Partnering with you
Rethinking change of shift
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.
Here’s How We Partner with Hospitals
We provide all the support to achieve excellence in under 60 days:
Planning and prep
- Services
- Timeline + milestones
- Roles & responsibilities
- Form customization
- Online & in-service training
- Software
- On-demand, tracked online training
- Hospital-wide license
Launch
- Services
- Form adjustments & additional customizations to meet unit needs
- Progress monitoring
- Software
- Web app to assess and track individual skills verification
Sustain excellence
- Software
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Track staff progress towards achieving Nurses First Excellence
- Verify skills PRN for new hires, annually/biannually for performance review
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"We rolled out hospital-wide almost overnight. We were able to embed the same process for change of shift in every unit. We were able to free our nurses to focus on care, not information gathering."
— CNO at a 600-bed US hospital
Nurses First is supported by the 1Unit Platform
Online Training
Brief “what to do and why” videos + quiz delivered by an engaging Nurses First Educator to learn the Nurses First processes of Change of Shift Huddle and Bedside Handover
Electronic Skills Assessments
A web-app for any assessor to conduct a real-time skills assessment, to offer constructive feedback on 9 high-performance behaviors, and verify competence in Bedside Handover
Performance Analytics
Charts, data, and custom activity reports – with personalized actionable insights – to gauge progress of each individual nurse and unit in acquiring Bedside Handover skills
Our 1Unit App is a web-app that works equally well on smartphones, tablets, and workstations, making integration and standardization easier than ever.
Voices from the Frontline
“I think it cuts out all the unnecessary information that isn’t needed that nurses may just pass on that doesn’t need to be included. So it keeps us focused on the patient and what they’re here for and the medical facts and not social things or other things that can sometimes creep into report.”
– Nurse
“I try to listen to which patients either have fallen or we’re very worried about falling because if the bed alarm goes off and you’re the only person sitting in the nurses station, you want to know how fast should I run to that bed alarm? I think that’s very useful information that we parse out in the morning huddle.”
– Nurse
“I really like the quality safety checklist with the Foley Catheters. Sometimes I think they get left in longer than they’re supposed to. People forget about it. You know, foley was in and this has been in for so many days, can we do a voiding trial on this patient?”
– Nurse
“If I had to tell myself something now that I wish I knew three, six months ago, it would have been, we should have done this sooner. We should have been after Nurses First a year ago.”
– AVP Acute Care
“[It elevates] what nurses have to communicate. It’s professionalism, it’s accuracy…So learn it, stick with it, follow our lead and you won’t be sorry.”
– CNO
“I think it cuts out all the unnecessary information that isn’t needed that nurses may just pass on that doesn’t need to be included. So it keep us focused on the patient and what they’re here for and the medical facts and not social things or other things that can sometimes creep into report.”
– Nurse
“We rolled out hospital-wide almost overnight. We were able to embed the same process for change of shift in every unit. We were able to free our nurses to focus on care, not information gathering.”
– CNO
“Help her to be a great member of this team, even if it’s only for today”
– Sarah, RN
“We see the benefits of having the uniform process.”
– Amy, RN
“The change of shift huddle kind of gets everybody ready, gets everyone there and … gives you a positive attitude for the day and you know incoming admissions, discharges, what’s planned.”
– Nurse
“It’s been amazing how this has played out.”
– Kathy, AVP
“There is no way in the past that would have happened”
– Ron, MD
“I’m not worried about going to work anymore.”
– Nurse
“We’re incorporating [the] patient more with the bedside handoff reports so they’re more aware of what’s going on with their care. And, their questions and their input.”
– Nurse
“Nurses hear [the information] for the entire floor. So it triggers you to say, okay, so 21 has a bed alarm. That’s not my patient, but 21 has a bed alarm, so I need to make sure that if something happens in that room, I [know when I] go in there, we’re all responsible.”
– Nurse
“When you do it this way you have a cohesiveness on the unit”
– Ashlie, RN
“She came back to the ward really proud and really confident that she’d given it a great handover”
– Amy, RN
” I think the good thing about the [Nurses First] bedside handover is that you can tweak it to your unit. So handovers before would not have been potentially as accurate as what I would like them to be or expect them to be. Whereas now we’ve got this process and yeah you could give that handover and it’d be 98% accurate.”
– Unit Nurse Manager
“I try to listen to which patients either have fallen or we’re very worried about falling because if the bed alarm goes off and you’re the only person sitting in the nurses station, you want to know how fast should I run to that bed alarm? I think that’s very useful information that we parse out in the morning huddle.”
– Charge Nurse
“[This] is a skillset that we knew we needed…Staff watched the video and had immediate interest, asking “Where do we sign up?”
– CNO
“Having something already filled out by the previous nurse, handing it to you, and you going in together, you’re just looking along and you can listen, you’re not worried about writing down and that’s made this much easier.”
– Nurse
“You’ve got a structure and you make sure you don’t miss anything. It’s really easy to just write in the information and as you go through you think of something that you didn’t even remember at the time, but because it’s already there to sort of remind you, it helps with bringing on that memory. But I think [Nurses First] is really good.“
– Student Nurse
“It has truly changed the way that we start our shift…it’s just amazing how this has played out.”
– Director of Nursing
“[Nurses First bedside handover] gives you information and it gives you a reliance on your, on your team member that you’re going to get the information you need to have a great experience with that patient.”
– Director of Nursing
“Nurses first has given us that structure that I think we need as nurses.”
– AVP Acute Care
“A young nurse had to handover a patient to the ICU team, went over there with absolute confidence standing in front of ICU physicians and nurses all staring at her. She didn’t feel nervous because she just pulled out the bedside handover tool and she just went through it like we do on the ward, systems approach, and then she looked at everybody. She expected all these questions to come, but she’d covered everything. Not even the doctors had any questions and she came back to the ward really proud and really confident that she’d given it a great handover.”
– Charge Nurse
“Often in our medical system I think patients sometimes feel they’re left out: what’s going on with their treatment, when are they going to see their doctor next. It was incredible what I saw… Less time waiting for an in-patient bed, shorter hospital stays, better patient outcomes, and an increased patient and family, and staff satisfaction.”
– CNO
“If we have relieving staff, we use the huddle to introduce them. Everybody says hi, we let everybody know their name and who they’re working with so that people can see them in the corridor and check in if they’re okay and they know their name. It historically has made the relieving staff really feel welcome and valued and happy within the unit and happy to come back to the unit as well.”
– Charge Nurse
“We had a Medical Emergency Team response one night. And one of the new Grad nurses was in charge of this patient, she gave handover to the MET team as they arrived. And I was so proud of her. She did an amazing job and the MET team just looked at her and from their eyes she could have been a nurse with 20 years experience.”
– Charge Nurse
“Less time in hospital, the freeing up of beds. The care is better. The communication is better.”
– Chair Regional Health Authority
“I think change of shift huddle is exciting. The nurses really enjoy that and they take time to prepare the change of shift huddle … it’s unbelieveable. They’re doing a great job at it. So I think that’s something that’s really enjoyed.”
– Unit Nurse Manager
“From their eyes she could have been a nurse with 20 years experience”
– Ellen, RN
“There’s a great continuity and a safety net effectively for every patient, every time, every day.”
– Sarah, Charge Nurse
“The bedside report that we use in bedside handover gives you a head to toe assessment. It keeps you organized so you’re not bouncing between subjects. And it paints a better picture that way.”
– Nurse
“I think a lot of the value from change of shift huddle in the morning is you get how many people are leaving, how many surgeries you expects, DNRs, high fall risks, runs through all of the important things that you need to know if something’s happening in a room and it’s not your patient and you just happen to run in, you can say I remember this patient’s high fall risk and take the right actions.”
– Nurse
“There’s a couple of times that we’ve had patients that have needed a little bit more emotional support. And so that’s been noted in the change of shift huddle, which I think is really appropriate, especially for us [nurses] because we’re all in and out of each other’s rooms for most of [the] shift.”
– Nurse
“This is the way healthcare should be.”
– Patient
“Physicians seek out that nurse”
– Brittany, RN
Can my unit do it ourselves?
Yes. To succeed with a homegrown approach, you’ll typically need 3-6 months and a few dedicated staff.
Recipe for a Homegrown Approach: 15 Ingredients
- Steering Committee – to lead the project and develop all materials
- Change of Shift Huddle form that covers the essentials
- Standard Bedside Handover form that covers the essentials
- A Pilot Period – to test and refine both forms
- Customize both forms for each unit – so nurses like their forms and feel that they’ve been tailored for them
- A Checklist of High Performance Behaviors for Bedside Handover – so nurses know what “great” looks like
- Communication Materials, like handouts and FAQs – so nurses buy into the change
- Training Videos – so nurses can learn the basics in a bite-size way
- In-Service Nurse Educators, Identified and Trained – to conduct in-service training for as many nurses as possible
- Learning Management System – to deliver online videos, quizzes, and to track learner progress
- Unit Assessors, Identified and Trained – to conduct real-time skills assessments at the bedside
- Skills Assessment Data Collection System – to capture and collate skills assessment results
- Conduct Skills Assessments – so nurses can discover their blind spots and verify their competency
- Progress Dashboards – so nurse leaders can track nurse and unit progress toward Bedside Handover Excellence, and to compare performance across units, managers, and individual staff
- Sustainability Plan – so nurses maintain the new routines and hold onto them tightly
Our Nurses First implementation program includes these 15 ingredients in a streamlined, field-tested way.
"We have had consultants before, and they are just consultants. But you guys feel like family, part of our hospital family."
There’s great power in beginnings.
Change the first 20 minutes of each shift,
and you change the culture of your unit
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.
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