Bringing the Nursing Team Together

In the Nurses First Team Huddle, the off-going shift welcomes and hands over the unit to all oncoming staff. The summaries are structured, warm, professional, and brief, lasting about 3 min. The information is timely, unit information all staff should know.  Our Team Huddle approach helps create a supportive peer culture and sets a positive tone for the upcoming shift. It’s the most professional, efficient team meeting you’ll see anywhere in the hospital and it all starts with a 1-page form.

“We relied on [charge nurses] to be leaders, but this actually helped them become leaders.” – Director of Nursing


Why Nurses Like It

Example (Abridged)

Frequently Asked Questions
About Change of Shift Huddle

What is the Change of Shift Huddle?

Change of Shift Huddle is the first process at the start of each shift. It’s a 3-5-minute structured presentation prepared and given from a member of the outgoing shift to the entire oncoming shift. Think of Change of Shift Huddle as a way to give staff and the unit itself the same respect we give our patients.

How is this different than the huddles we are doing today?

The Nurses First version of Change of Shift Huddle happens precisely at the start of every shift and hands over the unit in a way that connects us psychologically, intellectually, and emotionally.

By starting at a regular time, Change of Shift Huddle facilitates timeliness and can help reduce tardiness and incremental overtime.

On successful Nurses First units, hospital executives who pop-in occasionally to observe a Change of Shift Huddle are likely to remark that they’ve seldom seen a more positive, professional, and efficient face-to-face meeting in a hospital. 

What topics does Change of Shift Huddle cover?

Change of Shift Huddle “reveals” information that all staff should know and sets a positive tone for the upcoming shift. There are 4 areas covered:

Team: Who’s the charge nurse today? Who’s the unit clerk? Who are all the nurses and techs? In short, who are our colleagues and resources for this shift?

Environment: What’s the census? Any pending admissions? What was the feel on the previous shift? What went well? What could have gone better?

Advocacy: Which patients have specific care issues to highlight? Which patients have safety issues everyone should know about? Which patients and families are requiring extra emotional support? Who needs interpreter services?

Motivation: What will be the quote – the piece of wit or wisdom – that will help warm, inspire, or set the mood for the oncoming shift?

Voices from the Frontline

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

“It’s been amazing how this has played out.”

– Kathy, AVP

“Help her to be a great member of this team, even if it’s only for today”

– Sarah, RN

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