Running head: REIMPLEMENTATION OF A BEDSIDE SHIFT REPORT REIMPLEMENTATION OF A BEDSIDE SHIFT REPORT Reimplementation of A Bedside Shift Report Problem Statement The underlying challenge experienced by most of the healthcare facilities when it comes to implementing bedside shift report is the lack of necessary skills and knowledge by nursing staff as well as the impact of changes it will bring after implementation to nursing practice. Direct care providers must stay engaged in the implementation process for this project change to bear fruits to unit-related outcomes of care and accessibility. Leadership commitment and program evaluation are what I believe this project proposal is going to provide to enhance change compliance and increased staff accountability. As a result, bedside shift report (BSR) has become a popular solution in most of the healthcare facilities nowadays as it improves patient satisfaction and ensures effective communication among families, patients and staffs (Dorvil, 2018). Evidence-Based Literature about Bedside Shift Report (BSR) American Nurses Association (2001) provides a plethora of evidence-based practice and even provides templates to use on their website, supporting nurses reporting the bedside. Their mission is to advance nursing to the highest standards possible by setting objectives and goals that enable them to help transform health care, and what better way to do that than by integrating nurse, patient, and family into report together. According to Dorvil (2018), BSR implementation comes with many benefits, primarily when caregivers use patient-centric innovative care to maintain quality of care. Hospital efforts in providing quality care are supported by evidence-based practice whereby promoting this excellence of service delivery yields more benefit to healthcare facilities as well as to the consumers of healthcare services (McAllen et al., 2018). Pre-Implementation Plan In this proposal, I have chosen Lewin’s theory of change, as it is rooted in social psychology. My BSR implementation aligns with this theory because it associated with aspects of behaviorism and developed an interest in Gestalt psychology (Rani, 2017). My BSR project proposal will follow the three stages proposed by Lewin that, first, I will unfreeze the current position, then shift the focus to the new situation and finally refreeze the new situation. Moving to a new situation and refreezing the new condition serves best as my initial survey analysis, which will help me develop the re-education training program for all involved stakeholders. The BSR will incorporate the off-going and the on-coming nurse in the patient’s room, at the bedside. This measure will ensure that four eyes are laid on the patient to assess mentation, lines, drains, tubes, and drips/correct intravenous medication, as well as skin. While both nurses are doing this, they will integrate patient and family, if the patient should choose, listen, interject, and add.

1. Running head: REIMPLEMENTATION OF A BEDSIDE SHIFT
REPORT
REIMPLEMENTATION OF A BEDSIDE SHIFT REPORT
Reimplementation of A Bedside Shift Report
Problem Statement
The underlying challenge experienced by most of the healthcare
facilities when it comes to implementing bedside shift report is
the lack of necessary skills and knowledge by nursing staff as
well as the impact of changes it will bring after implementation
to nursing practice. Direct care providers must stay engaged in
the implementation process for this project change to bear fruits
to unit-related outcomes of care and accessibility. Leadership
commitment and program evaluation are what I believe this
project proposal is going to provide to enhance change
compliance and increased staff accountability. As a result,
bedside shift report (BSR) has become a popular solution in
most of the healthcare facilities nowadays as it improves patient
satisfaction and ensures effective communication among
families, patients and staffs (Dorvil, 2018).
Evidence-Based Literature about Bedside Shift Report (BSR)
American Nurses Association (2001) provides a plethora of
evidence-based practice and even provides templates to use on
their website, supporting nurses reporting the bedside. Their
mission is to advance nursing to the highest standards possible
by setting objectives and goals that enable them to help
transform health care, and what better way to do that than by
integrating nurse, patient, and family into report together.
According to Dorvil (2018), BSR implementation comes with
many benefits, primarily when caregivers use patient-centric
innovative care to maintain quality of care. Hospital efforts in
providing quality care are supported by evidence-based practice
whereby promoting this excellence of service delivery yields

2. more benefit to healthcare facilities as well as to the consumers
of healthcare services (McAllen et al., 2018).
Pre-Implementation Plan
In this proposal, I have chosen Lewin’s theory of change, as it
is rooted in social psychology. My BSR implementation aligns
with this theory because it associated with aspects of
behaviorism and developed an interest in Gestalt psychology
(Rani, 2017). My BSR project proposal will follow the three
stages proposed by Lewin that, first, I will unfreeze the current
position, then shift the focus to the new situation and finally
refreeze the new situation. Moving to a new situation and
refreezing the new condition serves best as my initial survey
analysis, which will help me develop the re-education training
program for all involved stakeholders.
The BSR will incorporate the off-going and the on-coming
nurse in the patient’s room, at the bedside. This measure will
ensure that four eyes are laid on the patient to assess mentation,
lines, drains, tubes, and drips/correct intravenous medication, as
well as skin. While both nurses are doing this, they will
integrate patient and family, if the patient should choose, listen,
interject, and add to the chief complaint, history, concerns, and
what the plan is for the patient. Overall, this clinical practice
project’s goal is to increase safety while improving patient
satisfaction and outcome (Rani, 2017).
Before laying the plan, I plan to consult with different
stakeholders such as the CNO, supervisors, managers, assistant
directors, division directors, and medical personnel in order to
mirror the objectives of the proposal with the hospital nursing
leadership. The BSR will be introduced to each department’s
staff meeting through formal presentation and discussion to
train and educate them about the overall design of the BSR
project. For staff members to effectively adapt to the new
change, nursing leaders will round twice daily at shift change to
lending support and encouragement during the implementation
process. Members of the leadership team will validate BSR
competency from staff members after 60 days of

3. implementation. In the form of periodic rounding, monitoring
and supervision will take effect by the same nursing leadership
to ensure all operations run smoothly and as projected. Before
the implementation of the BSR proposal, I obtained ethical
approval from the hospital ethics committee.
References
American Nurses Association. (2001). Code of ethics for nurses
with interpretive statements. Nursesbooks. Org.
Dorvil, B. (2018). The secrets to successful nurse bedside shift
report implementation and sustainability. Nursing Management,
49(6), 20.
McAllen, E. R., Stephens, K., Swanson-Biearman, B., Kerr, K.,
& Whiteman, K. (2018). Moving shift report to the bedside: An
evidence-based quality improvement project. OJIN: The Online
Journal of Issues in Nursing, 23(2).
Rani, M. (2017). Improving Patient Satisfaction with Nursing
Communication in an Acute Care Setting.
Question #4. Identify at least four market mechanisms used by
some governments. What are the advantages and disadvantages,
empirical and normative, of using market mechanisms?
Market Mechanism：
Outsourcing
Privatization
Public – private partnership
Competitive sourcing
Thinking about the Public service value
(#4I think THE major issue about most market based
mechanisms. mention in any of the disadvantages the main
thing--- what is the goal of the organization doing the job?
Profit or Public Interest? Think about this.)
Intro: Market Mechanism: (4) Anything where you induce

4. competition in some way to facilitate public policy
o Empirical means what is observable. What IS The factual
impacts?
o Normative means the idea, what should be.
- How do market mechanisms impact the ideals of public
administration
Empirical:
1 : originating in or based on observation or experience
empirical data.
2 : relying on experience or observation alone often without due
regard for system and theory an empirical basis for the theory.
3 : capable of being verified or disproved by observation or
experiment empirical laws.
Syn: experimental, factual, observational
Normative:
1: of, relating to, or determining norms or standards
2: conforming to or based on norms; Things that should be!
Syn: regularizing, regulating, standardizing
Identify at least four market mechanisms that have been used by
some governments to manage their operations What are the
advantages and disadvantages of using market mechanisms, both
empirically and normatively?
Outsourcing
-a unit of government selecting a vendor to provide a
service that the unit historically would provide by itself.
Privatization:
· Transferring an existing public entity or enterprise to private
ownership ( can be done w/ competition)
(PPP) Public- private partnerships

5. · Contracts that are often long term between private sector and
gov’t
Competitive sourcing:
· Determines whether commercial activities should be
performed by gov’t or private sector
1. Outsourcing (MOST COMMON)- a unit of government
selecting a vendor to provide a service that the unit historically
would provide by itself.
- Contracts out organizational activities to vendors or suppliers
· Vendor/ Buss/ Orgs.
o Specialize in activity.
o Do it efficiently & Effectively.
o Do service at a more affordable rate than the organization
itself.
Ex. A city outsourcing their fire
department/police
· -Government remains responsible for provision of all services
& management decisions (AKA they make the rules about how,
contract company delivers it).
-Goal: reduce costs, to access expertise on a long-term basis in
order to be able to vary its quantity and mix over time.
Outsourcing (contracting out) “is the practice whereby
governments contract with private sector providers for the
provision of services to government ministries and agencies, or
directly to citizens on behalf of the government.” In other
words, outsourcing is an alternative to the provision of public
services by in-house agencies or companies controlled by the
government. The cornerstone of outsourcing is an open and
competitive procurement process to select the provider.

6. Advantages
· Empirical
· Harnesses competition and accountability to increase
productivity
· Reduce dependence on a single supplier or service provider
· Higher performance at a lower cost
· Provides government services at a fraction of the price
· Allows government to create contracts with organizations in
the free market that can provide excellent service
· The aim is to contain costs, increase productivity, or improve
quality
· Normative
· Enables government to take advantage of specialized skills,
new technology, and innovation that are lacking in public sector
· enables you to plan and execute more effective, targeted
campaigns and projects that you wouldn’t ordinarily be able to
take on. This gives your business the chance to take new risks
and experiment with different methods of exposure. (Open
market)
· outsource with a reliable individual or agency should give you
peace of mind that tasks are being handled expertly and
efficiently without you having to worry
Disadvantages
· Empirical
- Personnel disruptions/displacement
- Hidden cost
- low bid contracting without careful specification of service
quality can lead to poor service.
· Normative
- Limit flexibility in govt responses in emergencies or time-
sensitive situations
- Complex and time consuming if not managed well
- Less security: privacy can be at risk
- Time frames may not be reliable.

7. 2. PUBLIC-PRIVATE PARTNERSHIPS (PPP) - A public & a
private entity collaborating for the delivery of a public service.
· Often long term CONTRACT between the private sector and
government- contract will outline which party holds which
responsibilities.
· Private entity finances & manages a project in return for
payment from the public org.
· SHARE the costs, risks, benefits, and profits
· Often used in infrastructure provisions
· Ex: Cities working with private tech companies to provide
high speed internet connections to residents.
Public-private partnerships (PPP) describes the arrangement as
a specific form of private sector involvement in the delivery of
public services in infrastructure projects located between
traditional public procurement and the full privatization of
public tasks. Another element describing the partnership, which
is given particular attention in literature, is the transfer
(sharing) of the significant risks associated with the project to
the private sector, coupled with the pre
Advantages:
· Empirical:
· Allows govt to pursue projects they otherwise could not afford
to finance
· Can generate revenue
· Incentivizing the private sector to deliver projects on time and
within budget
· Exploring PPPs as a way of introducing private sector
technology and innovation in providing better public services
through improved operational efficiency.
· Return on investment (ROI) might be greater than projects
with traditional, all-private or all-government fulfillment.
Innovative design and financing approaches become available

8. when the two entities work together.
· Normative:
· Utilize the expertise and skills of private sector
· Better infrastructure solutions than an initiative that is wholly
public or wholly private
· Faster project completions and reduced delays on
infrastructure projects
· Risks are fully appraised early on to determine project
feasibility
Disadvantages:
· Empirical:
· Government assumes greater portion of risk compared to other
forms of privatization
· Can increase government costs.
· Limit the competitiveness required for cost-effective
partnering.
· Profits of the projects can vary depending on the assumed risk,
the level of competition, and the complexity and scope of the
project.
· Normative
· Authority can be blurred and roles can be unclear between
partners
· If the expertise in the partnership lies heavily on the private
side, the government is at an inherent disadvantage
3. PRIVATIZATION- Transferring an existing public entity or
enterprise to private ownership.
- Can be done with or without competition.
- It differs from “outsourcing” in that the management and the
workforce—and often the equipment and facilities—remain the
same as before, except that they are now private employees (and
private equipment and facilities)
EX: private prisons, education (for-profit universities), Health
(private hospitals).

9. 3 Types:
1) Full Privatization: the entire gov’t agency is sold and it is
now private. Ex. Prisons
2) Partial Private: the equipment and facility remain gov’t
owned but the workforce is privatized. (EX: govt owned and
contractor operated)
3) Privatization in place: The work remains at the prior facility,
and can be both “full” privatization (i.e., labor and equipment),
or “partial” privatization (i.e., labor only).
· This arrangement preserves jobs and may guarantee workload,
although civil servants transition to contract labor
Privatization is the process of transferring property from public
ownership to private ownership and/or transferring the
management of a service or activity from the government to the
private sector. Privatization can be partial or complete. It may
also carry conditions as to the change in ownership.
Advantages:
· Empirical:
· Govt assets can be converted into revenue through sales to
private entities
· Public sector does not have to hire staff to provide a service
· Access to a larger talent pool or access specialist suppliers
with greater capabilities and higher quality.
· Contract payments to private company
· Normative:
· With competition - higher quality services at lower prices
· customers receive better prices and higher performance for
private services formerly provided by government monopolies
· Saves taxpayer money
· Limits political interest
· Private companies know what they are doing (they are the
experts)
Disadvantages:
· Empirical:

10. · Private monopoly, not necessary competition (like intended)
· The private companies can have other priorities (ex. opens
door to bulk water exports)
· Private sector focuses on stakeholders, instead of the residents
· Problems With Quality or fails to meet quality standards or
not deliver.
· Normative:
· Controversial because services that are typically considered to
be government responsibilities now are done for profit (about
profit and not service provision)
· Limits access to services for low-income Americans
· Removes job opportunity (salary and benefits) to local
employees
· Limitation to transparency
· Limits government to uphold standards and regulation
4. COMPETITIVE SOURCING: Competition for work between
private and public sectors
· Winner of competition (such as through competitive bidding)
will perform service
· Who can do the job faster, at a lower cost, with better
performance
· Determines whether commercial activities should be
performed by govt or private sector
Advantages
· Empirical: Higher quality services at lower cost
· Normative: Replaces government monopolies by introducing
competition
· Allows opportunity for govt to retain work of service
provision if wanted (unlike in outsourcing or privatization)
Disadvantages
· Empirical: Time consuming, expensive, & Complex.
· Normative: Forces public employees out of work
OVERALL:

11. Advantages
1. Utilization of private sector skills/expertise
2. Public organizations can gain competitive edge
3. Allow for more prosperous and effective distribution of
goods and services
4. More cost-effective
Disadvantages
1. Requires a skill set that differs from those typically held by
public managers
Negotiation, contract writing/management, monitoring external
partners, enterprise management, etc.
1. Loss of control over public expenditure
2. Contract terms may extend beyond current administrations
3. Emphasis on lowest bids; can result in less of priority of
quality of services
4. Disruption in workforce
5. Can shift focus away from public service values to profits.
“Public Service Values”
Public Service Value Fluff
- Public Service- something organized by the govt or an official
body in order to benefit all the ppl in a particular society or
community
- Public servants shall perform their duties and arrange their
private affairs so that public confidence and trust in the
integrity, objectivity and impartially of government are
conserved and enhanced.
- Public Servants are motivated to serve the public
- Public Servants are not motivated by profit and only have the
public’s interest at hand
Additional Resources:
Market mechanisms; why should we run government like a
business? Because in the private sector, the market acts through
capitalism and competition to be the most efficient environment
of production. Government as a monopoly does not have the

12. motivation to save money, but the private sector does. The
reform logic states that we should use market mechanisms to
somehow get the government to think about efficiency and not
just regulation. Some widely used market mechanisms are
outsourcing, competitive sourcing, fixed priced contracts,
performance based contracts, privatization and public private
partnerships and vouchers such as food stamps.
When using these market mechanisms, there are advantages and
disadvantages. Empirical theory talks about how participative
leadership works (what actually happens), while normative
theory talks about why it is a good thing- given public service
values. In order for a market mechanism to work for the
organization, it will all depend on the execution of the
mechanism and the mechanism actually being tried by the
organization.
Outsourcing is the organizational activities that are contracted
out to vendors or suppliers who specialize in these activities
(usually in a competitive fashion).
It’s advantages: efficiency and it reduces cost because it
harnesses competition and brings the pressure of the
marketplace to bear on the inefficient producers. It allows better
management control by freeing government managers of most of
the distracting influences of overtly political organizations and
civil service constraints. Managers see more directly the costs
and benefits of their decisions. Outsourcing enables the
government to take advantage of specialized skills, new
technology, and innovation that lacks in its own organization.
Its disadvantages: limits the flexibility of government in
responding to emergencies if not provided for in advance
(through contract). Contracting processes can be complex and
time consuming. Outsourcing can also cause personnel issues
and transition problems if not planned accordingly.
Empirically (what is): government cannot fulfill all of the
functions needed by its stakeholders alone due to regulation,

13. cost, and bureaucratic process, therefore relies on outsourcing.
Normatively(what should be): with outsourcing it can be argued
that government should provide certain function because it is
their duty to provide certain services to the public.
Competitive sourcing occurs when government or current public
providers compete with the private sector to carry out
commercial government activities. It’s advantages: regardless of
who wins, the federal government achieves significant
performance improvements and savings of 20-50%. It introduces
competition and wherever possible, eliminates monopolies.
There is no loss of government control since government is still
responsible for providing high-quality performance within the
quoted costs. This competition leads to improved quality at
lower cost. Disadvantages include: resistance and controversy
from federal employees, unions, political allies and government
managers, it is seen as an assault on federal employees by
shifting their jobs to the private sector. Managers fear loss of
control over the work, fear of losing federal jobs and the
process is time consuming and complex.
Empirically (what is): If a public agency loses the bid they may
lose the jobs and employees. This can decrease morale and trust
in the agency.
Normatively (what should be):Should save money and create a
free open competitive space.
Public-Private Partnerships are attempts made to combine the
best of both, the public and private-sectors, in a competitive
environment. It allows the public and private sectors to share
costs, risks, benefits and profits. Instead of the government
providing the resources for public functions, the work is
actually financed by the private sector in a variety of
approaches. Advantages include: sharing the risk, government
can take advantage of privately owned infrastructure,

14. technology, and financing. It allows government to finance
facilities or services needed that it could not afford to fund. It
makes the most productive use of valuable government assets by
bringing in revenue, reducing overhead costs and providing
investments for facilities. However, one disadvantage is that
authority can be blurred. Others: potential for roles to be made
unclear between public private partners and government
assumes a greater portion of risk compared to other forms of
privatization.
Empirically (what is): Public-Private Partnerships take
advantage of the needs of the government by seeking ways to
make investors happy.
Normatively (what should be): Public-Private Partnerships
should have a shared cost and mutual benefit of working
together to achieve a common purpose.
Question #4. Identify at least four market mechanisms used by
some governments. What are the advantages and disadvantages,
empirical and normative, of using market mechanisms?
Market Mechanism：
Outsourcing
Privatization
Public – private partnership
Competitive sourcing
Thinking about the Public service value
2 pages single space