Handover is one of the most controversial subjects in nursing. It is difficult. It feels pointless sometimes. It takes forever.
Honestly, you could be assessing patients instead of hearing the (sometimes) half-baked opinions of your coworkers. However, what they say could also help you better serve your patients. Listening to handover may help you avoid reinventing the wheel. Your coworker may also have insights that could elude you if you walk into a situation cold. Of course, simply knowing what the patient has done the previous shift is helpful as well.
Nurses have always had some form of handover. Some have gone so far as recording the information, but the newest form is to conduct handover in the room within the patient’s hearing. Of course, this can cause many complications, but it is supposed to help the patient be a part of their care. Handover may not be necessary, though. With the advent of computer generated notes and lab results, do you really need someone to rehash what you already know? This is the main question when it comes to handover. Is the previous nurse telling you what you already know or can readily find out? If so, what is the point of enduring a handover?
Since handover has been present in nursing for many, many decades, it is easy to see where it can be helpful. Handover can help you know what is significant about the patient. For instance, the outgoing nurse can point out to you a high potassium level and let you know what has been done about it. The outgoing nurse can also tell you if the doctors are aware of it and what they have done since the last blood test was recorded. One of the biggest pros of handover is continuity of care.
Another pro of handover is knowing what to expect. If the nurse before you heard rales on listening to the lungs, then you can assess whether that sound is getting better, getting worse, or is the same as before. In addition, you also will know that the assessment finding is not new, and you can simply monitor it for any changes. In other words, handover avoids reinventing the wheel. You don’t need to address every assessment finding, because they may have already been addressed. The outgoing nurse is a wealth of information about the overall health of the patient and can save you a great deal of work by just telling you what is going on.
The cons of handover seem to mirror the pros. Sometimes, they are just a rehash of what you already know. Nurses do an extensive amount of research before their shift, and they only have to look in the computer to know lab values, orders, and pharmacy requests. In some ways, the handover is redundant, and it is keeping the nurse from getting to the patient and getting their job done. Nurses can assess for themselves. They don’t need to be told what to find when they are capable of finding it themselves.
Privacy is also an issue with handover. Many times, handover is conducted in the hall, and others can overhear patient particulars. Recording the report is difficult, takes time, and also can breach privacy. Some facilities have moved to conducting handover in the room, but this can take a very long time. Patients will not understand what the handover is about, and this means that they will ask many questions about terminology that they don’t technically need to know. For instance, they may want to know what bowel sounds are. If they are normal for the patient, then they technically don’t need to know what they are.
There are very good reasons for keeping handover and some reasonable reasons for getting rid of it. It probably should not be dismissed completely. Instead, protocols should be set for what is relayed in handover. The process should not be a gab fest but a simple recounting of specifically what took place during the last shift. Assessment data is not needed. Lab results and orders are not needed. A recitation of the steps taken during the last shift should suffice. Handover is probably necessary in some form, but that isn’t to say that it shouldn’t be reformed.
The best option is simply to modify how handover is given and to avoid some of the repetition and privacy issues that exist with this common practice.