The Best Nursing Change of Shift Report

Picture yourself as a patient waking up in a cold hospital room and dreading the day. A stranger comes in, says they will be your nurse today, and then leaves the room to get your morning medication. You feel a little empty.

Another day, your friendly night nurse walks in and introduces you to the oncoming nurse. They smile, discuss your care with you and ask if you need anything to make you more comfortable. You request a warm blanket. You feel included and informed about your care.

Which change of shift would you prefer if you were a patient?

Change of Shift Report

Change of shift report, or handoff, happens when you are assuming the new patient assignment. Pertinent information is exchanged from the nurse leaving so you can start your shift to safely take care of the patient.

As a 25-year veteran nurse, I have seen many different ways handoffs can occur, including the following:

• Audiotape report recorded and played back for the oncoming shift

• Handwritten report

• Computer printouts of patient information

• Verbal report with groups at the desk or conference room

• Charge nurse reporting for all the patients

There is one person missing from these examples of handoffs—the patient! 

According to research studies, a bedside report that includes the patient is the gold standard.

Bedside Report 

A bedside report (BSR) includes the nurses between shifts, the patient, and the family. The starting point is introducing the on-coming nurse and making the patient feel comfortable. 

Next, nurses review the overall care and updates. Safety checks can occur at the same time:

• Activating the bed/chair alarms for a high fall risk patient 

• Ensure the call light and possessions are in reach

• Evaluating IV lines to ensure fluids and medications are as prescribed

• Review of patient’s status

  • Are the wounds/surgical sites intact?

  • Has a new symptom emerged?

  • Is the patient physically presenting as they did during the shift? 

Then, start with the basics: the patient’s name, age, and diagnosis. 

The off-going nurse should also address the following: 

• Allergies

• Discharge planning

• Labs that are outside normal ranges, and if labs need to be collected

• Medications, including the effectiveness of PRN administrations

• Outstanding provider orders

• Physical symptoms that are abnormal

• Prescribed diet

• Psychosocial concerns

• Patient medical history

• Tests and procedures pending or completed

• Telemetry status

This list is not all-inclusive. It will vary by unit and specialty, so it would be a great idea to make a standard check-off with your team. 

It is best practice to review the complete list of doctor’s orders with the off-going shift. Opening up the electronic medical record (EMR) to review together can inform as well. This way, the nurses can address questions or discrepancies. 

As a nurse, you are responsible for carrying out the doctor's orders, so be crystal clear on the list for the day. Painting a picture of the patient’s day is helpful for the on-coming nurse, and a BSR achieves this. 

Reasons a Bedside Report Is Best

Safety is the main reason BSR is optimal. Studies show that after introducing BSR, falls decreased by 24%, preventable errors decreased, and more medication administration errors were “caught.”

Other reasons include:

• Improved nurse accountability

• Increase in patient satisfaction with this enhanced communication process

Bedside Report 

What if the inevitable interruption occurs? For example, the patient needs to go to the bathroom while you are giving the BSR, and there is no CNA in sight. It is a great time to confirm the patient’s ambulation status with the off-going nurse. Also, you can do a quick visual scan of the patient’s skin and respiratory status. As nurses, we are great at multitasking.

What if the oncoming nurse wants to sit and drink coffee while exchanging information? The reluctance to incorporate a BSR is common. We get it; it is easier to sit and chat with your nurse BFF. But walking to the patient’s room helps you fully get started for the work ahead. Face-to-face communication is key.

What if you see an error during the BSR? Correct the error without alarming the patient. Let the nurse know the discrepancy outside of the patient’s earshot and determine the next steps. We are human, and mistakes happen. With a BSR, you may have caught the miss early. 

When Not To Do a BSR

Patients may want their privacy. A patient with advanced dementia will not take part in a BSR. And, of course, we do not wake patients up for a BSR. Sharing sensitive information privately with only nurses is appropriate. 

BSR is a time to use your incredible nursing judgment. For example, you can still do the basic BSR safety scan on the sleeping patient. Then speak away from the patient for other facts. 

Here are some other tips for bedside reporting:

• Be friendly

• Be professional

• Be non-judgmental if incomplete work is present 

• Encourage privacy. If people are in the room, ensure the patient would like a BSR or have their visitors step outside

The BSR is complete, and you are ready to tackle the day. You have developed a warm relationship with your patient by providing the requested blanket. 

If you are the off-going nurse, you can leave with the satisfaction of knowing that your patient is in capable hands. Congratulate yourself on a great shift report.