Neuro TT

Running head: NURSING LEADERSHIP 1

Nursing Leadership: Bedside Shift Report and Catheter-Associated Urinary Tract Infections

Mickey Mouse

Northern Illinois University

NURSING LEADERSHIP 2

Practice Setting

In considering areas to begin my nursing career, I find that I am drawn to medical-

surgical float-pool nursing in an acute care hospital setting. I believe working in this setting

would be beneficial as a new graduate nurse to gain experience and continue learning with

bedside care within a diverse population of patients. Practicing nursing care with patients who

are being treated for a variety of conditions will allow me to build upon the foundational

knowledge I have gained in the classroom setting and the clinical experiences I received though

the Northern Illinois University nursing program. I believe being part of the float-pool will either

motivate me to decide on a specific area of interest to focus on, such as Cardiac. If I continue to

work within the float-pool I believe it will give me the opportunity to actively create deeper

connections between optimal patient care and outcomes to classroom lessons, clinical practice

skills and evidence-based research. I want to be able to positively impact the hospital and

patients I work with by contributing to multiple units. In my capstone clinical I had the

opportunity to float through medical-surgical units at Advocate Good Samaritan Hospital.

Working with other float nurses gave me insight on the job benefits for both the nurse, the

hospital and other healthcare professionals. I enjoy the rewarding possibilities given to the float

nurses, as scheduling seems to be more flexible, and each day the float nurse can be placed

where she is needed most to help short-staffed units or units with a higher ratio of patients than

usual requiring additional attention due to acuity.

Medical-Surgical Issues

Regardless of where the nurse is floated for the day, current literature highlights the need

to focus on subjects that continuously effect medical-surgical areas throughout hospitals such as

patient safety, patient satisfaction and infection prevention (Mitchell et al., 2018). For the

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purpose of this paper, two specific issues that will be focused on include improving patient safety

and satisfaction through communication with nurse-to-nurse handoff in the form of Bedside Shift

Report (BSR) and infection prevention of Catheter Associated Urinary Tract Infections

(CAUTI).

Numerous studies have shown a positive correlation in BSR to patient safety, higher rates

of nurse satisfaction and improved patient satisfaction (Mitchell et al., 2018). In acute care

hospitals with various medical-surgical floors, accurate professional team communication has

been noted as essential in providing pertinent, safe, high-quality, patient-centered care (Evans et

al., 2012). A reliable and appropriate shift report from nurse to nurse should include patient

information such as diagnosis, medical and nursing care plan, medication information,

hemodynamic trends, any procedures performed during stay, and other topics discussed during

rounding (Sadule-Rios et al., 2017). It may be more reliable if nurses would follow a

standardized form to report with (McAllen et al., 2018). Successful communication through

BSR and handoff has been shown to allow for continuity of care, the active involvement of the

patient and family in decision making and the opportunity for nurses to visually analyze the

patient and the environment (Maxson et al., 2012). As a result, BSRs are associated with reduced

fall rates and reduced safety risks (McAllen et al., 2018).

Unfortunately, despite the evidence in its benefits, BSR is not a standard in all hospitals

and some nurses are choosing not give shift reports near the patient. In many cases, shift reports

are occurring outside of the patient rooms with nurses utilizing self-developed report forms in

areas such as conference rooms, nursing stations, hallways, or through electronic devices with no

face-to-face contact at all (McAllen et al., 2018). Two barriers to utilizing BSR have been

reported. BSR increases time of patient reports due to interrupted workflow by external sources,

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or by patients and their families, while the nurses discuss care (Tobiano et al., 2017). Second,

BSR may risk patient confidentiality if outsiders overhear communication (Tobiano et al., 2017).

In contrast, evidence disproving these barriers is growing and showing the negative

impact of not performing BSR. In one study, a team implemented BSR on a 532-bed, acute care

hospital (McAllen et al, 2018. Prior to the introduction of BSR, the hospital faced numerous

patients fall incidents, consistently scored below the goal of 90% on patient satisfaction and

below an 85% in communication (McAllen et al., 2018). In only four months after introduction

and utilization of BSR at a compliance rate of 94%, patient satisfaction scores significantly

improved and patient falls decreased by 24% overall with orthopedics reducing falls by 55.6%,

neurology reducing falls by 16.9% and general surgery reducing falls at 6.9% (McAllen et al.,

2018). Similarly, across the literature, another study found increased results in patient

satisfaction and safety. After introduction of BSR, this study further emphasized increased nurse

satisfaction from 37% to 78% and lowered total report time from 45 minutes to 29 minutes

(Evans et al., 2012).

CAUTI is another issue in the medical-surgical area that is ongoing has been related to

infection prevention. Despite the potential to eradicate CAUTI, prevalence of the healthcare

associated urinary tract infection related to catheters is estimated to cost the United States

between $876 to $10,197 per patient (Hollenbeak & Schilling, 2018). CAUTI is associated with

negative outcomes in patients in acute care including increased lengths of hospital stay, urethral

inflammation, strictures, Clostridium difficile growth causing further infection, independence and

mobility impairment, unnecessary patient readmissions, mechanical and urinary trauma, and

even mortality (Lo et al., 2014). At a national level, major health initiatives by the Joint

Commission, Agency for Healthcare Research and Quality and the Department of Health and

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Human Services have set out with goals to eliminate or reduce CAUTI (McAlearney et al.,

2017). Still, of all healthcare associated infections, indwelling urinary catheters are responsible

for 70-80% and it is estimated that up to 16% of all adult hospital patients will have a urinary

catheter at some time during inpatient admissions (Lo et al., 2014). Current research supports

that CAUTI is continuing to occur for multiple reasons. In review of the literature, experts

contribute unnecessary length of time or duration of catherization use as the single most

important risk factor for developing a UTI (Lo et al., 2014). Additionally, poor hygiene, failure

in aseptic technique, and improper management (including not maintaining a closed drainage

system), are all major contributors to CAUTI (McAlearney et al., 2017).

Leadership Impact Using Bedside Shift Report

According to the literature, hospitals across the United States have started implementing

BSR (McAllen et al., 2018). Unfortunately, misconceptions of BSR act as restraining forces,

making many nurses choose to continue to give and receive patient reports away from the

bedside (McAllen et al., 2018). Evidence-based research should be used as a driving force as it

continues to disprove the nonfactual perceptions or beliefs on BSR, such as it is too time

consuming to include the patient and family and that it risks breaching confidentially (Mitchell et

al., 2018). Instead, research shows that patient safety, nurse satisfaction and patient satisfaction,

increases when nurses give report at the bedside (Mitchell et al., 2018). With these facts, I

believe I can use my tested strengths as an achiever, communicator, relator, activator and

commander to educate, and be an influence, to my future healthcare team. By adopting BSR into

my daily routine, I will set an example to my peers and positively impact the medical-surgical

units that I will work in. Experts discuss all registered nurses can be leaders that act as

innovators, or agents of change, to promote improvements in healthcare, aid in the development

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of effective policies and practices, and introduce ideas that may benefit patients, hospitals or

society (Thomas, Seifert, & Joyner, 2016).

On a smaller scale, in adopting BSR into my own daily routine, I would inform patients

of BSR and the benefits for both staff and patients in participating in this method. I would use a

standardized report form for communication with other nurses. The literature proves that a

standardized report sheet is the safest way to deliver communication in handoff that is accurate

and aids in the prevention of information gaps or errors in patient care (Mitchell et al., 2018).

Additionally, nurses that use BSR increase nurse accountability by allowing both the incoming

and outgoing nurse to visualize the patient, improve teamwork among healthcare teams and plan

accordingly for patient care, allow more opportunities for questions and clarification of patient

treatment plans, allow for inclusion and better understanding of medical treatment for patients

and their family, and increase mentorship between nurses (Mitchell et al., 2018).

Further, there have been many cases of nurses aiming for change by getting the support

of co-workers, charge nurses and upper management. For example, one nurse reported on her

journey to implement BSR as standard practice on the unit she worked in. In this case, after

attending a conference on patient-center care, she and a colleague were given a project to

improve patient safety (Ferris, 2013). She and her colleague developed and practiced

standardized scripting in BSR with other healthcare professionals with the support of their

administrative team, their clinical director and their chief nurse (Ferris, 2013). Together, they all

participated in educating other nurses on the BSR initiative supported by research and evidence-

based practice results (Ferris, 2013).

On a larger scale, inspired by stories such as the one previously described, I would like to

volunteer to collaborate with upper management on BSR protocol and advocate for BSR policy.

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Once having gained support working with a team of professionals, I would highlight the need for

implementing change in requiring BSR using a standardized form on all medical-surgical units to

improve communication and patient safety. One standardized report format that repeatedly

shows success in the implementation of BSR is the Introduction, Situation, Background,

Assessment, Recommendation and Question (ISBARQ) form (McAllen et al., 2018). As

described in the literature, I would additionally recommend using Kotter’s Eight Stage Process

for Major Change, which has proven to be a successful guide to implementation (McAllen et al.,

2018). Finally, I would also recommend the Plan, Do, Study, Act (PDSA) cycles which have

shown to be beneficial in evaluating practice change throughout the process (McAllen et al.,

2018).

Conclusion

The American Academy of Nursing calls to action nurse leaders in healthcare as they

describe innovative ideas that can create permeant changes that improve patient care and

promote a culture of safety in healthcare (Thomas, Seifert, & Joyner, 2016). All Registered

Nurses have the power to recognize and use their unique skills to make a positive difference in

patient outcomes as they advocate for patients through research, studies, policy, and healthcare

initiatives. By applying nursing experience, medical knowledge, and continuing education, nurse

leaders will be able to promote, achieve and revolutionize healthcare. Achieving advancements

by directing change will not only impact the nurse leaders’ surroundings but can potentially

inspire other nurses to create positive changes that help to break down barriers currently

inhibiting successful patient care. The first step in driving change as a nurse leader is the

decision to focus on major issues within the field such as CAUTI and BSR. For me, I hope to

leave an impact on safety and communication by diligently working towards patient involvement

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in care through a standardized form and BSR with all healthcare staff. It is with great hope that

other nurses can become active in the process to advocate for change by pushing forward and

vocalizing what they recognize as issues throughout healthcare that require revision.

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References

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nursing report: Implementation and outcomes. Medsurg Nursing, 21(5).

Ferris, C. (2013). Implementing bedside shift report. American Nurse Today, 8(3), 47-49.

Hollenbeak, C. S., & Schilling, A. L. (2018). The attributable cost of catheter-associated urinary

tract infections in the United States: A systematic review. American Journal of Infection

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Lo, E., Nicolle, L. E., Coffin, S. E., Gould, C., Maragakis, L. L., Meddings, J., Pegus, D. A.,

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