Change of Shift Huddle
The Best Way to Start Each Nursing Shift
In the Nurses First™ Team Huddle, the off-going shift welcomes and hands over the unit to all oncoming staff as the first act of every shift. The out-going charge nurse gives a 3-minute structured presentation to the entire on-coming shift, handing over the unit as if it were a patient.
Our structure is warm, professional, and brief — setting 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 free 1-page form.
“Nurses First has truly changed the way we start our shift. We now do a team huddle – that’s fabulous. The charge nurses – we relied on them to be leaders, but this actually helped them become leaders. It’s just amazing how this has played out.” –Nursing Executive
Start your shift together, as a team
On units without a Change of Shift Huddle, nurses may start each shift less like a team and more like a group of individuals running around. It can take most of the shift to really gel as a team, and by that time, the shift is almost over.
On other units the huddle can last for 10 or 15 minutes, becoming a staff meeting — and no one wants to start each shift with a staff meeting.
A well-organized Change of Shift Huddle can set a positive tone for the upcoming shift and rally a team together. Every nurse gets a chance to start the shift with a feel for the unit as a whole, to see each other, and to hear meaningful details about patients with greater care needs.
Introduction
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?
The N1 Daily Pulse Report
Our Change of Shift Huddle template has highly valuable information about unit health and patient flow, so the N1 Daily Pulse digitizes the huddle sheets to extract insights for nursing leaders:
- Shift Report (stress level last shift)
- # Discharges Last Shift
- # Expected Discharged
- # Pending Admissions
- Catches & Saves
- What can we do better?
- # Villagers
- # Patients or Families Requiring Extra Emotional Support (P-FREES)
- Today’s Motivational Quote
The N1 Daily Pulse report is a free feature of our 1Unit Software Platform. In this way, shift-specific data about unit health can be aggregated and reported upward to nursing leaders for each participating unit.
Right after huddle, the charge nurse digitizes the form using our mobile app, and that auto-populates the N1 Daily Pulse Report for each shift.
The N1 Daily Pulse Report can reveal deeper insights and help leaders prioritize their attention:
- Knowing which units are highly stressed enables leaders to efficiently allocate resources and ease the burden on staff;
- Capturing “catches & saves” every day can improve event reporting, reveal repeated themes, and recognize nursing “wins” that are often overlooked; and
- The Patient Flow metrics can support any daily meetings about discharges.
“A mental workload measure, even though it is likely to be subjective, is a better predictor of failure than a (more easily quantifiable) measure of system performance itself because an increase in mental workload anticipates a decrement in performance.” – Thomas Sheridan, Professor Emeritus, MIT
The N1 Trends Report
The N1 Trends Report is another feature of our 1Unit Software Platform. It enables leaders to easily compare units over longer periods of time and identify continuing issues on specific units.
Knowing which units tend to be more highly stressed over weeks and months can reveal hidden patterns over time. These insights can then be used to efficiently allocate resources between units and better support staff on units that are experiencing high-demand and continued stressful conditions.
Voices from the Frontline
“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