At the end of a demanding shift that has sapped your focus and energy, it’s somehow now time for (arguably) the most crucial half-hour of your workday: the nurse-to-nurse shift change.
Passing off care to the next nurse is one of the most important and delicate parts of the job. A thorough and efficient transition is paramount to the comfort and care of your patient, and it’s critical for the next nurse to be able to start their shift with the information they need. An incomplete or poorly managed handover, on the other hand, can be disastrous.
How you perform a shift change is decided by your facility’s specific protocols and, to some degree, your own preference. The three tips outlined here are designed to make the shift switch easier for everyone and can be, if implemented, game changers for safety and satisfaction.
There have been some recent changes to practices in the nurse-to-nurse handoff – a shift in the shift change, as it were, such as movement toward the bedside handoff. Here, we’ll speak to the reasons this practice and others can make the transition easier and more complete for your patient and your shift successor.
The Basics: What’s in a Nurse-to-Nurse Shift Change?
A shift change is the short overlap between nurses assigned to the same patients, during which updates and information are exchanged. A properly executed transition ensures patient safety and brings the next nurse up to speed. Having a process in place is vital – literally: It could save your patient’s life. You only have about 30 minutes, leaving somewhere between three and seven minutes per patient for handover, depending on how many are being transitioned.
Specific tasks and protocols will vary depending on what type of facility you’re in and what type of patients you treat, but generally speaking, the shift change is the time to communicate a patient’s current condition and anything that has changed during your shift to the incoming nurse. It’s a lot to communicate in a short period of time, and patient well-being depends on a fastidious transition. Here are three tips to make your shift-to-shift changes better for nurse and patient alike.
Tip 1: Have a Handoff Checklist
Maybe you know your handoff by heart. Maybe you know the protocols, the processes, the safety measures. But did you know that up to 80% of medical errors may occur at the transition of care? And did you further know that, according to one study, the use of a checklist reduces errors by half? Checklists consistently reduce medical mistakes, yet surprisingly, considering the evidence, checklist use is still far from standard industry-wide.
For a nurse-to-nurse shift change, use of a checklist benefits both sides of the handoff. That’s because even if you’ve done your job perfectly, it’s possible the incoming nurse missed or misunderstood something during a verbal exchange, or needs to recheck a detail once you’ve left. Having a checklist saves you both from uncertainty, sets the incoming nurse up for a better shift, and can help prevent errors both minor and catastrophic.
Your checklist should include questions you’ll want to ask the patient and family during a bedside handoff (see more on bedside transition below), and it should be easy to integrate into your shift change, without adding significant time. If your facility doesn’t already have a standardized checklist for you to use, you can check out the Agency for Healthcare Research and Quality (AHRQ) Bedside Shift Report Checklist for an example.
Tip 2: The Case for the Bedside Handoff
The handoff to the incoming nurse at the end of your shift can take a few different forms. Primarily for the sake of time, this exchange is often done through a written report, an audio recording, or sometimes through a face-to-face private conversation between the two nurses, at the desk or even in the hallway.
There’s a fourth option, and in many ways a better one: the bedside shift report (BSR). At the bedside, nurses can exchange information in the physical space, which not only promotes visualization, but may also trigger additional points of communication. This practice also gives the patient greater involvement in their own care, which can be meaningful and engender trust between nurse and patient. Including the patient in their report also provides the opportunity for them to offer additional or unrecorded information – for example, new pain or another symptom – or clarify a detail. It also gives patients and their family members the opportunity to ask questions and greet the incoming nurse.
Yes, bedside shift changes require you to travel from room to room, but it has quantifiable benefits to both patient outcomes and patient satisfaction. In one case study, hospitals with full bedside handoff implementation received 98% satisfaction ratings in patient surveys, with the top-scored question being “nurse kept you informed.” This type of improved feedback has also been anecdotally common.
Of course, a bedside handoff needs to comply with all privacy and HIPAA regulations. Any new test results or information the patient may not want to share with family should be left out of the report, or given in the presence of the patient only. Difficult news is also best communicated outside of the bedside shift change. As with anything, it’s all about communication. Check in with your patient about whom they want to be present, and when in doubt, ask visitors and family to step outside the room until you’ve finished the handoff.
Tip 3: Practice Good Housekeeping
Technically, this part of the shift change happens before the actual handoff, but it’s just as important. Good housekeeping simply means leaving things in order. Don’t make your exit until you’ve finished any paperwork, tidied up workstation(s), and closed any loops on conversations and reporting.
Good housekeeping also means completing as many rotating tasks as you can before the end of your shift. This includes filling IV bags, administering medications, changing catheters, etc. The incoming nurse will appreciate it; it gives them a little more breathing room on their rounds, creating a smoother shift change and a calmer first interaction with each patient.
Wrapping up loose ends isn’t just about being a good nursing citizen. Making sure everything is up to date and properly communicated or documented before you leave will help ensure nothing important falls behind schedule, or worse, is missed. This is one additional way to keep errors at bay.
Oh, and if time allows, consider putting on a fresh pot of coffee for that next nurse, too.
Go Forth and Make Good Shift Change Choices
Follow these three tips and you’ll make your shift changes more efficient, more pleasant, and safer. The incoming nurse will appreciate the extra effort, your patients will be grateful for the additional communication, and you’ll be able to leave your shift with peace of mind.
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