"[Nurses] are surprised that something so simple can make our lives so much easier and more efficient."
- Charge Nurse
"[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."
- Chief Nursing Officer
"[This] is a skillset that we knew we needed ... Staff watched the video and had immediate interest, asking 'Where do we sign up?’"
- Chief Nursing Officer
"You're informing your colleagues and empowering them to help each other out so that their day, every day, is better."
- Nurse Team Leader
"We relied on [charge nurses] to be leaders, but this actually helped them become leaders."
- Director of Nursing
"It truly has changed the way that we start our shift ... it's just amazing how this has played out."
- Director of Nursing

Protect against nursing handover variation

Bedside handover structure, training, and skills verification designed by patient safety experts who are also nurses

Join the thousands of nurses who standardize their bedside handover
– faster for nurses, safer for patients.

Hospital nursing is more complex than ever

And bedside nurses are feeling burned out

Nurses will hand off patients more than 100,000 times this year at your hospital

(For hospitals with 150+ beds)

High-reliability hospitals can’t afford to let things fall through the cracks

Variable = Unsafe

For 160 years, nursing has advanced by elevating tasks into elite competencies

With specific skills to learn, practice, and verify

Structured Bedside Handover is the new standard

When every patient handoff is done right, nurses feel less stress, care improves, and HCAHPS scores go up

Nurses prefer standardized
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

“It helps me be succinct and get out all the right information.

– Jordan, Trainee Nurse, CCU

“It’s faster. It’s more organized. Definitely a time saver. I think it’s cut report down by 15 minutes.”

– Robin, 2-East

Trusted by leading hospitals and health systems

Change the first 20 minutes of each shift,
and you change the culture of your unit

There’s great power in beginnings.

 

Start with a Change of Shift Huddle

  • Outgoing shift hands over unit to all oncoming staff
  • Structured, warm, professional, brief (~3 min)
  • Timely unit information all staff should know
  • Learn more ➔

Then structure the Bedside Handover

  • Outgoing nurse hands over care at bedside with patient invited to participate
  • Standardized for safer, more efficient clinical handover
  • Warm, professional, brief (2-5 min)
  • Ensures oncoming nurse starts shift with all info needed for continuity and safety
  • Learn more ➔

Hardwire Bedside Handover Excellence to Make It Stick

  • Teach the high-performance behaviors
  • Verify competence
  • Achieve and sustain excellence – every nurse, every patient, every shift
  • Learn more ➔

Daily routines are worth perfecting • Small changes add up to big impact

Change of Shift Huddle Bring the Nursing Team Together

Our nurses didn’t feel like a team. We started each shift more like a group of individuals running around.

So we began a Change of Shift Huddle. 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 it starts with a 1-page form. You can use ours. Tens of thousands of nursing shifts have used it.

Change of Shift Huddle videos

Why nurses like it

 

What it is

 

Example (Abridged)

 

Frequently Asked Questions (FAQs)
about Change of Shift Huddle

+ What's the purpose of Change of Shift Huddle?
To share forward the timely unit information all staff should know

Think of it as a way to give staff and the unit itself the same respect we give our patients.

It’s usually the off-going charge nurse who gives a 3-5-minute structured presentation to the entire on-coming shift, handing over the unit as if it were a patient.

+ What information is presented during Huddle?
On our units, we cover 4 areas.

They follow the acronym T-E-A-M.

(T)eam: Who are our colleagues and resources for this shift?

(E)nvironment: What’s our patient population? Any pending admissions and discharges? How did the previous shift go?

(A)dvocate: Which patients have specific issues around care, safety, or emotional support?

(M)otivate: A fun quote to help finish on a positive tone

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, the oncoming staff, and meaningful details about patients with greater care needs.

+ How can I start a Change of Shift Huddle on my unit?
Design a huddle form for your unit.

Or to save time, you can use our T.E.A.M. Sheet. It’s been designed and tested with the input of hundreds of nurses.

Structured Bedside Handover Faster for Nurses, Safer for Patients

As nurses, we dread getting bad handoff. When there’s no structure, each nurse gives report their own way. It feels less safe and more stressful — extra stress we don’t need.

So our units decided to standardize each bedside handover.

The heart of our handover is a structured, single-page shift report form. It uses an ISBAR framework, Review of Systems outline, and it’s customized for the unit. And it’s presented top to bottom by the outgoing nurse, then handed over with our patient.

Our 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.

Request a briefing to learn how your units can get going in under 60 days.

Here’s what’s different about a Structured Bedside Handover

High-quality aspects of 1Unit bedside handover

Bedside Handover videos

Why nurses like it

 

What it is

 

Example (Abridged)

 

FAQs about Bedside Handover

+ What's the purpose of Structured Bedside Handover?
To visit the patient and transfer care and responsibility in a warm, structured, super-professional shift report.

Structured Bedside Handover is presented by the outgoing nurse to the oncoming nurse and the patient. It empowers the patient and the oncoming nurse to do three critical tasks all at once:

  1. Verify information being reported
  2. Hear the status of nursing-sensitive quality and safety indicators
  3. Start the shift on the same page with the patient’s subjective goal – what the patient cares most about.

Bedside Handover typically takes 2-to-5 minutes, depending on the patient.

+ Why does everyone use the same form?
To finally apply a reliable structure to bedside handover.

The structure lets us be brief and to the point. It lets us give and receive handover in the exact same sequence every time. The flow of information is logical and just detailed enough for each patient.

Reducing unnecessary variation is a tried and true way to improve quality.

A consistent structure cuts down on communication errors and reduces anxiety for the nurse receiving handover.

When we hear information in the same predictable order every time, our brains can start making sense of the information right away.

The evidence base reinforces this: To reduce patient harm, we want to use the same tool for each bedside handover.

Comforting and educational for patients.

Applying a structure to Bedside Handover is also comforting for the patient; repetition helps the patients learn what to expect, no matter which nurse they have.

And if they know what’s being discussed on a regular basis, it can help them feel greater control and even begin to correct errors themselves.

+ Why is the whole shift report done at the bedside?
To ensure accuracy, pass on trust, and visually assess our patients.

We nurses may hesitate to take the last few steps to bring our handover to the patient’s bedside, but giving report with your patient is the best way to ensure accuracy and pass on the trust you built during the shift. Plus, we can visually assess our patients as we hear about them – it makes their story and their status come alive.

And it gives the patient and family a chance to see us in a highly professional light. Units that achieve Bedside Handover Excellence report patient satisfaction scores that jump into the top percentiles.

There’s so much we miss when we stay in the hallway. The only good reason not to be at the bedside is if we’re making the patient anxious or uncomfortable by being at the bedside.

+ How should the information be structured?
Here’s what’s worked on our units.

Our tool follows the ISBAR format to help paint a living picture of who the patient is right now and what needs to be done on the upcoming shift.

First is I, for identity. This is where patient identity is verified.

Next is S, for situation. This is where information that will likely not change during a hospitalization is presented (information such as diagnosis, allergies, and code status)

Then comes B, for background. Here the patient’s medical history can be outlined. In this section, every nurse has permission to be concise. Things in the remote past or unrelated hospitalizations can be left out.

Next is the A, for assessment. This section can be thought of as a shift summary.

  • It starts with the patient’s subjective goal for the shift – which is what the patient cares most about.
  • It then covers abnormal assessment findings and responses to interventions. This is broken down in a familiar ‘review of systems’ format.
  • At the end of the assessment section is a ‘quality-safety checklist.’ These items are the most common, preventable complications that patients experience in the hospital. Essentially, it’s what we need to check to keep them safe.

Finally, R is for recommendations. This is a chance for the outgoing nurse to communicate any outstanding tasks to follow-up on during the next shift – things like labs, dressing changes, and procedures.

+ How can I standardize a structured bedside handover on my unit?
Request a briefing to learn how to get started.

Designed for nursing leaders, this short briefing will help you learn how we’ve implemented Structured Bedside Handover on our units — and get tools and tips for yours.

Bedside Handover Excellence Do It Right + Make It Stick

When our units first started Bedside Handover, it was just OK. We used a standard form, but handover wasn’t consistent.

(That’s because just having a policy – and having it performed with excellence on the front lines – can be two different realities.)

So we changed our perspective – elevating Bedside Handover from a task to a skill with purpose that we practice every shift. And nurses are experts at mastering new skills. The winning recipe is the same: Learning, Practice, and Feedback

  • One key was making a list of 9 high-performance behaviors that make Bedside Handover go really well for everyone.
  • We then set a goal for our unit to achieve Bedside Handover Excellence, which means all our nurses are verified as expert in Bedside Handover.

And that’s what made it stick. Now we notice a better start and end to our shifts, better use of everyone’s time, and better care – both for our patients and each other.

Bedside Handover Excellence video

High-performance behavior
training (preview)

 

FAQs about Bedside Handover Excellence

+ 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:

  1. A unit-wide commitment to excellence
  2. Learning – short videos and an in-service
  3. Checklist of high-performance behaviors
  4. Skills assessments and feedback from a trained assessor
  5. 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 video.

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 — in-service training, online 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:

  1. Learning Management System to deliver online videos, quizzes, and to track learner progress
  2. Skills Assessment record-keeping to track who’s been assessed and how they performed.
  3. 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.)

Combined, these tools will streamline and standardize your journey to achieving Bedside Handover Excellence. They’ll also give hospital leaders the confidence to say to others, “It’s not just a policy; we actually know that every nurse has been trained and competency-verified.”

Click image to zoom in

Patient Safety and Quality Improvement Get Everyone Doing the Same Thing Every Day

A Stronger Culture of Patient Safety is Achievable

“The Joint Commission has identified communication as the top contributing factor to medical error, with handoffs playing a role in an estimated 80% of serious preventable adverse events.

– The Joint Commission

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. Nursing handover is typically inconsistent and unstructured.

Let’s review the evidence base:

Structured, nurse-designed communication is better

Acute care today is complex. But quality in complex systems is never the default. It must be designed. The best tools simplify what’s complex, without losing detail.

Structure by itself is not enough. The SBAR or “handover” screen in an EMR has a structure — but it’s far from an ideal tool. Nurses are practical — we only want stuff that works.

That’s why any tool deployed across a hospital needs a pedigree — years of thoughtful iteration, tested and refined by thousands of nurses across hundreds of units.

Standardized, patient-centered communication is safer

Errors arise from unnecessary variation. Standardized communication is the answer.

The literature is clear: To reduce patient harm, we want to use the same tool for each bedside handover.

Here’s what’s worked for us:
+ First, Structure the Bedside Handover Form

The form we use on our units follows familiar ISBAR and Systems Review formats and has been rigorously tested and refined hundreds of times. It’s not a script — nurses don’t like that — but it is a time-tested structure that aligns every nurse with a common mental model of what’s essential to report, and in what order.

“Other ways of doing nursing report make you feel like a robot. For the last 10 years, we’ve used another strategy out there on the market. But it was so scripted. ‘You need to say this, this, and this in a certain order.’ We lost sight of being ourselves and being real to the patient.  … This bedside handover report provides us with an awesome way of keeping us on task with what we should be reporting and involving the patient with each and every day.”

-Amy, Unit Nurse Manager

For an example of what thoughtful structure looks like, consider the Nursing Quality Safety Checklist designed by our hospital Quality Improvement (QI) experts:

This structure wraps six separate QI projects into one efficient checklist.

When rolled out across a hospital, this checklist hardwires twice-daily moments to highlight potentially preventable complications for every patient in each participating unit — and a third time with a physician if used during Structured Interdisciplinary Bedside Rounds.

+ Next, Standardize the Bedside Handover Delivery

On our units, every unit in the hospital starts with the same standard ISBAR form, and then gets shoulder-to-shoulder help customizing it to reflect the needs of their patient population. In that way, every nurse on the unit uses the same form, and even float nurses see small differences between units.

To make it stick, every nurse is trained in the same efficient way and assessed with a standard set of 9 high-performance behaviors to achieve Bedside Handover Excellence.

Nurses First aligns with several national efforts

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IOM

“Crossing the quality chasm” & “To err is human”

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JCAHO

NPSG 2021

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CMS

Hospital Acquired Complications (HACs)

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QSEN

Quality Safety metrics and KPIs

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Magnet

Pathways to excellence & Magnet goals

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NDNQI

The National Database of Nursing Quality Indicators

Patient Experience Boost HCAHPS Scores for Nursing Communication

High Patient Satisfaction Scores Are Achievable

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. (And asking stressed-out nurses to also be “customer service agents” isn’t the best approach.)

What if there was a trick to hardwire a daily “wow moment” for each patient? And what if that trick also made nursing handoff more efficient and safe?

Structured Bedside Handover creates that daily “wow moment.” We do it because it’s better for nurses and safer for patients, but it also boosts HCAHPS scores for nursing communication.

For example, look at what happened in 2019 when a med-surg unit at a Southwestern US hospital implemented our Nurses First program.

Before the program, scores for “Nursing Communication” and “Rate the Hospital” were in the low single-digit percentiles. But after achieving Bedside Handover Excellence, they saw HCAHPS scores jump to the 81st and 89th percentiles:

Click image to zoom in
When every nursing handover is a “wow moment,” patients notice.

A Structured Bedside Handover gives patients what they want: Clarity, thoroughness, and empowerment.

It’s unfair. We nurses already do all that. But we often don’t get credit for it.

A warm, super-professional handover helps us get credit in the eyes of patients for all the things we’re already doing.

And for nurses, that overdue recognition feels rewarding.

Schedule a briefing to learn how to boost patient satisfaction scores on your units:

Nurse Staff Satisfaction and Engagement Support your nurses with the best tools

Higher Nursing Satisfaction Is Achievable

No Bad Handoffs ➔ Better Shifts ➔ Happier Nurses

We’re living in a new era. Hospital nursing is more complex than ever — and 1-out-of-2 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. We prefer hospitals that:

  • Reduce our stress
  • Help us get familiar with our patients as quickly as possible
  • Reduce unnecessary variation in communication
  • Make us feel part of a high-performing team and a collaborative work culture

“When you get good report, your day will be better.”

– Walela, Bedside Nurse

The best way to support nurses is to give us the resources we need to do our best work. That includes an efficient, standardized handover that lets us hit the ground running — wasting less time searching for information, and more time for what we like to do: problem solving and proactively getting ahead in our day.

Less stress can mean lower turnover. Nursing turnover fell to less than 3% on the unit where we first developed our standardized communication processes.

Behaviors become habits, and habits become culture.

You’re already doing a lot to support your nurses. You can get the most out of those efforts by transforming the most stressful part of a nursing shift — the first 30 minutes — with an efficient Change of Shift Huddle and a Structured Bedside Handover.

It’s a straightforward way to support your nurses — at a time when they need it the most.

As you think about your own change of shift, any questions that we can answer for you?

Here's how to get started

See results in under 60 days

When we help hospitals, we take them through 3 steps to achieve excellence in under 60 days:

  1. Get everything ready
  2. Launch
  3. Achieve and sustain excellence

We provide all the support needed to achieve Bedside Handover Excellence on each participating unit. Up to 12 units at a hospital can launch together.

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

Can my units do it ourselves?

Yes. To succeed with a homegrown approach, you’ll want these 15 ingredients, and 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.

Deciding if homegrown is right for you? Set up a 1:1 conversation with our CNO who can help you ask the right questions:

Why We Do This

Your patients are our patients.

We help take care of them by giving you up-to-date access to tools and best practices, and by helping you make them work for your hospital.

It’s a privilege to share this information with you. Thank you for the chance to support you and your nurses in the care of their patients.

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