Meeting the New Nurse at Change of Shift

Hospital places can be disorienting for patients and their families. The best way for patients to feel that they have some control over their hospital stay is information: information about their medical plan of care, information about the treatments and procedures prescribed for them, and information about the nurses assigned to them. Regarding this last item, patients and their families should strive to meet the nurse assigned to their care at the start of each shift, as this introduction can help alleviate some of the anxiety that comes with a hospital stay.

Nurses are the primary interface between patients and the hospital environment, and ideally, patients would have the same nurses, or the same rotation of nurses, during their own hospital stay. This, of course, is not realistic, since any one nurse may not work full-time, or may work at any one of a number of nurses' stations through the hospital on any given day. In addition, depending on the practices of the hospital, nurses may work eight or twelve hours per shift; accordingly, during a twenty-four hour hospital stay, there could be two or three different nurses providing care. If the hospital admission is for forty-eight hours, that number could double to four or six different nurses, depending on the length of the nursing shifts. This on-going turnover in the caregiver role can be a source of anxiety for patients and their families.

Hospitals follow various practices to ensure the accuracy and completeness of the communications between outgoing and oncoming nurses, but the following information is generally included in the hand-off: the patient name and medical record number, the relevant medical history and the reason for hospitalization, important events that occurred during the shift just ending, tasks to be performed by the oncoming nurse during the incoming shift, any procedures for which the patient is scheduled, and any other information the oncoming necessity should know. These hand-off communications can take place at the bedside next to the patient, or outside the patient's room.

Patients and their families can be engaged with this change of shift process even if the hand-off communication between the outgoing and oncoming nurses takes place outside the patient's room. Shift changes, for hospitals on eight-hour shifts, typically take place at 7:00 am, 3:00 pm, and 11:00 pm. For hospitals on twelve-hour shifts, these changes usually occur at 7:00 am and 7:00 pm. Patients and their families can request the outgoing nurse to introduce the oncoming nurse to them, and this would provide an ideal time for patients and family members to ask any questions they may have, or mention any concerns. Such introductions can increase the confidence of patients and family members that the oncoming nurse is aware of particular details of the patient's hospitalization, and enhance their communications with the nurse over the incoming shift.

Depending on the circumstances of the patient's hospitalization, face-to-face introductions may be particularly important for the change of shifts occurring at 7:00 am and 3:00 pm, for hospitals using eight-hour shifts, and 7:00 am and 7:00 pm for those using twelve-hour shifts. Patients may be trying to sleep at the third change of shift for hospitals using eight-hour shifts, 11:00 pm, and may not wish to be disturbed. If so, patients can ask the 3:00 pm shift nurse to have any hand-off communications at 11:00 pm take place outside the patient's room, and also have the introduction to the night nurse deferred till morning.

In-patient hospitalization can be overwhelmingly stressful. Part of the stress is the turnover in nurseries and staff during the patient stay: this stress can be managed. The outgoing nurse provides essential information to the oncoming nurse about the patient as part of the continuity of care. This hand-off communication can take place at the bedside or outside the patient's room, depending on the hospital's practices. Even if the hand-off takes place outside the room, patients and their families can still request the outgoing nurse to introduce the oncoming necessity to them during change of shift.