Structured Bedside Handover
“Everyone used to have their own script for handover, some were lengthy, others didn’t give enough information. Bedside handover has given us structure and everyone’s on the same wavelength”
Kristen, 6A South
Faster For Nurses, Safer For Patients
Nurses dread getting bad patient handoffs where there is no structure, making handoff less safe and more stressful. Structured Bedside Handover standardizes each handover with a structured, single-page shift report form. It uses an ISBAR framework, Review of Systems outline, and it’s customized for each unit. This form is presented top to bottom by the outgoing nurse, then handed over with our patient.
We find nurses much prefer this nurse-designed form over the EMR and its overstuffed SBAR screen. We believe standardized nursing communication should be made as easy as possible. The best tools simplify what’s complex, without losing detail.
Nurses First™ Structured Bedside Handover Features
- Structured for better clinical handover
- Warm, professional, & brief (3-5 min)
- At bedside with patient invited to participate
- Ensures oncoming nurse starts with information needed for continuity, safety, patient advocacy and rounds readiness
- Helps off-going shift leave on time
Why Nurses Like It
Example In Use
Frequently Asked Questions
About Bedside Handover
What is Bedside Handover?
Bedside Handover is a brief, structured shift report presented by the outgoing nurse to the oncoming nurse and the patient. It empowers the patient and the oncoming nurse to verify information being reported, to hear the status of nursing-sensitive quality and safety indicators, and to start the shift on the same page with the patient’s subjective goal – what the patient cares most about.
The Nurses First implementation of Bedside Handover elevates shift report from a task to an elite competency – with specific skills to learn, practice, and verify.
How long does Bedside Handover take?
Bedside Handover usually takes 2-5 minutes per patient.
How is this different from the shift report or handover we are doing today?
The Nurses First version of Bedside Handover is unique in a few ways. First, it’s user-friendly: it has a streamlined, front-and-back single page format using an ISBAR outline with a review of systems. Many thousands of nurses have refined this Bedside Handover for Nurses First. So, the information needed for continuity and safety flows in the same logical sequence every time. That’s super-important. When we hear information in the same predictable order every time, our brains can start making sense of the information right away (instead of having to do extra work just to figure out what information is coming at us and what’s most important).
Second, it’s always done at the bedside. Let’s face it, as nurses we sometimes shy away from doing handover with the patient. But if we’re at the bedside lots of positives happen at once. One positive is that we can visually assess our patients as we hear about them – it makes the story and the status come alive and creates a living picture of who the patient is right now. Another positive is the accountability it creates – it lets us verify information we’re hearing as we hear it.
Last, but not least, it gives the patient and family a chance to see us in a highly professional light. Their confidence in us grows. They notice when we invite their inputs. They hear us make accuracy a priority. And they feel greater control over their care and safety.
What’s covered during Bedside Handover?
The Bedside Handover report is a pre-printed 1-page front-and-back sheet. It uses the familiar ISBAR format (Identity, Situation, Background, Assessment, Recommendation) with a review of systems to help build a picture of who this patient is right now and what needs to be done on the upcoming shift.
What’s special is it flows from top-to-bottom in a simple, logical way. It quickly becomes familiar after using it just a few times.
The structure lets us be brief and to the point. It lets us give and receive handover in the exact same sequence every time.
Before the launch of Bedside Handover, we will work with the nurses on each participating unit to smartly customize their version of the report to meet the needs of their unit and patient population.
What is the role of the patient and family during Bedside Handover?
Ideally, to listen, learn, and help verify that the information is accurate.
How do I know if I’m doing Bedside Handover really well?
The art of Bedside Handover is to communicate accurate information that’s inherently complex and changing across at least three different people – you, your oncoming colleague, and the patient.
To make it easier, friendlier, and more purposeful, we’ve pinpointed the 9 high-performance behaviors for doing bedside handover really well.
When an outgoing nurse consistently practices these 9 high-performance behaviors, it signifies competence.
Nurses First is designed to help us know exactly when we’ve achieved competence on our journey to becoming an expert in Bedside Handover. We’ve made it easy to assess these high-performance behaviors electronically with the 1Unit Software Platform.
What are Electronic Skills Assessments?
Electronic skills assessments are unique and valuable. Electronic skills assessments help staff learn from real-time feedback. They also show staff we’re paying attention and can easily collect data about the integrity of the processes. Nurse Managers and executives can use this data to support individuals who are struggling, strengthen regular performance reviews, and sustain overall great performance.
How do Electronic Skills Assessments happen?
Soon after the launch of the Nurses First processes, Nurse Managers and their assessors begin the process of assessing their nurses.
In this picture, two nurses are conducting a Bedside Handover. The third is a charge nurse who is in the role of an assessor. She is using the 1Unit software to conduct a real-time electronic skills assessment.
On the assessor’s device is a list of the 9 high-performance behaviors for Bedside Handover. They are tapping the boxes next to each high-performance behavior that the outgoing nurse is performing successfully while giving the Bedside Handover.
After the handover, the 3 nurses return to the hallway, and the assessor privately shows the outgoing nurse how they did – revealing any blind spots they may have. This feedback is real-time, objective, and specific. The outgoing nurse now knows exactly what to work on with the next patient.
When a score of at least 8-out-of-9 is earned for three different Bedside Handovers, the 1Unit Software Platform marks that nurse as ‘Competency Verified’.
Nurses should be re-verified at least once every 24 months.
What other benefits are associated with Nurses First Bedside Handover?
One of the additional benefits of the Nurses First Bedside Handover process is that it ensures every nurse can start and end each shift ready to do any type of interdisciplinary rounds or advocate for any of their patients at any time during their shift. N1 Bedside Handover ensures review of a unit specific quality-safety checklist, containing common HACs, occurs at least twice every day to prevent unintentional harm and costs. Nurse colleagues can also easily step-in for each other if needed, as the pertinent patient information is readily available. Units with Nurses First have seen significant improvements in patient experience.
Bedside Handover Excellence
Do It Right + Make It Stick
Using a standard bedside handover form offers consistency in the data but not necessarily the handover. Having a policy and having it performed with excellence on the front lines can be two different realities.
Elevating Bedside Handover from a task to a skill that is practiced every shift, enables nurses to become experts through mastering these new skills. The winning recipe is the same: Learning, Practice, and Feedback.
- Follow the list of high-performance behaviors that make Bedside Handover go really well for everyone.
- Set a goal for units to achieve Bedside Handover Excellence, which means all nurses are verified as experts in Bedside Handover.
That’s what made it stick. Notice a better start and end to shifts, better use of everyone’s time, and better care, both for patients and each other.
Bedside Handover Excellence FAQs
Why care about Bedside Handover Excellence?
It’s the standard for high-reliability hospitals.
For 150 years, nursing has advanced by elevating tasks into elite competencies — with specific skills to learn, practice, and verify.
Bedside Handover is the next essential competency for our profession to elevate.
To make it stick on our units, Bedside Handover Excellence consists of five pieces:
- A unit-wide commitment to excellence
- Learning – short videos and an in-service
- Checklist of high-performance behaviors
- Skills assessments and feedback from a trained assessor
- Dashboards to track nurse and unit progress
This is how our units take training and performance transparency for nursing communication to a new level.
(1) How do we establish a unit-wide commitment to excellence?
Share your vision with your staff. You can use our videos.
Many Nurse Managers like to get staff buy-in through 1-on-1 conversations. Some will also send around a video of a gold standard Bedside Handover, to show what’s possible.
Points to emphasize with your staff:
- This is an easy way we can care for one another each shift
- It’ll save us time and be safer for patients
- It’ll elevate how patients see us and feel cared for
Even veteran nurses who feel confident in their handoffs agree that when they hear information in the same predictable order every time, their brains can start making sense of the information right away.
(2) What's the best way to teach Bedside Handover?
Make learning short and sweet.
Nurses are busy – we like to learn in quick little bites, and then get back to work.
So on our units, we teach the basics with (1) a few short “how and why” videos and (2) a quick in-service training.
And make feedback objective, specific, and real-time.
Skills assessments help deepen the learning and reveal individual blind spots.
This trio of learning modalities — online training, in-service training, plus assessment and feedback — is what works best on our units.
(3) Why establish high-performance behaviors for Bedside Handover?
Skills assessments work best with objective criteria.
On our units, we call these “high-performance behaviors.”
First, we start with the simple recognition that doing a Bedside Handover is more than a task. It’s a core nursing competency. Plus, it’s the rare nursing skill that integrates a patient, a colleague, and a tool at the same time.
To make it easier, friendlier, and more useful, we developed 9 High-performance Behaviors that make Bedside Handover go really well for everyone. These behaviors boost collaboration, patient participation, and professional courtesy.
Here are a few of ours, refined from observing thousands of handoffs:
#3: Read through the Bedside Handover Report from start to finish without jumping around
#4: Speak directly to the patient and address them directly as “you”
#5: Use words patients understand, for example, “to prevent blood clots” instead of “VTE prophylaxis”
#7: Inform the oncoming nurse of pending tasks, orders, medications, and labs
(4) What's the best way to conduct skills assessments?
Empower charge nurses as assessors, and let them loose.
We all have blind spots. And we usually prefer to learn about those blind spots in a way that is private and constructive.
So on our units, we empower a pool of unit assessors — such as charge nurses — to conduct real-time skills assessments at the bedside. Each assessment is an objective evaluation of the 9 High-performance Behaviors. During a Bedside Handover, was each behavior demonstrated?
The assessor watches a handover, checks the boxes next to each successful behavior, and privately shares the results back in the hallway.
This simple process delivers feedback that is real-time, objective, and specific to show what needs work. Now the outgoing nurse who delivered the handover knows exactly how to improve for the next patient. That’s empowering.
A nurse who earns an 8-out-of-9 for three different Bedside Handovers is considered to be verified as competent.
It takes around 5 weeks for a 25-nurse unit doing 4 assessments per weekday. Not a small effort, but also not particularly cumbersome — especially given the tremendous value of standardizing these important skills.
(5) How can we track nurse and unit progress?
Customized software makes it easy.
The right software is ideal for helping nurse leaders solve hard problems — like hardwiring a new Bedside Handover protocol across a hospital or health system.
On our units, we use a piece of software specifically designed by our nurses and healthcare engineers. We’re happy to show you a demo.
If you’d like to use your own software, here are the 3 features you’ll want:
- Learning Management System to deliver online videos, quizzes, and to track learner progress
- Skills Assessment record-keeping to track who’s been assessed and how they performed.
- Progress Dashboard – simple charts to track nurse and unit progress toward Bedside Handover Excellence, and to compare performance across units, managers, and individual staff.
(We’ve found it to be ideal if the skills assessments can be done by a unit assessor electronically using a smartphone or tablet, to combine assessment and data entry into one fluid step.)
Bedside Handover Excellence Example Training Video
Voices from the Frontline
“Physicians seek out that nurse”
– Brittany, RN
“We see the benefits of having the uniform process.”
– Amy, RN
“When you do it this way you have a cohesiveness on the unit”
– Ashlie, RN
There’s great power in beginnings.
Change the first 20 minutes of each shift,
and you change the culture of your unit
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.
Send me the TEAM Huddle Sheet
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.
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.
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:
-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