DURING CLINICAL EXPERIENCES as students in the nursing program at the Massachusetts College of Pharmacy and Health Sciences, the authors noted that change-of-shift reports lacked standardization. Frequently, nurses conducted change-of-shift reports in an individual manner rather than following a systematic approach. Communication was inconsistent and nurse-to-nurse handoffs appeared inadequate or, at times, didn't occur at all.
The authors took an interest in this topic because this lack of standardization has the potential to threaten patient safety. The following literature review, a research-based project, aims to reveal more about the change-of-shift reporting process and suggests ways to improve upon the current practice by standardizing the procedure and moving the handoff to the patient's bedside.
Current change-of-shift reports, which often occur outside of patients' rooms, can be detrimental to patient care. Consider these situations:
- A patient 3 hours post-op is in pain and needs assistance getting to the bathroom. The unlicensed assistive personnel are with other patients. He doesn't see his assigned RN for an hour during the change of shift.
- An older patient with dementia relies on her daughter to remember all medical care instructions. When her daughter wasn't included in the change-of-shift report, critical information was lost.
- You're the nurse assigned to seven patients. When rounding on your patients, you didn't see your seventh patient until an hour after your shift began. Your patient's I.V. infusion infiltrated during this time.
These scenarios could have been altered for the better if the nurses had conducted change-of-shift report at the bedside.
Traditionally, the nurse change-of-shift report lacks standardization, exclusively involves nurses who communicate away from the patient's bedside, and doesn't include the patient, family, or other members of the healthcare team. The change-of-shift report is intended to communicate critical patient information to the oncoming nurse. Unfortunately, the traditional approach causes information to be lost, creating situations that threaten patient safety.
In the report, The Future of Nursing: Leading Change, Advancing Health, the Institute of Medicine (IOM) stated that when handoff reports are inadequate, safety often fails first.1 To improve patient safety outcomes during change-of-shift reporting, change is warranted.
Get the ball rolling
Promoting the goal of improving communication among members of the healthcare team, The Joint Commission emphasizes that patients must become actively involved with their care and recommends the implementation of a standardized nurse change-of-shift report as one of its National Patient Safety Goals.2 Patients' desire to be more involved in their healthcare decisions also serves as an important factor driving the change from the traditional change-of-shift report.3 Hospitals place significant emphasis on the results of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. These standardized and publicly reported surveys detail patients' perspectives on their care while hospitalized.4 Hospital administrators and other stakeholders are pushing to implement programs such as systematic change-of-shift report at the bedside to improve self-reported patient satisfaction scores.4 Adopting a patient-centered approach with the bedside change-of-shift report gives healthcare institutions the opportunity to rise to The Joint Commission standards, meet patient needs, and improve HCAHPS scores.
What does the literature say?
Numerous studies conducted over the years on the nurse change-of-shift report have recognized that making a change to bedside reporting has challenges but that overall, bedside reporting has a positive influence on patient safety and patient and nurse satisfaction.5 Recent studies have shown that bedside change-of-shift reports improve patient satisfaction as patients feel better informed and more involved with medical decisions about their healthcare.3,5
Many nurses prefer bedside reporting as well. Nurses have reported that using bedside handoffs decreases the time needed to complete their report.5 Nurses have also reported improved accuracy and service delivery using handoff reports conducted at the bedside.6
Although this research is compelling, the literature provides mostly anecdotal data limited to small sample sizes that look at one nursing unit or one aspect of a handoff.7
Healthcare facilities and nurses who want to move the change-of-shift report to the patient's bedside must first ensure that all nursing staff perceive a need for a change. In the absence of a perceived need, nursing leaders must present evidence-based practice (EBP) on the topic, including outcomes, such as enhanced nurse and patient satisfaction and improvements in patient care and safety.3,5,6 Informational meetings, consistent encouragement, and shared successes from area hospitals already implementing the bedside change-of-shift report are other ways to ensure transition success.
It begins with nurses
In the Future of Nursing, the IOM urges nurses to practice to the full extent of their education and training and to become full partners with other healthcare professionals. Because nurses are at the center of patient care, they have a clear opportunity to transform the current change-of-shift reporting practices. This review of literature shows that by moving the change-of-shift report to the bedside, nurses can deliver holistic patient-centered care, spend their time more efficiently, effectively communicate with others on the healthcare team, and provide a safer environment for patients.
1. Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health
. Washington, DC: National Academies Press; 2010.
2. Laws D, Amato S. Incorporating bedside reporting into change-of-shift report. Rehabil Nurs
3. Anderson CD, Mangino RR. Nurse shift report: who says you can't talk in front of the patient. Nurs Adm Q
5. Chapman KB. Improving communication among nurses, patients, and physicians. Am J Nurs
. 2009;109(11 suppl):21–25.
6. Chaboyer W, McMurray A, Wallis M. Bedside nursing handover: a case study. Int J Nurs Pract
7. Friesen M, White S, Byers J. Handoffs: implications for Nurses. In: Hughes R, ed. Patient Safety and Quality: An Evidence-Based Handbook for Nurses
. Rockville, MD: Agency for Health Care Research and Quality; 2008:2-285-2-332.