Original article Quantitative assessment of bedside nursing report
Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!
