A hospital shift change is controlled chaos. The old staff is working to complete their tasks and any last-minute issues. The new staff arrives and tries to collect the necessary information on their assigned patients. Nursing handovers -- or shift reports -- differ sometimes according to unit, even within the same hospital. Some nursing handovers take place at the patient's bedside, while others are conducted in conference rooms. The type of report that accompanies the nursing handover varies as well, from verbal updates to dictated notes to printed reports. Changes taken to improve the quality of the handover process must overcome institutional and individual resistance to change. Here's how to improve using Lewen's three-step model of change:
- Skill level:
- Moderately Challenging
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Things you need
- New approved shift report template
"Unfreeze" the current nursing handover process. This might be already underway in the form of staff, physician, patient and visitor dissatisfaction. If not, solicit staff opinions on the current procedure via a survey. Unfreezing present procedure might require quicker exit from shifts for the personnel completing their workday, fewer questions regarding responsibilities for the oncoming shift and fewer visitor, patient and physician complaints.
Begin the change or transition process. Remove institutional and individual obstacles to change. Understand the current procedures -- and deficits. Establish practice guidelines based upon research, staffing ratios, patient needs and your institution's atmosphere. Schedule informational meetings so that all involved personnel are ready and aware of the change.
"Freeze" the accomplished changes. Plan follow-ups for each nursing unit participating in the change. Assess for any perceived difficulties. Ensure that the new shift template is printed and stocked in all the nursing units.
Tips and warnings
- Like the children's game, "Telephone," a study by Pothier demonstrated how important shift reports are by using 12 simulated patients over five handovers. Verbal reports only resulted in the "loss of all data after three cycles," note-taking allowed for only 31% of data retention, while a typed sheet improved data retention to almost 100%. Use a typed handout or template.
- Include staff input into your unfreezing phase by collecting suggestions of what needs to be added to the nursing handover procedure and what needs to be eliminated. Failure to include staff input ensures that your personnel will not be as personally invested in the change.
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- "British Journal of Nursing"; Pilot Study to Show the Loss of Important Data in Nursing Handover Abstract; David Pothier, et al; 2005
- Change-Management-Coach.com: Kurt Lewin Change Management Model
- "Conwy & Denbighshire NHS Trust"; Nursing Handover for Adult Patients Guidelines; Alexandra Buckley; November 2006
- "Wodonga Reg Hlth Srv"; Review of Nursing Shift ... Handover at a Regional Hospital; Andrew Brown
- "Griffith Univ"; Bedside Handover; One Quality Improvement Strategy; Wendy Chaboyer, et al;
- "Nursing Administration Quarterly"; Nurse Shift Report; Cherrie Anderson, et al; April 2006
- "Health and Nursing Policy Issues"; Examining the Effects That Manipulating Info in the Change of Shift Report ...; Dawn Dowding; October 2007