Welcome to the latest in a series of interviews conducted by the AMSN Digital Content Committee (DCC) with session presenters from the 2024 AMSN Annual Convention. Deltra Muoki, Ph.D., APRN, AGNP-C, CMSRN, CNE, NE-BC, a member of the DCC, talks with Meredith Kuhlmann, BSN, RN, NC-BC, and Olawunmi Obisesan, Ph.D., DHEd., CPHQ, MCHES, RN, of Missouri Baptist Medical Center about their convention session, “Boosting Handoff Conversations: Increasing Efficiency With a Standardized Nurse Handoff Shift Report.”

Deltra Muoki: To begin, could you both share your current roles with our audience?

Meredith Kuhlmann: I am a bedside nurse in the float pool. I work three 12-hour shifts a week, and I do this research on the side as a little bit of extra hours. I have a lot of outside education that I'm working on as well. I just finished my nurse coaching certification this past summer. I'm going to start working on a certification in holistic nursing, and I started my master's in January for population health. I've got a lot of little things going on, but the three 12-hour shifts on the floor is my day job.

Olawunmi Obisesan: I am the research and outcomes manager for Missouri Baptist. My role is to facilitate nursing research in the hospital — that interdisciplinary collaborative research between nursing and other professions. You tell me an idea you want to research, and we're going to make it happen. I believe it's about time nurses stopped being consumers of information and became creators of information and knowledge, and that's what I drive. It is not enough to read all these peer-reviewed articles. How about you get your article and your research out there? So, I facilitate nursing research, quality improvement, and evidence-based practice (EBP) projects.

Muoki: Bedside shift reports are not a new concept, but we know there's still a lot of work that needs to be done to improve them. Some people do them; some people don't do them. Some people do them in different ways. How does the hospital culture affect implementing bedside shift reports or revising bedside shift reports so they can be standardized?

Kuhlmann: The organizational culture definitely plays a huge role in standardization. I think I mentioned this in my presentation that our entire system is doing an overhaul of the bedside shift report right now. It's been a huge undertaking and a huge culture shock for a lot of the nurses who are used to wanting to talk outside of the room. They still go in the room and say hi to the patient and do their safety checks, etc., but getting them to get to the bedside to really talk openly and freely in front of the patient about a lot of things has been a huge change for us.

Muoki: How do you overcome those barriers, and how do you get buy-in from nurses to take it inside the patient’s room?

Kuhlmann: I've just been trying to set a good example. When I'm going in to report and the nurse is wanting to gravitate to the little outside writing area, I just say, “Let's go in the room.” And I knock on the door and have them follow me into the room. It’s the same when I'm leaving at the end of the day, and it's my turn to give report. I just try to set a good example, not being afraid to speak up when we're doing a report.

I think it's just getting people comfortable with it; the more you do it, you see that it's not scary to say a lot of these things in front of the patient. For example, there was a nurse who didn't want to tell me some of the patient's history in front of the patient. Obviously, there are times when you have to use your clinical judgment, and there are things that you want to say outside of the room. She was only going to tell me that the patient had metastatic lung cancer and was not able to receive treatments right now because of his hospitalization. The patient knows he has metastatic cancer; it's just about finding a way to word things in front of the patient.

Obisesan: It also helps to have great supportive leadership — the hospital system leadership — push for it. This initiative is coming from the system. It's not Missouri Baptist saying, “We are doing this.” The health system as a whole is asking that we all move to bedside shift reporting. It's an expectation coming from system nursing leadership, and then the managers are tasked with auditing and making sure that the nurses are doing it. It may not be what you're comfortable with, but it's what the patients need.

We also know there are times that we would make exceptions. For example, we have something called a “mission moment,” where we share what patients are doing. We had a patient who lost a family member, and the patient's family sent a mission moment “shout-out” to the hospital saying they appreciated the nurses not doing a bedside shift report. They were already devastated, and they appreciated that the nurses went outside the room to do it because they didn't want to relive that experience. So even though the system leadership is saying it's what they expect of everybody, the nurses know that even though it's an expectation, there are times to use clinical judgment and not do it.

Muoki: Was it something that the nurses went to the leadership with, that they wanted to standardize the bedside shift report, or was it vice versa, handed down from the top? And how do you hold nurses accountable for actually doing the bedside shift report?

Obisesan: I was one of the two nurse scientists that the main hospital sent to the units to talk to the nurses about why they weren’t doing bedside shift reports. We realized that we did not have a standardized way of doing the shift report. Some would use paper, and some would report verbally. I had one unit that would pass the same sheet of paper from nurse to nurse to nurse. There was only one unit out of eight or 10 that we looked at that had a standardized tool, and it wasn't even a nursing tool; it was the physicians’ tool that they were using.

This was a qualitative study. So, we interviewed, transcribed the interview, and then we reported back to leadership. We found that the unit using the standardized tool was the only unit that did amazing on the interview, and we saw it in the patient satisfaction scores as well. Because the tool belonged to the physicians, the initiative began for a standardized bedside shift report for nurses. Our chief nursing officer (CNO) and our executive director for interprofessional practice, education, innovation, and research made the bedside shift report standard across the system.

Now, thanks to Meredith, we have an awesome tool that we can use to complement the bedside shift report. The unit managers are tasked with doing auditing and making sure that their nurses are doing it, and there is a dashboard where they can see daily compliance rates.

Muoki: What advice or words of wisdom can you provide for others who would like to replicate your project and implement or enhance the standardized bedside shift report at their facility?

Kuhlmann: My best advice would be that if you have an idea, don’t be afraid to go for it. I never thought I would be doing any sort of research project. I was just venting to someone about a year and a half ago, and she said, “Well, why don't you do an EBP project?” The timing of the classes worked out that I was able to attend, but I still did not have the confidence that I would be able to successfully implement anything. I remember pitching my idea to Ola, and she said, “This is great.” I saw the confidence that she had in me, and she didn't let me quit.

However, you need to have tough skin, too, when you're dealing with nurses who are very set in their ways, and they've used the same piece of paper for 22 years. You need to have some thick skin to coach people on what the benefits are, why it's OK to try something a little bit different, and show your research.

Muoki: Do you plan to expand this project in your facility? And if so, what will that look like, and what additional resources will you need?

Kuhlmann: Yes, this project is my baby, and I will keep pushing until I see the tool being utilized at the whole system level. We are currently implementing it on another unit. We've tweaked the embedded smart phrase a little bit to fit the needs of that particular unit.

This is probably my biggest undertaking because it's the largest floor that I've implemented it on. So, I need buy-in from more nurses, but I have a ton of leadership support on my floor. They're helping encourage staff to utilize the tool. There's still a lot of things that could be automatically populated into the handoff tool, rather than the nurses having to input that data themselves. I have had talks at a system level, and they seem very interested in talking with me about how we could enhance the tool further.

Muoki: So, you have plans on publishing?

Obisesan: We just turned it in for publication. I wanted to talk about when we came back from the 2024 AMSN Annual Convention. Never in my wildest dreams did I think we were going to come back with another twist to this project. Someone at the convention suggested looking at patient experience data, so we went back to our patient experience manager and asked for the HCAPHS data for that unit. It was obvious from our data that Meredith's tool increased our patient satisfaction with nurse communication. Our patient satisfaction scores were around 60, and when Meredith came in, the score went up to 90 and stayed in the 80s for about three to four months. Then we ended the pilot, and the score immediately went down to 70. But then it occurred to me that because the nurses had the patient’s information right in front of them, they could read it and communicate better.

This project would not be possible without our foundation donors, who donate money specifically for nursing research at our hospital, and our Nurse Executive Council, which approves funding for EBP fellowships. Meredith went through an EBP fellowship for 12 months. That means she’s working on this project, even outside her regular hours, but the hospital makes sure she gets paid out of research funding. Our CNO, Patricia Crimmins Reda (fondly known as PCR); the executive director for patient care services, Jane Bruegenhemke; and the director of nursing research, Catherine “Katy” Reese, were all there when she presented the study, and they all approved it. That's the kind of support she got that made this project happen.

I think every hospital trying to replicate this needs a Nurse Executive Council and nursing research/EBP funding. And another Meredith, of course, because of her tenacity. I remember when Meredith came to my office and said one nurse said she wasn’t going to use the tool. For every research project, there's always a nurse who doesn't want to do it.

Muoki: How do you plan to sustain the project?

Kuhlmann: We're trialing it on another unit, and I'm also sharing it more. No matter what floor I’m on, I tell everyone that I give report to, “Hey, look at this handoff tool that I'm using.” I'm starting to gain more interest by just telling people when I'm giving report. Like, “Let me show you how you can print this. Let me show you how you can add the smart phrase.” Things like that. I'm just spreading the word anywhere I can.

Obisesan: Our executive director for patient care services just approved the study that she's doing right now, so we are in phase two. Everybody's doing the bedside shift report, but one unit is doing it with the pre-filled nursing handoff, and other units are not. So, we're going to compare their patient experience outcomes and see if it makes a difference.

Muoki: This is exciting. What are the key takeaways from your project that you would like our audience to remember?

Kuhlmann: If you have a burning problem or question on your mind, remember that anyone is capable of making change. What is something that you can do, even if it's something you think is very small? We have to get out of that mindset of “we've always done it this way” and encourage nurses to be a part of change. I just have my BSN, so you don't have to have a ton of education to do something like this.

Obisesan: Be humble; I think that's what worked in Meredith's favor. She didn't go into the units saying, “You guys are not doing a great job.” She asked, “How can I make your life easier as we take care of all these patients?” And it was about being humble in taking feedback.

Also, I think every hospital needs a nurse scientist — anyone, whether they have an ADN, a BSN, or MSN, all they need to do is talk to that nurse scientist, and the study becomes real. I joke that we've done all the schooling for you; just tell us the idea, and we make it happen, because that’s what we do — facilitate nursing research.