Is Handover Still Necessary?

roser13, ASN, RN · Apr 13, 2016

By "handover" do you mean report?

If so, while I agree that some folks give a better report than others, it's far from pointless or unnecessary.

Not exactly sure what your point is. Do you seriously want to walk cold into your patient assignment every day?

Hollybobs · Apr 13, 2016

Is handover still necessary?
However, what they say could also help you better serve your patients. Listening to handover may help you avoid reinventing the wheel. Your coworker may also have insights that could elude you if you walk into a situation cold. Of course, simply knowing what the patient has done the previous shift is helpful as well.

You've sort of answered your own question there. It can be useful for a bit of peer support, for quick guidance if junior, for passing on communication from relatives/physio's/Dr's. For a heads-up or any warnings or triggers or no-no's. For patient preferences and for any jobs not been done that may need to be done asap. And more, probs.

akulahawkRN, ADN, RN, EMT-P · Apr 13, 2016

Handover is one of the most controversial subjects in nursing. It is difficult. It feels pointless sometimes. It takes forever.
Is handover still necessary?
Honestly, you could be assessing patients instead of hearing the (sometimes) half-baked opinions of your coworkers. However, what they say could also help you better serve your patients. Listening to handover may help you avoid reinventing the wheel. Your coworker may also have insights that could elude you if you walk into a situation cold. Of course, simply knowing what the patient has done the previous shift is helpful as well.

Disclaimer: I'm an ER Nurse... but mostly the bolded stuff above are reasons I want to get at least some kind of report about my patient assignment.

When I get report, I just want to truly know only a very few things. I want to know what the patient is complaining of, was anything done about it (what was given, when), has the provider seen the patient, the current medical plan, and is there anything not yet done. The rest, like vascular access, specific patient preferences, and the like are all things that are nice to know. I also simply want to know if "you" have done the patient assessment and put it into the computer already.

I can, if necessary, start off with just a quick look at the triage note or even the patient's "face sheet" and go from there. I do come from the prehospital world, so I'm OK with walking into a patient's room completely cold and doing my assessment from zero knowledge of the patient.

Worst case report would be "Patient 1 has CHF, is on Bi-Pap. Patient 2 has a laceration the left hand, it's been irrigated and numbed for suturing. Patient 3 is complaining of migraine pain, took Tylenol and ibuprofen without relief at home and was just put in the room. Patient 4 has upper abdominal pain, has a 20g IV in the Right AC, and is in CT right now." Yes, this is quite minimal, but I'm not entirely blind, I know where my patients are, and I can then begin doing my 2 minutes of research and meeting all my new patients.

willegan · Apr 13, 2016

Yeah sorry, reporting. =)

SleeepyRN · Apr 13, 2016

I don't think the question should be if report is necessary, but, rather, is the info provided in report useful. If not, then you're giving/receiving a poor report.

I could have cared for the same patient the last 3 days in a row. I still want updates. Any changes in condition, labs, orders....what has been done about it, and what needs to be done still.

Nothing makes me more uncomfortable than coming on shift after a poor report and hearing from a family member, "How is my mom today?" Because I don't know yet. I received a poor report. Many times largely in part because the nurse before me received a poor report and only knows what occured, or rather, didn't occur, on his/her shift.

I work in post acute rehab, and throughout report I often hear, pt 1, fine, pt 2, fine....Then a family member asks "Why has my mom's (insert medication) changed? How are the results of her x-ray from yesterday? I'm thinking, "what x-ray?" Well, don't I look incompetent, then. So instead of it being passed in 5 seconds in report as x-ray negative, MD/NP thinks it's such and such....I have to take 10 minutes to find results, read progress notes about why this patient had an x-ray, and if it's negative THEN what's the plan? Sigh....I'm rambling, I'm so frustrated just thinking about it.

calivianya, BSN, RN · Apr 13, 2016

It's 100% necessary.

Just digging through the chart doesn't tell me everything. Neuro status is a great example of something that's hard to quantify just by charting alone.

If all that's charted is that the patient is drowsy and does not follow commands... how drowsy is drowsy? If the patient took some effort to wake up and went right back out, is that the same or not? I would call that more lethargic, but would the previous nurse call it drowsy and wait until the patient is something closer to obtunded to call them lethargic? Or, did the patient just have a big neuro change between when the nurse last assessed him and when I got there?

The worst offender, though, is NIH scores post tPA administration. If the nurse bringing the patient up from the ED was not the one scoring the patient in the past, and I am a harsher grader than the one who was scoring the patient before, it might look like the patient jumped from a NIH of 8 to a NIH of 22, which will get me ordering a stat head CT per protocol to see if the patient developed a brain bleed.

I have taken several patients down for stat head CTs because of "NIH changes" in the past, and none of them have had a bleed - telling me if the ED nurse who took care of the patient brought him up instead of a resource nurse, I could have avoided wasting my time in CT. It's ridiculous the amount of time wasted because the ED nurse taking care of the patient can't be bothered to bring the patient up herself.

K+MgSO4, BSN · Apr 13, 2016

Imagine a hospital that doesn't have an EMR.... that has partial electronic repoting Systems for pathology, radiology and ED. Non of them talk to each other. A 25 bed ward has a clerk computer, nurse in charge computer, pharmacy computer and a grand total of 2 other computers....... this is 2016 in a quantertiary trauma centre in a first world country. ?..... think verbal handover is needed?

akulahawkRN, ADN, RN, EMT-P · Apr 13, 2016

Imagine a hospital that doesn't have an EMR.... that has partial electronic repoting Systems for pathology, radiology and ED. Non of them talk to each other. A 25 bed ward has a clerk computer, nurse in charge computer, pharmacy computer and a grand total of 2 other computers....... this is 2016 in a quantertiary trauma centre in a first world country. ?..... think verbal handover is needed?

Aside from being a trauma center, I was in a very similar hospital about 3-4 years ago, except for the "trauma center" thing. All the charting was done on paper, there were paper MARs, and so on. I think it was a little over a year ago that they transitioned to an EHR. They've gone from no EHR to having basically everything integrated in a very short time throughout their entire regional system, not just one hospital. If memory serves, the last time I was there working with patients was in early 2012. That was back when I was a student nurse and at least a couple classes "behind" mine had to contend with the same issues.

K+MgSO4, BSN · Apr 14, 2016

Aside from being a trauma center, I was in a very similar hospital about 3-4 years ago, except for the "trauma center" thing. All the charting was done on paper, there were paper MARs, and so on. I think it was a little over a year ago that they transitioned to an EHR. They've gone from no EHR to having basically everything integrated in a very short time throughout their entire regional system, not just one hospital. If memory serves, the last time I was there working with patients was in early 2012. That was back when I was a student nurse and at least a couple classes "behind" mine had to contend with the same issues.

The kids hospital up the street is implementing an EMR next month....4 year lead time to get to this point.

Been there,done that, ASN, RN · Apr 14, 2016

Appears that you don't value your coworkers nursing skills.

A clear and concise report should take 3 minutes per patient. If you are not experiencing that.. be the change.

If there was no handoff... when is the oncoming nurse LEGALLY responsible for the patient?