Reply To: Nursing Bedside Handover

  • Debra Bruene

    April 11, 2018 at 11:57 am

    When we rolled this out, there were a group of staff nurses who participated heavily in the process.  They helped to hold their peers accountable….. if they started to give report outside the room, they simply said “let’s go to the room to do this”.  As leaders, at change of shift, we walked through hallways each shift.  If someone was at the desk, we had frank conversation with them about why they were there and corrected misconceptions and restated our expectations.  We did that consistently for the first couple of weeks.  We provided handouts to any pulls from other areas re: expectations to make sure the process was consistent. (all units now do this process but not at the time).  In the morning, before report, the night shift and the day shift have huddle for 5ish minutes to talk about new initiatives, satisfaction scores, etc etc…. so this was a time each day for the first couple of weeks to talk through the process and ask what is working and what wasn’t, restate expectations.  The process was also reviewed in unit quality meetings with the staff nurses who helped begin the initiative.  After starting additional education/inservices were provided by members of the committee to address areas they were having trouble with.  For example, if a staff member said:  I had that patient yesterday, you can hit the highlights…. Then what should the nurse who is giving report say to that nurse.  What if the nurse saying that has worked here several years and is intimidating to you?  What if the family asks for you to do this outside of the room?  (we don’t change our standard for this reason and we explain the importance related to patient safety).  We went through several of those scenarios based on what issues the staff were having.   If after all of this, there was a nurse who we consistently found at the computer or outside of the hallway, or if a staff member informed the manager that a specific nurse never wants to follow the process,  the manager had a discussion with them and it was clear that if they did not want to adhere to this standard of care (for patient safety, to increase family centered  care, etc etc etc), they should probably think about working elsewhere as this was how we are doing things here.  If they continued to not follow the standard other discipline would be enacted as with any standard of care that is not followed.  I’m not sure if it ever came to that.


    Additionally, when we rolled it out, we had every nurse simulate a handoff.  We had very specific scripting regarding how to invite the family to participate (we encouraged them to if they wished- we certainly don’t discourage it).  So staff practiced that scripting, looked at body language, tone of voice etc.  This was key feedback.  After the initial roll out, as new staff were hired, they also demonstrated the handoff as the one coming in and the nurse leaving.   They demonstrated the order they went through handoff as well to ensure consistent report.   we also reviewed the process if there was a miss that should have been caught in handoff and was not…for example… the wrong IV rate was infusing and it was not caught in handoff.  We also reviewed it during competency review the first year… We did a scenario including a patient who received too much opioid and the nurse demonstrated care for that type of patient, but as part of the scenario they demonstrated handoff.  Many families verbalized relief knowing for sure what information the new nurse was being provided versus hoping the nurse leaving told the new nurse XYZ.  We also encouraged this time as a time for the new nurse to say, outside the room, for example….. I’ve never taken care of a patient with XYZ, so during handoff if you can give me a few extra hints or details, that would be great.  The staff leaving then could just say…. And the amount of chest tube drainage is marked here every X hours, there are no dependent loops in the foley, the foley bag is below the bladder, etc etc (talk out loud!). 


    Hope this is helpful.  I didn’t mean to write so much!!!


    ——Original Message——

    ​We would be open for tips as well.  It is definitely the expectation, and our staff can tell you why we do it, what benefit it is, and how it affects the patient/family in a positive way, yet if leadership isn’t around, it doesn’t happen.  We have had it as our expectation for close to 2 years now, yet we still don’t do it 100% of the time.  They aren’t at the desk, but they are in the hallways outside the room when they do it.  I would love to hear how you got your staff to be successful!  Our staff doesn’t want to wake the families and sees it as a burden when the families ask questions during report.

    Candace Young, RN
    Lubbock, TX
    United States