Making BSR Work at the Bedside

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This series explores how bedside shift report can strengthen communication, support teamwork, and bring patients and families into the conversation about their care.

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Today we are talking directly to the nurses and nursing staff who will bring bedside shift report to life.

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We are not trying to make report more complicated. We are asking nurses to make the handoff more deliberate, more consistent, and more inclusive.

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Exactly. From outgoing nurse and incoming nurse to outgoing nurse, incoming nurse, and patient.

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A better-connected conversation.

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Two reasons should stay at the center. First, communication supports teamwork and safety. Second, patients and families are at the center of our care.

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Correct. Bedside location does not automatically produce patient participation. The patient must be offered a meaningful opportunity to enter the conversation.

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Yes. Our responsibility is to invite and encourage participation. The patient decides how to participate.

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When a new patient is admitted, a nursing leader introduces bedside shift report. The leader gives the patient the AHRQ brochure and introduces the Best Care Board.

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Right. The board supports communication about the patient's care. It also includes a QR code the patient can scan to select priorities for discussion.

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Not at all. It helps the nursing team prepare. A patient may be worried about pain, mobility, tests, discharge planning, or something else that matters.

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Exactly.

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The outgoing nurse brings the clinical story of the shift. At the bedside, the outgoing nurse opens the patient's record in Epic and reviews documentation to communicate pertinent and current information.

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Right. The nurse uses clinical judgment to identify what the oncoming nurse needs to understand about the patient's condition, priorities, changes, and unfinished tasks.

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Yes. S-bar means Situation, Background, Assessment, and Recommendation. The AHRQ checklist also organizes report around S-bar and asks nurses to use language patients can understand.

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The implementation team will clarify exact tools and terminology. The important point is the nurse's responsibility. Technology supports clinical thinking. It does not replace it.

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Bedside shift report does not mean every detail must be spoken aloud. Nurses must use clinical judgment. Sensitive information may need to be discussed privately.

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Correct. A blended approach may be responsible. Nurses can exchange sensitive information privately and still complete the bedside portion.

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That is a good way to say it. Standardization gives us reliable core behaviors. Nursing judgment helps us apply them responsibly.

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The oncoming nurse connects the clinical handoff to the next shift and deliberately includes the patient. The nurse reviews priorities from the QR code and updates the Best Care Board.

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Questions like: What could have gone better during the last twelve hours? Do you have any concerns about safety? What do you want to happen during the next twelve hours?

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Exactly. Nurses still have clinical goals. But asking for the patient's goal creates space for information that may not otherwise enter the handoff.

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Yes. The oncoming nurse updates the board as part of the workflow. It makes the next shift's information visible and supports continued communication.

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The triad gives each participant a clear place. The outgoing nurse brings the clinical story. The oncoming nurse receives responsibility and creates the next connection. The patient brings priorities, questions, and goals.

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Yes. The theory brings together organizational care, collaborative care, person-centered precision care, and self-care within a culture of caring.

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Very practical. Competence means communicating accurate information. Compassion means seeing the patient as a person. Accountability means completing the handoff reliably. Sharing and engaging mean making room for each person's contribution.

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No. It explains why the triad matters. Organizations, professionals, patients, and families work together within a caring culture toward better outcomes.

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Respect the patient's choice. Invite participation, explain the opportunity, and conduct the handoff responsibly. Do not coerce the patient.

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Still invite the patient to identify priorities during bedside shift report and reinforce how the QR code can be used later. The nurse's responsibility to engage verbally remains.

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Acknowledge and address it when possible. Receiving a concern is not the same as responding to it. That distinction matters for digitally submitted priorities.

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Clarify it. The handoff policy expects interactive communication and provides an opportunity for questioning and verification.

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Return to the purpose. The checklist helps us remember core behaviors, but the goal is a reliable clinical handoff that includes the patient. The checklist supports the conversation. It is not the conversation.

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No. Those are useful supports, but bedside shift report is ultimately a nursing practice carried out through human interaction. Sustainability requires nursing adoption and a healthy nursing culture.

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Here is how Daniel RON-ick, Chief Nursing Officer at Covenant Medical Center, describes the foundation for this work.

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'I believe in the nurses at Covenant. When you combine the heart and compassion of our nurses with the clinical expertise of our charge nurses, and then layer in our leadership team's pursuit of excellence, the recipe for becoming the best place to give and receive care comes to life.'

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Exactly. It is built on confidence in Covenant nurses. The process gives nursing staff a clearer structure, a more deliberate way to include patients, and a shared workflow that can be observed and improved.

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Yes. Reliable practice is built with nurses, not simply handed to nurses.

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The evidence supports structured communication, but it also warns us not to confuse a template or a technology with reliable practice. The quality of information, nurse behavior, patient participation, and workflow fit all matter.

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Correct. A form can organize information, but it cannot make a nurse listen, clarify, or invite a patient into the conversation. Those are human behaviors, and they improve with practice, feedback, and a supportive culture.

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It is a fair concern, and I would not dismiss it. The checklist is only a support. The purpose is a reliable clinical handoff that includes the patient whenever possible. If we treat the checklist as the goal, we miss the point.

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We return to the patient in front of us. Standardization gives us core behaviors, but nursing judgment helps us apply those behaviors with respect, privacy, and clinical wisdom.

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It can look like asking a question, correcting a detail, naming a worry, setting a goal, or simply listening. The key is that the patient is offered a genuine opportunity to enter the conversation.

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Right. Listening is a valid choice. Our responsibility is to invite and encourage, not to force. Coercion would undermine trust and person-centered care.

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That is expected sometimes. The QR code is an additional pathway, not the only pathway. The nurse should still invite the patient to identify priorities verbally during bedside shift report and explain how the QR code can be used in the future.

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That is a real implementation risk. Receiving a concern is not the same as responding to it. The team should acknowledge the priority, discuss it when appropriate, and document or communicate the response.

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They use clinical judgment. Sensitive information may need to be exchanged privately. Visitors, roommates, patient preferences, and the nature of the information all shape that decision. A blended handoff can protect privacy while still completing the bedside portion.

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No, it is a responsible design option. The literature recognizes privacy as a legitimate concern. It does not claim one rigid sequence fits every patient.

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Epic helps nurses access information, but the nurse must review it, judge what is clinically relevant, and communicate it accurately. Technology supports clinical thinking. It does not replace it.

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The board makes key information visible for the patient and the team. The oncoming nurse updates it during bedside shift report. It also reminds the patient that the QR code can be used to submit priorities for a future handoff.

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S-bar gives nurses a shared structure: Situation, Background, Assessment, and Recommendation. It helps organize the clinical story, but nurses still use plain language so patients and families can follow.

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Communicate clearly, complete the clinical handoff, and create a meaningful opportunity for the patient to participate. That is the heart of bedside shift report.

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It makes the handoff more visible and more collaborative. The outgoing nurse shares the clinical story. The incoming nurse receives responsibility and asks questions. The patient hears the plan and can add important context.

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It is both! A workflow can be written down. A culture is built through repeated practice, trust, feedback, and leadership support. Nurses need to see that this process helps them, not just adds tasks.

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Practical feedback. What worked? What felt awkward? What took too long? What information was missing? What helped the patient engage? That feedback helps the team adapt the process to real clinical care.

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Yes. Reliable practice is built with nurses, not simply handed to nurses. The best improvements often come from the people doing the work at the bedside.

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The theory describes organizational care, collaborative care, person-centered precision care, and self-care within a culture of caring. Bedside shift report puts those ideas into action through competence, compassion, accountability, trusting, sharing, and engaging.

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Exactly. It is a way of practicing that keeps the patient at the center while supporting safe, reliable clinical communication.

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The process still matters, but it may need to be adapted. A blended handoff, a brief bedside check-in, or a focused conversation can preserve the core behaviors. The goal is not perfection. The goal is reliable, patient-centered communication under real conditions.

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The outgoing nurse gives a concise clinical update using S-bar. For example: 'Situation: Mr. Jones has new shortness of breath. Background: He has a history of heart failure. Assessment: His oxygen requirement increased overnight. Recommendation: Please monitor his breathing and recheck oxygen.'

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Right. The nurse uses judgment to decide what is pertinent. The goal is not to read every note. The goal is to transfer the clinical story accurately and invite questions.

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The oncoming nurse updates the Best Care Board, confirms understanding, asks clarifying questions, and invites the patient to share priorities or goals. That completes the triad.

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Yes, and that simple goal can be clinically important. It might reveal a fall risk, a mobility need, or a discharge barrier. When we ask, we learn what matters to the patient.

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Did we communicate? Did we include the patient? Did we leave the next nurse prepared to provide safe, compassionate care?

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It is. And if the answer to any of those is no, that is useful information. It tells us where to improve next time.

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You already have the clinical skill. Bedside shift report gives you a shared structure to use that skill even more deliberately. Invite the patient in, communicate clearly, and trust that small changes at the bedside can make a big difference.

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Exactly. Better handoffs, better conversations, better care. That is why we are doing this.

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Yes. Every handoff is a chance to connect, clarify, and prepare the next nurse for safe, compassionate care.

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Thank you.

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First, communication builds teamwork, and teamwork supports safety. Second, patients and families are at the center of our care. Third, bedside shift report moves the handoff from a nurse-to-nurse dyad toward a nurse-patient-nurse triad.

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The incoming nurse updates the Best Care Board, receives responsibility for the next shift, and deliberately includes the patient.

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Not every patient will participate the same way. Not every handoff will follow the same exact conversation. Privacy and clinical circumstances require nursing judgment. But the core expectation remains: communicate clearly, complete the clinical handoff, and create a meaningful opportunity for the patient to participate.

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Better handoffs.

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Better care.