Passing the Torch: Managing the Nursing Shift Handoff

We have all experienced that moment. You know, the one where you’ve arrived to your shift and accepted report only to find there’s an infiltrated IV in room 10, IV medications that were due at 6:00 PM, fluids are empty in room 7, Cardiology is calling to see if room 9 has been NPO for their stress test that you had no idea they were even scheduled for, and the patient in room 13 is calling for pain medication that the previous shift said they were going to administer before they left. Whew! It’s enough to make even the most patient, seasoned nurses feel completely overwhelmed and dare we say it, maybe even a little annoyed.

It is completely understandable if you’re feeling overwhelmed when faced with a situation like the one I described above. None of us want to arrive at our shift to find ourselves in the position of playing “catch up” by completing the previous shift’s tasks in addition to the normal set of time-sensitive things we must do on our own. However, we must also assess situations like this from another perspective. Though completed in twelve-hour shifts, nursing is always a twenty-four-hour job. Depending on the circumstances, nurses on the previous shift have no choice but to postpone certain tasks and ultimately hand those tasks off to the next shift. When this happens, it is important that we use our critical thinking and time management skills wisely to prioritize the tasks that are most pertinent to our patient’s care and safety during our shift – regardless of who was assigned to complete them originally. As a general rule of thumb, things like medication administration and assessment documentation are of wise priority to start with. Take special care to acknowledge your facility policy on sensitive subjects such as admission assessments (when such admissions arrive at near shift change), or morning insulin administration.

It’s important to understand that the shift prior to yours could have easily been very hectic. It’s possible they were understaffed (which is why travel nurses are needed in the first place). You’ll probably hear rumblings, but you still don’t know exactly what they walked into either; much less what they experienced throughout the duration of their twelve-hour nursing shift. While it can be stressful to see that empty bag of fluids hanging there or see that infiltrated IV, we should try our best to shift our mindset to see these situations as an opportunity for you to hone your own time-management skills AND an opportunity to give our fellow nurses a little grace. Bringing that bag of fluids into the room gives us another opportunity to lay eyes on our patient, and maybe now would be a good time to brush up on our IV starting skills. And if you find yourself needing a little support, do not be afraid to ask for help. Ask your charge nurse or even a fellow nurse on the floor (if they are not busy) if they would not mind performing one of those simpler tasks for you, then you can go address something that requires more of your attention.

Though some shifts do go more smoothly than others at times, there are no perfect nursing shifts, and there are no perfect nurses. In fact, I am sure we can all think back to moments when we have been lying in bed when we suddenly remember something we forgot to do for a patient. It’s usually nothing the next shift couldn’t have managed, right?

Of course, if we start to notice repeated patterns that potentially put patient safety at risk such as medications not being given, that should probably warrant a further conversation. However, there are trivial things here and there that we can afford to let go of because we have all experienced a shift where we were understaffed, overwhelmed, or just simply could not do it all.

Ultimately, we should remember that we are all in this together. We are all working together towards the same goal of patient health and wellness. We can allow grace for our fellow nurses, as we hope they would for us as well. We are all only human, after all. Our shift inconveniences don’t necessarily have to be setbacks if we get into the mindset of turning them into opportunities.

Sincerely,

Rachel Ferguson BSN, RN, ADON