Running Header: IMPROPER COMMUNICATION DURING SHIFT CHANGES 1

Improper Communication during Shift Changes

Olivia Volman

James Madison University

School of Nursing
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Introduction

In 2012 The Joint Commission released a statement about the importance on handoff

communication between nurses during their shift change. They determined that 80% of serious

errors made by healthcare professionals were due to shift change miscommunications (The Joint

Commission, 2012). They also determined that improper handoff communications increase a

patient’s time in the hospital and lead to improper care by the entire healthcare team (The Joint

Commission, 2012). Another study found that bedside handoff allows patients to advocate for

themselves, be involved in decision making, and remain as safe as possible during their time in

the hospital (Sadule-Rios, 2017). These findings show that proper communication and bedside

handoff are a major component to providing competent care to each of our patients.

Background

In my practice I have observed nurses fail to give a proper report to the incoming nurse

for their shift. The nurses are supposed to have an oral handoff at the patient’s bedside each

morning before their shift starts. However, I observed a nurse give a brief explanation of the big

topics that need to be covered for the patient that day with or without the patient in the room and

move on. The patient was not awake for the handoff and was not an active participant in any

decisions made during that time. This left the patient, the incoming nurse, and myself at a

disadvantage due to lack of knowledge about the entirety of the care that needed to be provided

for the day. I observed this situation and did not respond.

This situation caused me moral distress because I could see what decisions were being

made and how they broke protocol. I didn’t identify any lapses in care for my patient that day

thankfully, but the outcome could be worse for the patient in more of a long-term process.

Overall this could also affect other patients if the nurses get into a habit of this pattern. I can see
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how it can be an easy habit to learn because it is more time efficient for the nurses who wants to

go home after working a long shift and gives the incoming nurse the opportunity to start her day

faster. I believe healthcare should be more about what is good for the patient and how we can

best provide competent care for each individual. Creating an environment where they understand

and are able to question these medical decisions is very important. In nursing school, we discuss

listening to our patients and finding what works for them all the time. The only way to do that is

to give them the time that we can each and every shift.

Methods/Findings

At James Madison University we have eight key questions. These questions are used as a

guide for our own ethical thinking and decision making (James Madison University, 2018). Each

of these questions is something that we unconsciously think about each time we make a decision

however, when we highlight each one individually we begin to understand how we use these in

everyday life.

The first of the eight key questions is fairness, how can I best act to make sure that each

party involved is treated fairly? In this situation I believe that the patient is being treated unfairly

and to remedy this I would want to ensure that the patient is being included in each of the

handoffs and have the time to ask questions about their care and the plan for the day. We would

also want to ensure the nurses are being treated fairly by ensuring that they have enough time to

get a full bedside handoff on each of their patients, which we could help by having a lower nurse

to patient ratio. The next key question is outcomes, how can we achieve the best short and long-

term goals for each party involved? The Joint Commission discussed this in their statement when

they announced the need for proper communication (The Joint Commission, 2012). With and

improvement in communication during shifts changes we could solve many of the problems we
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have with our patients making everyone’s life easier. The third question is responsibilities, in this

situation what responsibilities does each person have? In this specific situation the nurses have a

responsibility to provide competent care to their patient. To ensure competency, having any

knowledge needed prior to treatment would be key. The previous nurse is responsible for

ensuring that everything she knows about this patient is passed along to the next nurse. Every

detail is important because as nurses we need to care for our patients as a whole person and not

just as one illness or injury. The incoming nurse is responsible for asking questions to clarify all

the information received and ask for more if he/she believes they don’t have the entire picture.

The fourth question is character, what actions best represent me and who I am? I believe

this can apply to each nurse with every decision they make. Every decision is a chance to show

that you are a knowledgeable, capable nurse who knows how to the very best for their patient.

The fifth question is liberty, how does a person’s ability to have control over themselves apply to

each situation? The really applies to the freedom that these nurses are taking away from their

patient. By not allowing the patient to play an active role in their own care we are doing them a

disservice and taking away freedoms that should always be granted to them. Every person should

have the chance to play a role in their care because everything we do for them affects them.

While we may think we know what is best for the patient only they can make that final decision.

The sixth question is empathy, how would I make this decision is I cared about each

person involved? In nursing I hope that each practicing nurse carries with them empathy for all

individuals. Being able to care about people and what they are going through helps to make our

jobs easier. The seventh question is authority, what do people in a place of authority expect from

my decision? These authorities could be the charge nurse or even the ANA or TJC. The charge

nurse would expect each nurse to be following hospital protocol by doing the bedside handoff.
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The ANA or TJC would expect that nurses are following the expectations they have announced.

They have expectations that each of them lays out in statements and that are backed by research

in hopes that nurses will follow them and believe their validity.

The eighth question is rights, what rights apply? This goes back to fairness and liberty in

that the patient has the right to make their own decisions and be their own advocate. The

American Nurses Association has created code of ethics that all nurses are supposed to follow in

their practice each and every day (ANA, 2016). Provision three which states, “The nurse

promotes, advocates for, and strives to protect the health, safety, and rights of the patient,” could

be used to help fix this dilemma (ANA, 2016). By not giving a full handoff between shifts the

nurse isn’t treating the patient’s health and safety as a priority nor are they advocating for the

rights of the patient. This patient could potentially have adverse long-term outcomes due to the

lack of information from each nurse providing care.

Conclusion

In conclusion, proper communication between nurses including patient involvement is

key to attaining the best possible care. We could attempt to remedy this problem by

implementing a standardized tool for shift change handoff reports. It’s important for all nurses to

maintain proper communication to ensure the best outcomes for our patients and to help reduce

the amount of time patients spend in the healthcare facility.

In retrospect I should have questioned the information from the outgoing nurse and

potentially talked to my professor to see if she wanted to bring this to the charge nurses attention

so that it didn’t become a pattern among the nurses on this floor. In the future I will remember

what I have observed and use it to remind myself that even after a long shift my patients deserve

the very best treatment that I can give them.

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References

American Association for Nurses (ANA). (2016). Code of ethics for nurses with interpretive

statements. Retrieved from

https://anacalif.memberclicks.net/assets/Events/RNDay/2016%20code%20of%20ethics%

20for%20nurses%20-%209%20provisions.pdf

James Madison University. (2018). The Eight Key Questions. Retrieved from

https://www.jmu.edu/mc/8-key-questions.shtml

Sadule-Rios, N. (2017). Off to a Good Start: Bedside Report. MEDSURG Nursing, 26(5), 343-

345.

The Joint Commission. (2012). Center for Transforming Healthcare releases targeted solutions

tool for handoff communication. Joint Commission Perspectives, 32(8), 1-3.