Exploring the Importance of the Nursing Shift Change

The shift change is one of the most crucial times of day at a hospital or nursing home.  At its best, it is the time when nurses from the outgoing shift and the incoming shift communicate with each other to ensure they stay on the same page with respect to the patient’s needs and any changes in needs or behavior.   At its worst, it either does not happen at all or when it happens, the appropriate information is not exchanged, which can result in errors and oversights in care. The traditional shift change consisted of nurses conferring in the hallway outside of patients rooms or at the nurse’s station and in some instances, writing up a medical report for the next nurse to read; these methods can result in important information to be left out. Hospitals in Washington are implementing a new method of shift change in order to prevent these occurrences, called bedside shift reports.

bedside reporting

Studies have shown that bedside shift reports make patients feel safe, included, and satisfied. During bedside shift reports, both nurses meet with the patient to handover information from the previous shift. This method helps nurses to communicate better with one another, as well as the patient and the patient’s family. In addition, this method also helps to prevent falls and other injuries. Beverly Johnson, CEO of the Institute for Patient and Family Centered Care in Bethesda, Maryland stated this method is a simple way to ensure that accurate information is passed on and that both nurses understand the care plan for each patient.

Bedside reporting has also helped improve hospital ratings of patient’s experiences, a subject that Medicare takes into consideration, connecting some payments with the measure of quality. Although bedside reporting has resulted in positive outcomes for the most part, there are some concerns about privacy policies potentially being violated. Advocates of patient’s rights do not believe that confidentiality should prevent the growth of bedside reporting. Patient’s will have the right to decline being involved in reporting and be able to choose which family members they would like present during the report. They will also be informed of the possibility that conversations may be overheard and asked which topics they would prefer to remain confidential.

The University of Washington Medical Center in Seattle bought together a patient and family advisory council in order to develop inclusive policies for family members. A woman named Christine Hernandez played an integral role in the council. Mrs. Hernandez’s husband was in ICU for numerous heart surgeries in 2007 over a period of six weeks with multiple complications. Mrs. Hernandez was not allowed to be present during shift change reports, which left her unsure of her husband’s progress. She said she was yearning for information but did not want to be labeled as the “meddlesome wife.” She voiced that the shift change would be the perfect opportunity for a family member to be get an update on the status and what to expect for the next shift.

Nurses at The University of Washington Medical Center began training sessions in spring of 2015 on how to perform a proper bedside report and master how to engage with patients; the University began reporting in July. The shift change is a period of 30 minutes, during which a nurse can have 3-6 patients, which they spend an average of 3-7 minutes with. Nurses are able to complete each patient because some conversations are quick and easy, leaving time for more difficult cases. Family members and nurses also have the option to continue conversation after the report is finished.

Bedside reporting is an innovative and inclusive method that many patients and families are responding to positively. One patient at The University stated that it felt weird to hear the nurses talking outside of her room as though she did not exist, bedside reporting makes her feel comfortable to speak out about her concerns. Hospitals with bedside reports receive much higher ratings on overall experience and communication than those that do not use bedside reporting.

The attorneys at Gallivan & Gallivan support bedside reporting at shift change.  We have seen many instances of neglect that may have been avoided had the staff members themselves and/or the staff and family members, been on the same page with regard to patient status/needs.

The Most Crucial Half-Hour at a Hospital: The Shift Change

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