Surviving the Nursing Shift Change


Nursing can be a challenging career under the best of circumstances. You're working long hours, oftentimes providing acute care to patients with challenging conditions. Making the work even more taxing is that most nurses who work in hospital settings are called upon to work rotating shifts, alternating days, evenings and nights. It can be physically exhausting and a constant battle to adjust sleep schedules.

The shift change becomes even more challenging - but, also more interesting and dynamic - when considering the hand-off of important patient information from shift to shift. There are established best practices in this aspect of the nursing shift change, and we reached out to one of Concorde's Nursing Program Directors for some advice.

Promoting the safe transfer of information

Nursing shift report and the hand-off is a critical aspect of the nursing responsibility and patient care, said Sonia Wisdom, RN, MSN, Director of Nursing Education at Concorde's campus in Miramar, Fla.

"The nursing hand-off report promotes the safe transfer of information and is an important patient safety component," Wisdom said. "Foster-Hunt et al (2015) indicated that it is during this time that there is a transfer of information, knowledge, and responsibility from one health professional to the other. If ineffective, Foster-Hunt et al (2014) indicated it results in reduced patient safety, wrong treatments, and outcomes, as well as delayed patient care."

The Institute of Medicine in 2001 called the hand-off an overly complex, cumbersome process that produces loss of information and inability to build on the strength of the health professional. Despite that fact, the hand-off shift report is a normal part of the day function of the nurse.

Digging deeper into the information

Carroll et al (2012) suggest that the hand-off shift report not only includes technical information about the patient, but also the interpersonal behavior, the relationships among the nurses and general likeability that will influence communication. Other challenges include variability in the structure of the report, presence of side-bar conversations, speed at which information was rendered, failure to convey essential information and the organization of the report.

A key finding in Foster-Hunter et al (2015) was that nurses with fewer than three years' experience were less organized and had greater challenges with the transfer of information.

Recommended nursing strategies

Several reports (Carroll et al, 2012; Foster-Hunt et al, 2015) recommended several strategies that new nurses can implement to help them organize shift-change reports.

These include employing simple communications strategies such as giving good eye contact, nodding to show understanding and communicating attentiveness. Structured, systematic reporting is always useful. The new nurse should constantly keep notes of important information that occurs throughout the day. They then should organize that information into a cohesive, clear report.

Your nursing degree program at Concorde will teach you the right methods of writing and recording such reports.

"New nurses may also benefit from having a mentor," Wisdom said. "Someone they can emulate or who can guide them in effectively transferring the information."

"Most of all, build a collegial relationship with co-workers and maintain a positive attitude to feedback. The shift-change report gets better with experience."


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