Nursing Handoff during Change of Shift

This paper outlines the implementation of a project aimed at improving
nursing handoff in the course of change of shift. It is built on the
premise that the provision of healthcare services usually involves a
change of healthcare providers. The incoming and outgoing nurses must,
therefore, exchange information crucial to the provision of healthcare
to the patient. However, many are the times when miscommunication occurs
during handoffs. This may jeopardize the safety of the patient. This
paper examines the problem and comes up with a solution for it. It
presents the likely barriers to the success of the project, as well as
efforts that can be done to safeguard its success.
Nursing has been a fundamental component of the healthcare sector for a
long time. It is charged with the responsibility of providing varied
scopes in different levels of healthcare aimed at assisting individuals
to maintain, attain, or even recover quality of life and optimal health.
Needless to say, the safety of patients tops the list of priorities for
nurses. Unfortunately, many are the times when the safety of compromised
especially in instances where there is a change of nurses under whose
care a patient is (Cairns et al, 2013). The transition is known as a
handoff, which refers to the transfer of authority, responsibility, as
well as information in the course of exchanges in care (Cairns et al,
2013). Underlining the importance of communication during handoffs is
the increased likelihood that information will be lost or missed.
Studies show that missing or incomplete information is one of the key
causes of adverse events in the healthcare sector. On the same note,
communication failure in the course of handoffs is the most often cited
predisposing factor to sentinel events (Cairns et al, 2013).
Scholars note that the efficacy of handoffs primarily depends on the
communication skill and style of the healthcare providers, as well as
the knowledge and experience of the two healthcare professionals
involved (Fitzsimons & Reinbeck, 2013). My interest in the issue of
nursing handoffs rests on the enormous role that it plays in enhancing
trust and patient safety. Scholars have noted that accurate and
consistent exchange of information pertaining to the patient is
imperative in maintaining patient, as well as promoting the safety of
According to the American Nurses Association, approximately 80 percent
of the serious medical errors occurring in the healthcare sector revolve
around miscommunication between the incoming and outgoing healthcare
providers in the course of handing off the patients (Fitzsimons &
Reinbeck, 2013). On the same note, scholars underline the fact that
defective handoffs may result in inappropriate treatment, delays in
treatment, as well as increase the duration of time within which an
individual stays in the hospital (Fitzsimons & Reinbeck, 2013).
Project to Improve Communication During Handoffs
Enhancing effective communication in the course of handoffs comes as
imperative especially considering the adoption of pay-for-performance
and value-based purchasing measures. This, in fact, is not only viable
from the patient safety perspective but also considering the financial
aspects. Effective communication would enhance patient experience, as
well as offer a trusting and safe environment for provision of
healthcare services.
In solving the problem of miscommunication, a bedside shift report
would be inculcated in the hospitals. This comes as one of the most
effective techniques that would improve the experience of patients in
healthcare centers, as well as ensure their safety. The implementation
of the bedside shift reports is speedy.
The incoming nurse checks the chart, treatments, and medical history, as
well as other pending aspects prior to getting into the patient’s
room. Both the incoming and outgoing nurse then proceed to the bedside
where the outgoing nurse would introduce the incoming one to the
The incoming nurse would then have the responsibility of asking the
patient certain details such as name and date of birth, as well as
checking the armband to ensure safety, after which he ensures that the
whiteboard is updated and checks the accuracy of intravenous medications
(Baker, 2010). Patients must also be advised, as well as educated as to
the occurrence of the bedside shift report before its occurrence (Baker,
2010). After this, the nurse would use the Situation Background
Assessment Recommendation technique to frame his conversations with the
outgoing nurse even in front of the patient so as to ensure that crucial
information is relayed in the bedside shift report.
Benefits of Bedside Shift Reports
Research shows that bedside shift reports coupled with enhanced patient
participation would promote trust and respect between patients and the
caregivers thereby enhancing accuracy in the information exchanged
between nurses (Cairns et al, 2013). Bedside shift reports also come as
an excellent technique for enhancing employee teamwork, accountability
and ownership. On the same note, it comes as a direct response to varied
goals of Joint Commission named Patient Safety Goals. These are
enhancing the accuracy pertaining to patient identification, enhancing
the efficacy of communication among healthcare providers and managing
handoff communications especially with regard to providing a chance for
asking and replying to questions (Baker, 2010). The third goal revolves
around encouraging active involvement of the patients in their
healthcare as a way of safeguarding the safety of patients.
Bedside shift reports also come as opportunities for real-time
conversations for nurses. This is because nurses are likely to be more
thorough, comprehensive and accurate in compiling their reports as they
know that someone else will be checking them (Baker, 2010). They would
ensure that the reports are in order before the shift takes place.
Bedside shift reports also come in handy in mentoring new nurses as they
become disciplined right from the beginning as their documentation would
be reviewed by other nurses, who would take them through other processes
such as medical therapy, environmental factors, assessments, and even
take a physical examination of their patients (Baker, 2010).
Barriers to implementation of the project
As much as the project comes with a number of positive effects, its
implementation faces a number of barriers. This is especially from the
concerned nurses. It is worth noting that the bedside shift reports are
a relatively new thing in the nursing profession. As much as many
healthcare professionals acknowledge its importance, they object to its
implementation as they view it as cumbersome and too much work to
compile. Implementing or introducing change is never easy and nurse as
the key participants would be likely to raise some issues.
On the same note, there are concerns as to the privacy of the
information placed on the bedside shift report. This is especially with
regard to passing confidential or highly sensitive information in the
presence of the patient.
Further, there are concerns pertaining to the length of time spent on
the bedside shift report as it may put the incoming nurse behind
schedule or delay the outgoing nurse.
On the same note, all levels of leadership in the healthcare
institution must show the willingness to implement the changes, offer
support to the staff, as well as offer some boundaries especially in
instances where some outliner would be unwilling to participate in the
Facilitation and implementation of Project Completion
The implementation of the project is undoubtedly a crucial aspect to
patient safety in the course of treatment. Nevertheless, its
introduction and implementation necessitates that some efforts be made
especially with regards to eliminating or neutralizing the effects of
barriers to its implementation.
One of the things that must be done is creating awareness and the
support of the key participants i.e. the nurses who will be using these
reports. It is imperative that they are made to understand the
importance of the reports, as well as their effects in the overall
safety of patients in the healthcare centers. In addition, any fears
that they may be having pertaining to their cumbersomeness must be
addressed before the implementation of the reports. It is imperative
that one emphasizes on the positive impact that the project would have
on their work. Incoming nurse team should be educated as pertaining to
the bedside shift report in case they are registry or float personnel
(Baker, 2010).
In addition, gaining the support of the leaders in all levels is
imperative to the overall success of the project. The leaders will not
only be involved in the implementation of the project but also in laying
the policy frameworks pertaining to the same, as well as the rules and
standards to which the nurses must adhere.
On the same note, it is imperative that the implementing nurses are
sensitive to information, as well as privacy of the patient. Key words
should be used to inform the patient as to the maintenance of his
privacy and safety of his information (Baker, 2010). Confidentiality
should be maintained by discussing sensitive details away from patients.
Opinions must be excluded from reports as criticism would create the
impression that the nurse is not credible (Baker, 2010). Nurses should
not be put on the spot in the patient’s vicinity rather clarification
pertaining to sensitive issues should be sought after completing bedside
shift report. Clear rules of engagement must be defined so as to ensure
or safeguard the overall success of the project.
Lessons learnt
The implementation of any project comes with unique and fundamental
lessons for all parties involved. One of the key lessons in the
implementation of the project is the importance of safeguarding the
participation of all stakeholders, especially those involved in direct
application of the same. Employees (or nurses in this case) own the
implementation process in instances where they feel that their opinion
is valued or even inculcated in the implementation process. This is the
basis of participatory leadership, as it allows the stakeholders to own
the process and drive its success. It is imperative that all parties are
brought on board so as to safeguard the success of the project. On the
same note, leaders must be willing to take charge of any project that
they introduce, while also inviting the input of other stakeholders.
Cairns, L.L., Dudjak, L.A., Hoffmann, R.L & Lorenz, H.L. (2013).
Utilizing Bedside Shift Report to Improve the Effectiveness of Shift
Handoff. Journal of Nursing Administration. Volume 43 Number 3., pp
160 – 165
Baker, S.J (2010). Bedside Shift Report Improves Patient Safety And
Nurse Accountability. Journal of Emergency Nursing 36: 355-8.
Fitzsimons, V & Reinbeck, D.M (2013). Evidence-based nursing: Improving
the patient experience through bedside shift report. Nursing Management.
Volume 44. Number 2 pp. 16 – 17