nursingforsocialjustice

Shift report (sometimes referred to as Shift Handover) is an important part of the day to day workflow of an inpatient health unit. Unique to mental health inpatient areas is the team-based aspect of shift report. Most patients admitted to mental health inpatient programs are ambulatory, most units are designed for patients to socialize with each other. Units are designed with common spaces. Some are designed with shared rooms and/or bathrooms. There are increasingly interdisciplinary teams that provide the 24/7 care. The process of clinicians starting a shift together and planning for the next however many hours they have ahead of them is integral to the patient care being delivered. Only recently has research and clinical review of the integral nursing records of handover been explored.

I have taken for granted the process of shift handover in my career. It is a process that requires more examination and scrutiny about the specifics of the process that are necessary to support safe patient care. A injection of chaos and ambiguity about the plans for patient care in the upcoming shift can lead to issues like missing information, unidentified risks, and lack of team cohesiveness. A curious difference that I noticed when I moved from Alberta to BC was that all nursing shifts in the collective agreement in AB have a 15 minute overlap to ensure that there is time for staff starting shift to recover handover. In my experience in BC the previous shift ends at the same time the next shift starts which leaves a gap in care where either patients are unable to receive care for a 15-30 minute length of time, or staff from the previous shift stay over the length of their shift to fill that gap in care. It is not ideal and I do not understand why the system in BC is structured this way other than efforts to cut costs of nursing expenditure.

Processes that are integral to competent care are sometimes invisible. There is not clear articulation of an evidence-based best practice standard. However, processes like these must be identified and explained for what they are in the complexity of the day go day nursing workflow. The organization, communication and planning that happens in the 15 minutes of handover are skills that are transferable and necessary for nursing care. The minutes minutes of handover is an opportunity to learn and practice leadership skills, team building, coaching, knowledge translation, a multitude of skills that are transferable to other areas of nursing and healthcare, and other environments where people work on complex teams. The complexity and necessity of a structured handover is something that should be interrogated as an integral nursing practice that enables optimal functioning of a healthcare system.

Peace,

Michell D.