How to Give an Amazing Nursing Handoff

Nurses must care for patients 24 hours a day, yet no one works a 24-hour shift. In order to ensure the patient’s safety and promote excellent care, communication between shifts is of paramount importance. Yet few nurses learn how to give report in a manner that ensures the transfer of critical information. Here’s how to make your shift report complete, accurate and excellent.

Styles of Report

There are several different styles of nursing report. In one, the team leader or manager collects information from the nurses caring for a group of patients and gives a verbal report to the entire oncoming nursing team. In another, individual nurses report to the nurse who is following them on the next shift. Sometimes reports are taped and at other times they are live verbal reports. A final method of giving  a report is the bedside report. This is usually given by the nurse going off shift to the oncoming nurse. Of all these methods, the least desirable is the taped report, as there is no opportunity to ask and answer questions. This is particularly true when the oncoming nurse has never cared for the patient before and knows nothing of his or her history. The bedside report, however, can be the best of the lot.

Key Components of Nursing Reports

No matter what style of report your organization uses, there are a number of key components that you should practice to ensure the information transfer is complete. They are:

  • Preparation – collect all the relevant data and write it down; do not rely on your memory. Begin this step far enough in advance of the change of shift that you will not be hurried and miss something important. It is often a good idea to take notes for report as you go through the day.
  • Presentation – One excellent way to give report is to present it in the form of a head-to-toe assessment. First, give a brief synopsis of the patient’s medical history and day’s events, including such important factors as surgery, diagnostic studies or changes from the previous shift. Next, cover the findings of your assessments and exams for all body systems. Give the current vital signs and any significant changes during the shift, important lab or diagnostic results, and intake and output. Do not rush through the information – speak clearly and concisely, without slang or jargon.
  • Cover all issues – make sure you touch on the plan of care, any safety issues, upcoming procedures and patient or family education issues.
  • Clarification – When you finish, pause to ask if there are any questions or if anything you said was unclear. Check that you have answered all questions by asking for confirmation.

Benefits of Bedside Reports

The practice of conducting report at the bedside has a number of benefits. First, both nurses have the opportunity to assess the patient and to see the same thing at the same time. Checking capillary refill, dressings or mental status together, for example, ensures that the oncoming nurse has actual experience to know whether the patient’s condition is changing later in the shift. Bedside rounds also help reassure the patient that the oncoming nurse is aware of any concerns and fully informed about the patient’s status. It offers an opportunity for patients and family members to meet a nurse who is new to them and to ask questions. For the oncoming nurse, bedside report helps with prioritizing the patient’s needs. Finally, there is good evidence to indicate that bedside report decreases falls. It also makes patients and family members feel more involved in care and decisions, promotes teamwork between nurses and shifts, and decreases the potential for errors.

No matter how good a nurse you are, if you can’t give a good report, you are letting your patients and team members down. The communication between shifts can either lead to errors and patient harm or ensure that information transmission protects the patient and improves care. The nurse who follows you may be from a temp agency, or may be returning after several days off. He or she may have never cared for your patient. It’s up to you to provide a complete, accurate picture to your colleague with an amazing report.

Sources

https://stanfordhealthcare.org/health-care-professionals/nursing/quality-safety/bedside-handoff.html
http://scrubsmag.com/giving-a-good-report/
https://minoritynurse.com/communication-is-key-the-importance-of-effective-hand-off-reporting/
https://scholarworks.gvsu.edu/cgi/viewcontent.cgi?article=1000&context=kcon_doctoralprojects
https://onlinelibrary.wiley.com/doi/abs/10.1111/jocn.12575

Chris Caulfield (RN, NP-C), is the Co-founder and Chief Nursing Officer of Intelycare which the fastest growing Per-Diem Nurse Staffing organization in the US. IntelyCare is a technological enhanced platform that was founded in 2016 and now has over over 3,000 IntelyPros (RN, LPN, and CNA employees) serving over 150 healthcare facilities throughout the northeastern US.

Prior to founding IntelyCare, Chris’ past Healthcare experience includes Long Term Care Nursing, Nursing Informatics, Labor Relations, Case Management, and a Urgent Care Nurse Practitioner.

Decreasing Falls in Nursing Home Patients

According to The Joint Commission, hundreds of thousands of patients fall in hospitals and Nursing Homes each year. Many patients in long-term care are there in the first place because of injuries sustained in a fall or because they have fallen repeatedly. Falls are one of the major reasons for patient’s to be re-admitted back to an acute care facility, which ultimately will have a significant negative effect on reimbursements for long-term care facilities starting in 2019. Decreasing falls in the elderly patient population requires a well-defined strategy, training and consistent use of basic safety techniques.

The Cost of Patient Falls

Individuals who suffer a fall may suffer serious injury, such as a fractured hip or wrist or a head injury. Lacerations can occur if the patient comes in contact with the edge of a bed or knocks a glass flower vase to the floor. Skin shearing may occur due to the fragility of an elderly patient’s epidermis. The Joint Commission notes that one study found a fall with an injury increased in-patient facility length of stay by an average of 6.3 days. Further, the average cost of a fall in which an injury is incurred is $14,000. The American Health Lawyers Association reports that recent settlements for injuries incurred by long term care patients ranged from $205,000 to $620,000. In addition, there is the cost to the patient in terms of pain and disability, the stress on the family, and the guilt and remorse suffered by the nurses responsible for safeguarding the patient.

Elderly Patients Are at Higher Risk

The elderly are more at risk of falls. They are more likely to have balance problems or need assistive devices to walk around. Muscle strength, flexibility and coordination may be problematic for an elderly person. Elderly people are statistically more likely to be on multiple medications, which may have such side effects as lower blood pressure or dizziness. Diuretics may mean an increased frequency of bathroom visits and some medications can cause diarrhea. In the acute care hospital, the elderly are more susceptible to confusion, whether from medications such as narcotics or from being in unfamiliar surroundings. In long-term care facilities, it is often the elderly patient who can no longer live independently – whether from physical disability or mental impairments such as dementia – who needs long-term care in the first place.

Best Practices for Reducing Falls

In 2009, the National Guidelines Clearinghouse published a number of best practice recommendations for fall prevention in long term care. These include:

  • Develop a specific program aimed at reducing falls. This should take into account the patient population, the environment of the long term care facility, and the numbers, skills and experience of the caregivers. If your facility does not have such a program, volunteer to start one.
  • Assess fall risks on admission and after a fall. If a patient does fall, determine the most likely reason for the fall to have occurred. Make changes to prevent a fall from happening again.
  • Develop exercise programs for long term care patients, particularly strength training. Tai chi can also help with balance and coordination problems.
  • Conduct medication reviews – patients who are taking certain medications, such as benzodiazepines, antidepressants, selective serotonin reuptake inhibitors (SSRIs) or multiple medications should be considered at high risk for falls.
  • Educate patients who are at increased risk and who are mentally competent. This can include safe transfer techniques, basic fall prevention such as not getting up abruptly from a sitting position or the use of assistive devices.
  • Conduct regular environmental assessments and modification – reduce clutter, ensure lighting is adequate and clean up spills promptly.

The Top Two

Of all the possible strategies a nurse can use to prevent patient falls, the top two are probably a careful and thorough patient assessment at regular intervals and the consistent use of basic safety techniques. The first helps ensure that patients who are developing balance problems, worsening dementia, medication side effects or confusion from hypoxia will be identified as early as possible. Each time you walk down the hall, make it a practice to glance in the patient rooms on each side. You will be surprised how much information you can glean in a three-second snapshot. Always practice the basics: put up side rails, lower the bed, engage wheel locks and make sure patients can reach call lights, water or other items on the bedside table. Use bed alarms and use them at a short interval, such as two or three seconds.

Protecting elderly patients from falls in long-term care requires unceasing vigilance on the part of nurses and CNAs. Reducing falls can prevent a readmission to an acute care hospital or an extension of what was planned to be a temporary stay in long term care. Regular training on fall prevention and always practicing what you learned in a training will help keep your patients safe.

Sources

http://rnao.ca/sites/rnao-ca/files/Falls_Prevention_-_Building_the_Foundations_for_Patient_Safety._A_Self_Learning_Package.pdf
https://www.managedhealthcareconnect.com/article/strategies-for-reducing-falls-long-term-care
https://scholarworks.bellarmine.edu/cgi/viewcontent.cgi?referer=https://www.google.com/&httpsredir=1&article=1008&context=tdc
https://www.beckershospitalreview.com/quality/5-proven-strategies-to-prevent-patient-falls.html
https://www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/index.html
http://rn-journal.com/journal-of-nursing/preventing-falls-in-the-elderly-long-term-care-facilities

Chris Caulfield (RN, NP-C), is the Co-founder and Chief Nursing Officer of Intelycare which the fastest growing Per-Diem Nurse Staffing organization in the US. IntelyCare is a technological enhanced platform that was founded in 2016 and now has over over 3,000 IntelyPros (RN, LPN, and CNA employees) serving over 150 healthcare facilities throughout the northeastern US.

Prior to founding IntelyCare, Chris’ past Healthcare experience includes Long Term Care Nursing, Nursing Informatics, Labor Relations, Case Management, and a Urgent Care Nurse Practitioner.

Why Taking Breaks Is So Important For Nurses

The Problem with Taking Breaks

Nursing is a giving profession and we nurses tend to give a lot, but not all of that giving is by choice. In a conventional job, taking breaks is part of a normal shift. With nurses, there are patients who must receive care. However, providing that care is not always black and white. Patient safety is the top concern and that is sometimes difficult to pull off when so many cogs affect how the wheel turns. For example, a Long Term Care nurse might have twenty patients and two are about to be sent out to appointments, while at the same time you’re expecting two incoming admissions. Not knowing when these patients will arrive makes giving nurses breaks less predictable. Outside factors can make it impossible to stick to a routine schedule that is commonplace in many other industries. When nurses do not receive breaks they become fatigued and that leads to a decrease in patient safety.

There are many studies across many industries that point to the dangers of fatigue on the job. Long-haul truck drivers are a perfect example. If they are too tired to drive they not only risk their own lives but those of other drivers on a road. It is the same with nurses, though the mechanism of injury is different and the outcome varies. A wrong med here, loss of compassion there, lack of infection control, critical medications are given late… the list of possibilities is unfortunately endless. The results show up in data such as increased re-admissions, job turn over, elevated frequencies of call-ins, poor inter-professional relationships, etc.

It seems so easy to fix – just allow nurses to take breaks and eat lunch. Simple, right? The problem is that nursing is not that “cut and dry.” Nursing comes with a high degree of unpredictability and requires around-the-clock constant care. Many times, that care does not fit neatly into a timetable or regimen. Patients always come first. That said, there are definitely ways to manage nurses’ fatigue and even improve your overall quality of care. So, what can be done?

The Road to Caring with Exhaustion

One solution is to ensure your facility is set up with a reliable On-Demand per-diem staffing partner in order to give your internal nurses their own break and reduce the mandatory overtime that’s become commonplace among inpatient health-care facilities. The statistics show that tired nurses have a negative impact on the care they provide, but rarely do we look at their financial impact at their facilities. Tired nurses make mistakes that lead to lawsuits, workers compensation claims, hiring expenses, training, recruitment, etc. Too many patient injuries or too many re-admissions can cause hospitals to lose the faith to discharge their patients back to these LTC facilities. Ensuring that nurses take breaks is important and worth the investment, especially if it leads to decreased readmission frequencies.

Another important fix is to educate nurses so that they understand the impact of caring for themselves at home. There are additional studies that point to the lack of sleep as part of the honest of fatigue. Educating people on how to relax at home and at work is important. Finally, building and maintaining your own internal per-diem pool, as well as a trusted outside per-diem nursing partner who specializes in last minute fill ins, can be very effective tools to help cover short-staff issues. Focusing on these issues will help your facility to improve improve patient care, decrease readmission frequencies, and improve the relationship between nurses as well as the hospital and its community, all while saving you more money in the long run.

Keep your nurses fresh. Well rested nurses do their best work. It takes a lot of energy to care for other people, but we can’t forget to care for ourselves, too.

Deeper Reading and Sources

[1] Association of Sleep and Fatigue With Decision Regret Among Critical Care Nurses 

[2] The Effects of Fatigue and Sleepiness on Nurse Performance and Patient Safety

Chris Caulfield (RN, NP-C), is the Co-founder and Chief Nursing Officer of Intelycare which the fastest growing Per-Diem Nurse Staffing organization in the US. IntelyCare is a technological enhanced platform that was founded in 2016 and now has over over 3,000 IntelyPros (RN, LPN, and CNA employees) serving over 150 healthcare facilities throughout the northeastern US.

Prior to founding IntelyCare, Chris’ past Healthcare experience includes Long Term Care Nursing, Nursing Informatics, Labor Relations, Case Management, and a Urgent Care Nurse Practitioner.

Top 8 Issues with Short Staffing

Top 8 Issues with Short Staffing

As healthcare systems accommodate the retirement of baby boomer nurses and work to do more with less to make ends meet, many organizations find themselves short staffed. And while the best nurses will do whatever it takes to care for their patients, operating without enough help is bound to lead to serious problems.

Here, we share the top eight consequences of short staffing in healthcare.

#1 – Patient mortality increases.

As overworked nurses become tired and rushed, the risk of medical errors with the potential to harm a patient increases. Keeping nurses fresh and ready to provide the best care will lead to significantly better patient outcomes.

#2 – Patient satisfaction decreases.

As patients wait longer for a response to their call lights and get less face-to-face time with staff, their perception of the care they are receiving becomes more negative than positive. Making sure your nurses are able to respond to all patients in a timely fashion is important to ensure patients are happiest with your facility’s care.

#3 – Team dynamics are strained.

Even something like a simple bathroom break can be long enough to cause petty arguments. When you need every minute of you can get from your nurses, this can be quite the disruption. In addition, coworkers who worked harmoniously can grow apart in the face of short staffing.

#4 – Nurses get burned out.

Nursing is an incredibly challenging career prone to burnout in the first place. When caregivers and clinical professionals don’t have the support and resources they need, the burnout process can be accelerated. Unfortunately, this means facilities can be put in the precarious position of consistent hiring.  

#5 – Call-outs happen more regularly.

Working short-staffed is physically, mentally, and emotionally straining on the nurses on duty. It increases their risk of getting sick or even simply too fatigued after a long work week. Nurses need time to recharge their batteries, too, but unfortunately sometimes that’s the reason for calling out. To compound the issue, if your floor is already short on staff, call-outs only worsen the issue. This causes an even lower quality of patient care as there simply aren’t enough nurses to go around! Plus, those who are working are asked to do even more, which leads to further fatigue for them.

#6 – The risk of abuse & neglect increases.

This immense physical and mental strain can break down the patience and resolve that most nurses demonstrate every day. Unfortunately, that means it’s easier for your staff to lose their temper with a patient, physician, or coworker. While many skilled living facilities choose to cut staff to save money, they neglect value the risk associated with more outbursts and lesser care. 

#7 – Turnover goes through the roof.

When an organization is short staffed for a week or even a month or two, nurses generally hang in there and push through. The high-quality nurses are usually team players. They’re willing to “buckle down” in times of need. But what happens when short staffing drags on for months and months?  Unfortunately, many nurses begin to look elsewhere for jobs that are less demanding and ultimately, less stressful.

#8 – Costs actually go up.

Besides the overtime you need to pay your existing nurses to cover the short-staffed floors and the call-outs, you might need to deal with an increase in medical claims from your sick & stressed employees. In general, more call-outs and greater turnover can lead to a lower quality of care (more errors), and a definite increase in expensesWorking short staffed actually increases costs and negatively impacts patient care in the long run.

Chris Caulfield RN,MSN
Chief Nursing Officer | IntelyCare

Chris Caulfield (RN, NP-C), is the Co-founder and Chief Nursing Officer of Intelycare which the fastest growing Per-Diem Nurse Staffing organization in the US. IntelyCare is a technological enhanced platform that was founded in 2016 and now has over over 3,000 IntelyPros (RN, LPN, and CNA employees) serving over 150 healthcare facilities throughout the northeastern US.

Prior to founding IntelyCare, Chris’ past Healthcare experience includes Long Term Care Nursing, Nursing Informatics, Labor Relations, Case Management, and a Urgent Care Nurse Practitioner.

Self-Care Of Nurses To Prevent Work-Fatigue Syndrome

As much as we want to portray a “superhero” persona to the public, nurses are mortal beings who are also capable of experiencing wear and tear of the body. The job itself is hailed as one of the most dangerous jobs because of the many elements that a nurse encounters in their working environment. Some of these factors include strenuous and physical exertion on the job, work hazards like getting exposed to diseases, radiation, and surgical smoke, combative and aggressive patients and their demanding and impatient families. Nurses also experience stress concerning their employment status and relationship with colleagues and the administration they are working with. Understaffing concerns and the increased rate of turnovers in hospitals and nursing homes  leave nurses in a state of fatigue and dissatisfaction in their work. To overcome the implications of stress, nurses should be able to practice the art and skills of self-care. As soon as these skills are practiced, it can help to lessen the effects and seriousness of the negative implications of their work, enhance their dealings with other people in the workplace, and gives a positive outlook in their daily working lives.

Work-Fatigue Syndrome

Everybody gets tired from work especially after a very tiring day. The endurance of the body is only limited to a certain number of hours until the energy levels wear down and the body feels the effects of work. Persons who work and deal with emergency and life-threatening situations are much prone to suffer from the work-related fatigue compared to those who are employed in regular work environments. As an example, healthcare professionals are cited to have an increased risk of work-related hazard and can experience work-fatigue syndrome as much as soldiers in the battlefield.

Unlike doctors and other ancillary staff, nurses stay with the patients and their families most of the time. This condition alone already places the nurse in a stressful situation due to the many tasks that they need to implement to the patient. Studies revealed that nurses who are exposed extensive work-related stress can suffer from burnout and psychological imbalance (Smith-Miller, Shaw-Kokot, Curro, & Jones, 2014). These effects on the nurse can lead to some further serious complications such as compromising patient safety secondary to errors in nursing care practice, medication safety administration, documentation errors, and even interpersonal relationship of the nurse with other members of the healthcare team (Martin, 2015). As such, there are also many research on how to help nurses lessen the burden of their clinical work and focus more on the self first before taking care of others.

It’s Not Being Selfish

You cannot give what you do not have. This old time saying proves everything about nursing and other service-oriented profession. One must remember that to be effective and successful in your chosen career, you must entail enough preparations – intellectually, physically, emotionally, and psychologically. Failure to do so can lead to being unprepared and can compromise your skills and performance in doing your job. Taking care of oneself first is not selfishness. In fact, this just proves that you value your work more and by doing the necessary self-care allows you to offer more of yourself. The following strategies can help in minimizing stress on the job and helps with taking of yourself both in mind and body.

Apply The Nursing Process

Nursing process is not only for patients. You can also utilize this approach in solving your self-care deficit problems. The first thing that should be done is to conduct a thorough assessment of yourself:

  • Do you always feel tired? Are you having more tired days now compared to your previous experiences?
  • Are you gaining or losing weight?
  • Do you have trouble in sleeping?
  • Are you committing mistakes on the job?
  • Are you feeling inadequate in your present work?
  • Do you encounter personal or work-related confrontations?
  • Do you have more time in work than spending personal time?
  • Are you always not present in family and friends’ celebrations?
  • Do you feel stagnant in your present job?
  • When was the last time you have taken a long vacation?

The questions posted above will give you a head start on how to examine your present situation. It is not a standardized questionnaire that can diagnose whether you lack self-care or not, rather a simple introjection of thoughts and feelings about how you are doing with your present work. If most of the questions here are answered with a yes, then it is time to pause and plan for your self-care interventions. As you go along, some strategies can be effective while some are not. You can gauge the effectiveness of every strategy if there are some improvements in your work and wellness state. Otherwise, your evaluation will tell you to do away with this method and look for alternative ways to help you with self-care practices.

Helpful Strategies

Physical Dimension. In this aspect, the focus would be your eating and sleeping habits as well as physical strength and endurance. Incorporate healthy meals into your daily food intake. Don’t rely much on the vending machine for your breakfast, lunch or dinner. Get enough rest before your shift starts. A 2-hour sleep before your work-schedule can boost one’s energy. Power naps are also proven ways to restore energy, but you need to check the policy of the administration if they allow short time breaks for sleeping while on the job. You don’t need to enroll in an exclusive gym to get enough exercise. You can apply simple exercise regimen even while at work. Park your car far from the employee’s entrance to give you ample time to walk. If your workplace is just near to your place, it is better to walk than commute.

Psychological Dimension. Mental clarity is achieved if the senses and brain functioning are well-rested. Experts recommend exploring a hobby or engage oneself in travel and adventure. Our five senses need a break from the routinely activities. Travel to new places and discover wonderful sights, taste new dishes, indulge in long massages, and bask in many variations of aromatherapy.

Final Words

There are many other ways that nurses can help themselves in attaining physical and mental wellness to help them with their work and prevent from succumbing in work fatigue syndrome. All it takes is the commitment and determination to partake in self-care routines and get connected with the outside world other than work alone.

References:

Martin, C. J. (2015). The effects of nurse staffing on quality of care. MedSurg Nursing24(2), S4-S4.
Smith-Miller, C. A., Shaw-Kokot, J., Curro, B., & Jones, C. B. (2014). An integrative review: fatigue among nurses in acute care settings. Journal of Nursing Administration44(9), 487-494.

 

Chris Caulfield (RN, NP-C), is the Co-founder and Chief Nursing Officer of Intelycare which the fastest growing Per-Diem Nurse Staffing organization in the US. IntelyCare is a technological enhanced platform that was founded in 2016 and now has over over 3,000 IntelyPros (RN, LPN, and CNA employees) serving over 150 healthcare facilities throughout the northeastern US.

Prior to founding IntelyCare, Chris’ past Healthcare experience includes Long Term Care Nursing, Nursing Informatics, Labor Relations, Case Management, and a Urgent Care Nurse Practitioner.