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
    • Track staff progress towards achieving Nurses First Excellence
    • Verify skills PRN for new hires, annually/biannually for performance review

"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

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

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

 

  1. Steering Committee – to lead the project and develop all materials
  2. Change of Shift Huddle form that covers the essentials
  3. Standard Bedside Handover form that covers the essentials
  4. A Pilot Period – to test and refine both forms
  5. Customize both forms for each unit – so nurses like their forms and feel that they’ve been tailored for them
  6. A Checklist of High Performance Behaviors for Bedside Handover – so nurses know what “great” looks like
  7. Communication Materials, like handouts and FAQs – so nurses buy into the change
  8. Training Videos – so nurses can learn the basics in a bite-size way
  9. In-Service Nurse Educators, Identified and Trained – to conduct in-service training for as many nurses as possible
  10. Learning Management System – to deliver online videos, quizzes, and to track learner progress
  11. Unit Assessors, Identified and Trained – to conduct real-time skills assessments at the bedside
  12. Skills Assessment Data Collection System – to capture and collate skills assessment results
  13. Conduct Skills Assessments – so nurses can discover their blind spots and verify their competency
  14. 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
  15. 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