Tips for a Smooth Nursing Shift Change
At the end of a long day of caring for patients, it’s time to give the end-of-shift report to the oncoming nurses. Although it may be tempting to rush through this routine duty, patient safety hinges on a complete and correct exchange of information.
“We underestimate its importance,” says Elizabeth Henneman, RN, PhD, CCNS, an assistant professor in the School of Nursing at the University of Massachusetts Amherst. “It is one of the most critical times we have to communicate accurate information about the patient’s status and the plan for future care.”
Seasoned nurses like Henneman say the shift report can be a positive experience for outgoing and oncoming nurses alike if they avoid common pitfalls and observe some best practices.
Safety Is Key
One of the most frequent errors during a shift report is inadvertently omitting critical safety information, says Henneman, who is also an ICU nurse at Baystate Medical Center. “We often think that the oncoming nurse will get this information somewhere else, such as on the chart, but this verbal communication is key,” she says.
Henneman teaches nursing students the three key safety areas to cover: allergies, code status and medical team members. Allergy information is critical, because it may dictate which medications can be safely administered to a patient. Code status includes information about whether a patient wants to be resuscitated. Finally, oncoming nurses need to know the members of the patient’s medical team in case a nurse needs to call for help.
In addition to safety information, an outgoing nurse must inform the oncoming nurse about a patient’s medical history and current condition. This information needs to be conveyed methodically, such as moving through each body system (cardiac, urinary, etc.) or going from head to toe.
Another key piece of information is the patient’s future care plan. “The future care plan is one of the most important things that can be missed,” Henneman says. “As nurses, we should always know where we are heading, because this prioritizes what we are doing.”
For example, a nurse who is ending a shift may know that a patient will be going to the operating room for a procedure. The oncoming nurse needs to know this so she can be sure the patient does not eat.
Work from a Cheat Sheet
Remembering each patient’s details throughout the day may seem overwhelming. To keep track of important developments, Evelyn McLaughlin, RN, CNS, MSN, a medical/surgical clinical nurse specialist at Torrance Memorial Medical Center, encourages new nurses to carry a cheat sheet during their shift. Nurses can use this sheet to record lab results, physicians’ comments and information about problems that arose.
McLaughlin urges nurses to update the sheet throughout their shifts rather than waiting to the end to add information. Although recording the information in the moment may take more time, doing so usually results in a better end-of-shift report. “It takes less time if the outgoing nurse delivers a comprehensive report rather than giving a very skimpy report that requires the oncoming nurse to ask questions and fish for information,” McLaughlin adds.
If an oncoming nurse has a question the outgoing nurse cannot answer, McLaughlin encourages the outgoing nurse to offer to get the answer. “It shows that you are a team player,” she says. “It can create tension between nurses when the shift report is not adequate.”
Patients Aid in Shift Reporting
In October 2006, Torrance Memorial started experimenting with a new method of shift reporting that has improved the transition between shifts. Nurses started walking to each patient’s room to give the report, McLaughlin says. Oncoming nurses see things in a patient’s room that trigger important questions. An additional benefit is that patients can confirm the details the outgoing nurses are communicating.
For McLaughlin, who previously oriented new nurses, seeing a good shift report is one of the greatest rewards. “I’ve noticed that the new graduates sometimes give better reports than the senior nurses,” she says. “They have learned a better way of really doing a comprehensive end-of-shift report.”