Nurses First™

Nursing Handover Training That Achieves All 3 E’s

Efficacy • Efficiency • Engagement

Tools and training to hardwire standardized communication at the change of shift.

1Unit Nurses First Bedside Handover 3 Es

Register for an upcoming webinar

Register for a webinar to ask the hard questions like, “How can we do this hospital-wide?” and “How do we ensure this will support our nurses?”

Designed for Nurses by Nurses

Nurses will hand off patients more than 100,000 times this year at your hospital

High-reliability hospitals can’t afford to let things fall through the cracks

Works with hospital complexities and reduces burn out

1Unit Nurses First Structured Triple-E Bedside Handover

Access to reliable and predictable information is essential to a safe and collaborative nursing practice. Every shift is a chance to actively ensure our patients stay safe in the hospital. Co-produced care is better care, and partnerships with patients and families is at the heart of nursing care.

A Nurses First™ start of shift

Streamline the start of every shift
for optimal communication, workflow and safety

Nurses First 101

 Nurses First elevates a core task into an elite competency


Nurses First (N1) is designed by nurses for nurses. N1 standardizes information transfer at each shift and is offered to help staff start each shift with what is needed to be their best.

N1 is designed to improve the culture, safety, and efficiency profile of nursing care. It has been developed in the field from thousands of nursing shifts and refined across dozens of implementations. Nurses in over 100 hospital units worldwide have field-tested and refined the N1 processes, using timeless principles and modern evidence-based practice.

There’s great power in beginnings.

Change the first 20 minutes of each shift,
and you change the culture of your unit

1Unit Nurses First Change of Shift Huddle

Team Huddle

Our nurses didn’t feel like a team and started each shift more like a group of individuals running around. So we began a Change of Shift Huddle which takes 3 minutes. The off-going charge nurse reads through a standard form to the oncoming shift. It’s the most professional, efficient team meeting you’ll see anywhere in the hospital and starts with a 1-page form. You can use ours. Tens of thousands of nursing shifts have used it.

1Unit Nurses First Structured Triple-E Bedside Handover

Bedside Handover

As nurses, we dread getting bad handoff. When there’s no structure, each nurse gives report their own way and it feels less safe and more stressful.

So our units decided to standardize each bedside handover. The heart of our handover is a structured, single-page shift report form using an ISBAR framework, Review of Systems outline, and it’s customized for the unit. It’s presented top to bottom by the outgoing nurse, then handed over with our patient.

Safety and Quality

The assurance of quality and safety is the single most significant responsibility of leaders in healthcare delivery. It’s a cornerstone of our careers.

The hand-off process is pivotal to patient safety. Many breaches of patient safety occur around change-of-shift. Most hospitals have adopted some level of bedside handover by now, but telling nurses to give report at the bedside doesn’t reduce unnecessary variation. Every nurse has their own way of giving report and nursing handover is typically inconsistent and unstructured.

Patient Satisfaction

High patient satisfaction scores are achievable and it’s a natural result of hardwiring a daily “wow moment” for each patient.
HCAHPS scores are driven by “top box” positive responses, but it’s hard to impress every patient every day. Asking stressed-out nurses to also be “customer service agents” isn’t the best approach.

Nurse Engagement

We’re living in a new era. Hospital nursing is more complex than ever and 50% of bedside nurses now say they’re burnt out. Turnover rates are spiking. Nurses choose hospitals that find meaningful ways to care for them, and we leave the ones that don’t. They prefer hospitals that:

-Reduce stress
-Help them get familiar with patients as quickly as possible
-Reduce unnecessary variation in communication
-Make them feel part of a high-performing team
-Have a collaborative work culture

Why We Do This

Your patients are our patients.

We help take care of them by giving you up-to-date access to tools and best practices, and by helping you make them work for your hospital.

It’s a privilege to share this information with you. Thank you for the chance to support you and your nurses in the care of their patients.

Frequently Asked Questions about Nurses First

What is Nurses First?

Nurses First (N1) is designed by nurses for nurses. We offer N1 to units ready to start each shift with the support and information to be our best.

N1 is designed to improve the culture, safety, and efficiency profile of nursing care. It has been developed in the field from thousands of nursing shifts and refined across dozens of implementations.

N1 units standardize and sustain the following evidence-based communication processes through each nursing shift:

  • Change of Shift Huddle
  • Bedside Handover

Nurses in over 100 hospital units worldwide have field-tested and refined these two processes for Nurses First — timeless principles and fresh evidence-based practice.

N1 is based on a ‘pay-it-forward’ ethos of nurses caring for each other first, starting every shift feeling supported by each other.

For the first act of every shift, N1 brings the outgoing and oncoming nursing staff together in a Change of Shift Huddle, handing over the unit as if it were a patient.

Then we go to the heart of nursing by visiting the patient, transferring care and responsibility in a warm, super-professional Bedside Handover. Nurses First elevates Bedside Handover from a task into purposeful skill set we learn, practice, and role model.

Why the focus on Change of Shift?

Yes, both Change of Shift Huddle and Bedside Handover are nursing processes that we do in the first 30 minutes of the shift.

There are a few reasons we focus on this first half-hour:

  • There is great power in beginnings. Our first interactions set the tone for the shift. Are we a team of professionals looking out for each other – or a set of individuals doing our own thing?
  • The outgoing shift has accumulated a lot of knowledge – and it can either be fully passed along, or partially walk out the door with them.
  • Small improvements in daily routines have power. When it’s something we do multiple times a day, small moments really add up.
  • Units with a super-professional change of shift – every shift – tend to be calmer, to run more smoothly, and to handle stress and crisis better.

Is this more work for frontline nurses?

Actually, since the right information and details are handed over at the change of shift, we spend less time searching for information and much less time playing catch-up and dealing with surprises later in the shift. The pay-it-forward approach is less work because it’s more proactive. The work also feels more purposeful and collaborative.

What happens during a Nurses First implementation?

Customization happens during in-service training and launch usually happens the following Monday. More detail is in the N1 Partnering With You page.

In Step 5, the unit has the chance to try to achieve Nurses First Excellence.

For participating units, implementation proceeds through several stages, culminating in Nurses First Excellence:

  • Preparation and Readiness – the local Nurses First Project Officer is appointed, receives mentoring, and publishes the implementation timeline
  • Nurse Manager orientation – Nurse Managers and charge nurses learn about Nurses First and their implementation roles
  • Online Training – as many staff as possible from participating units complete a 25-minute online training module before receiving onsite training.
  • Onsite Training Week – for 2-3 days, Nurses First educators visit each unit each day at scheduled times to lead:
    • In-Service Training – participating units receive a brief ‘in-service’ style onsite training, led by Nurses First educators reaching as many nurses as possible
    • Assessor Training – nurse managers and their assessors learn how to use the 1Unit Software Platform to conduct and monitor electronic skills assessments of Bedside Handover
  • Customization – staff on each unit participate in customizing the Nurses First templates: the Change of Shift Huddle sheet (1-page) and the Bedside Handover form (1-page, front-and-back)
  • Launch – the week after onsite training, the Nurses First processes of Change of Shift Huddle and Bedside Handover officially launch and begin
  • Skills-Assessment Planning – the Project Officer and nurse managers develop an assessor pool (3-5 assessors for each unit) and choose a hospital-wide deadline within approx. 4-8 weeks by which to complete all skills assessments
  • Skills-Assessment Period – the assessor pool on each unit conducts an average of 3-4 skills assessments per day, and the Project Officer reviews weekly “Nurses First Activity Reports” to track and manage progress of each participating unit
  • Nurses First Excellence – units earn Nurses First Excellence as long >90% of nurses are verified as competent in Bedside Handover and there is a governance and accountability model in place to maintain training, verification and service level commitments on each unit.

In-service training typically happens over a 3-day period (e.g., Tue – Thurs) so we can reach as many nurses as possible.

Nurses First Training
Online training 25 min (anywhere, anytime)
In-service training 25 min (on unit, during a shift)
Total 50 min

What is “Nurses First Excellence?”

When >90% of nurses on a unit have been skills-verified in Bedside Handover competence, the unit has achieved Nurses First Excellence and there is a governance and accountability model in place to maintain training, verification and service level commitments on each unit.

This is an important milestone. It means a pay-it-forward skill set is verifiable on the unit. Nurses First Excellence means nurses, leaders, and patients can have high confidence in the communication between shifts for that unit.

A unit can maintain Nurses First Excellence by refreshing verification for >90% of nurses at least every other year. This includes training and verifying the Bedside Handover skills of new hires.

1Unit Nurses First Structured Triple-E Bedside Handover

How we partner with you

Nurses First provides units the opportunity to give exquisite attention to a specific part of their daily routine, shift change. As a new group comes in to take the reigns from their off-going teammates, the transfer of care of the unit and each patient should be handled in a very intentional way. So we start the shift with a brief and warm Team Huddle that communicates timely information that all staff should know. Then nurses pair off for Structured Bedside Handover, an efficient, consistent, nurse-developed and patient-centered version of giving report. The concepts are not novel, but the way they are put into practice and sustained with high performance behaviors is why hospitals ask us to partner with them.

Voices from the Frontline

When clinicians, patients, and hospital leaders all say they love something, that’s worth listening to.

“From their eyes she could have been a nurse with 20 years experience”

– Ellen, RN

“She came back to the ward really proud and really confident that she’d given it a great handover”

– Amy, RN

“There is no way in the past that would have happened”

– Ron, MD

Nurses First Readiness

The easy way to reveal frontline enthusiasm for a safer and more efficient nursing handover.

Unit nurses watch a quick video and answer 4 short questions

Get a report revealing frontline enthusiasm and readiness

Share the consensus with nurse leaders to support a pilot