Successful nursing handovers: tips for every shift
Clear communication is critical. Here’s how to make the most of handovers
I’ve seen handovers from many nursing perspectives.
Since starting at the Blackpool Teaching Hospitals NHS Foundation Trust as a healthcare assistant in 2005, I have been a staff nurse, sister and ward manager, and last year I became a matron.
Handovers are vital – so make them as effective as possible
I cover three care of older people wards and one general medical ward. Once or twice a month I’m on the wards as a staff nurse, working alongside the team. That’s something I won’t give up – I like to do it.
While my workload doesn’t allow me to join in handovers every day, I do when I can, around three or four times a week.
Clear, concise handovers are critical for maintaining patient safety, especially when staff are working flat out, as we have throughout the COVID-19 pandemic.
View our COVID-19 resource centreBased on my experience of working as a nurse at various levels, these are some of my tips for making handovers as effective as possible.
Involve the whole team in handovers
This is something I’ve learned from reviewing incidents, having to attend coroners’ court proceedings and other formal processes.
It’s so important that everyone in the team takes part in handovers, even the housekeeper – I want them to know when a patient needs a high-protein diet, supplements and snacks.
Handover must be a whole-team affair.
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Highlight risks and prioritise safety
Make sure everyone knows which patients are at high risk of deterioration – and highlight the risks at every handover because they can change from one shift to the next.
Does everyone know which patients have diabetes, or are at risk of falls or pressure damage?
We’re trying to ensure we recognise deteriorating patients earlier.
In the morning handover, for example, nurses will know if they need to undertake an extra set of observations on a patient before they do anything else. We’re looking to minimise harm but to do that we need to be aware of the risks to every individual.
Be specific about patients’ conditions and symptoms
Don’t simply say, for example, that a patient has dementia – provide details, describe symptoms and behaviour.
Ask ‘Have we contacted the family to establish a baseline?’ and ‘Could it be sepsis rather than dementia?’.
Socially distanced handovers must respect patient confidentiality
COVID-19 brought so many new challenges, among them communicating while wearing masks and personal protective equipment. Maintaining social distance during handovers also presents problems.
Balanced against all of that is the need to maintain confidentiality, so choose the location for handover carefully and ensure all those present can hear what’s being said but that patient details can’t be overheard.
Try out different approaches
On one of our care of older people wards, rather than different nurses handing over a group of patients, we trialled the nurse in charge doing the entire handover.
It’s been a success and means the nurses ending their shift can stay with their patients. It’s also improved communication between the nurse in charge and the other nurses.
All wards are different, so find a process that works for yours.
Don’t forget nursing students and agency nurses
Should you include agency staff and nursing students in handover? Absolutely, yes.
Our hospital has a high number of vacancies so we’ve been supported by agency staff. The nurse in charge or, more usually, the ward manager always does an induction for them.
Agency nurses get to know how the ward works and are a crucial part of handovers, as are students.
Keep handover short but focused
For morning handover, we aim to be done in 20 minutes or half an hour at most, depending on whether patients have deteriorated in the night.
Try to know your patients – but be honest when you don’t
Sometimes it’s difficult to remember everything – and that’s fair enough. Be honest and don’t try to cover up for things you don’t know.
If you’ve had a challenging shift and you’ve taken out a patient’s catheter but have been too distracted to notice whether they’ve passed urine, just be honest and say so. It’s safer that way.
Make sure you listen to colleagues and patients
Don’t forget that healthcare assistants are equally valuable members of the team; be as attentive to them as to any other member of staff.
Listen to what patients say too, so you can report it back to the rest of the team in handover.
Be ready to learn
Finally – and this is important – use handovers as lessons.
As nurses we ought to be reviewing our processes and looking for changes we can make that will encourage excellent care.
There’s no point in filling in a form to report an incident if you don’t learn from it. If an incident takes place on one of our wards, I always share it with all our ward managers.
I don’t say where it occurred because it’s not about blame or pointing fingers, but if an incident has happened on one ward it could happen anywhere, so we must all learn from it.
Maria Jennings is matron, care of older people, Blackpool Teaching Hospitals NHS Foundation Trust