Impact at Hospital Shift Change

Resources for Nursing
June 4, 2013 — 1,469 views  
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As a shift in the hospital draws to a close, the nurses and medical assistants busily make final rounds from patient to patient as they do any final vital signs, empty Foley catheters, add up the intake and outputs, freshen drinking water and a myriad other last minute chores. Joint Commission refers to this hour as the time for the ‘four P’s, (pain, position, potty and possessions) as staff cares for the patients.” The nurse manager makes the staff assignment for the oncoming staff.

The nurses are ready for “handoff”, which requires giving a full report to the oncoming nurse for the new shift. This is a very important time for the patient’s safety as 60 percent of sentinel events can occur due to poor communication. 

One of the most effective ways for the nurses to give a report on each patient is to make rounds together to each patient’s room. This is an opportunity for the oncoming nurse to introduce herself to the patient. The off-going nurse shares all the pertinent information on the patient with the incoming nurse using the “situation-background-assessment-recommendation (SBAR), which is a standard method of communication.” These discussions can include the patient and their family members, so any questions can be answered. 

The nursing assistants also need to introduce themselves as they come in to take the patient’s vital signs and meet any other patient need.

A safety check is also done at this time. For instance, IV lines, catheters, high-alert medications and any other equipment should be checked by the two nurses. Patient falls are another big problem in hospitals, and it is not just the elderly that fall. 

Other characteristics that cause hospital falls are patients that already have a history of falling, cognitive impairment, visual impairment, balance and gait disorders, weakness, musculoskeletal disorders and the use of assistive devices for mobility. Pain medications, incontinence or the need for assistance can all be responsible for falls. Always instruct the patient to call for help to get out of bed. Place the call light close to the patient and show them how to use it. Keep all the bedrails up. Many hospitals have alarms on the beds to notify staff when a patient tries to get up.

In the nursing report the information that should be shared includes the patient’s daily goals, any upcoming procedures, pain management, diet, any new orders, problems that may have occurred during the last shift and the projected discharge date. The individualized patient’s goals are reviewed, and the patient’s progress is noted.

A good nurse manager has the ability and leadership skill to facilitate positive changes that make a difference in the care the patient will receive; plus, the unit will run more smoothly. The nurse manager needs to have the skills to build a cohesive healthcare team.

Healthcare reform is happening on the local, state and national level. New legislation, new technology, policy reforms and changing standards of care are continually being developed. Healthcare management teams work on process improvement programs, ways to improve patient care, work to reduce costs and enhance efficiency.

Resources for Nursing