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It is the end of a hectic shift, and one by one you see your colleagues for the next shift. If your patients were the perfect angels, then you’re probably lounging around in your chair. However, when your patients were unstable, demanding and agitated, you suddenly feel the urge to leave the spoils of a toxic duty behind.

Male and female Nurses Discussing A Clipboard At The Reception I
Male and Female nurses discussing a report at the nurse station in a hospital

But alas! Your shift doesn’t end until you’ve done your end of shift endorsement. When that happens, aren’t you the least bit tempted to get it over with so you can leave? When you’re familiar with the patient’s case and treatment, don’t you want to rush through the endorsement?

However, just like bedside care, it requires a certain amount of time. It is important that an end of shift report should be unbiased and complete. After all, it will be the basis for the patient’s plan of care for the incoming shift.

Over time, endorsing a patient has become a routine that most of the essential information are being left out. According to the World Health Organization, reports compiled by the Joint Commission in the US, miscommunication is a top cause of sentinel events.

Information breakdown from one nurse to another may result in inappropriate treatment and management, and may potentially harm the patient. The same issue with end of shift reports is present in the United Kingdom as well as in Australia.

Although there is no perfect way in rendering an endorsement, there are certain strategies for an effective handover report. By following these strategies, you’ll be a master at making the best endorsements.

  1. An endorsement should be done by nurses face to face. A study done by physicians Solet, et. al (n.d) concluded that a vis-à-vis approach to endorsement is more effective.

  2. Choose a quiet or secluded area with fewer distractions. When there are so many people speaking at the same time, you’re bound to be distracted and the incoming nurse might miss some important information.

  3. Always be organized with what you are endorsing. Even if the patient has been in the unit for months, it is still best to start with the patient’s name and personal information.

  4. Before proceeding to the patient’s history, you should first cover all the safety information of the patient. It is a must to state the patient’s code status and enumerate his/her allergies, if there are.

  5. Discuss in detail the patient’s medical history. This would be very helpful especially if it’s the first time for the incoming nurse to handle that particular patient. This will allow him/her to see the whole picture of the patient’s medical and nursing management.

  6. Enumerate all assessments made that are relevant to the patient’s case and diagnosis. During endorsement is also the best time to relay all pertinent physical assessment to the incoming nurse, as discussed by Jennifer Ward. Sharing with the incoming nurse what your recent findings for the patient are, will help in the patient’s care plan for the next shift.

  7. Discuss everything that is attached to your patient’s body. If there is a peripheral or central line, if there are drains and tubes coming out of body cavities, when it was inserted and when the dressing should be changed. All of these information will help prevent the risk of developing infection.

  8. Talk about issues with medications and treatments. PRN medications and when they were last given and the dosage, are important data. Certain medications cannot be given in the same spot consecutively like insulin injections. Robert Disnmoor writes that rotating injection sites will minimize the build-up of fats on the site which impedes drug absorption.

  9. Discuss the possible discharge plans for the patient. Will the patient continue to stay in the unit for the next few days, transferred to a different ward or will they be handed with a clean bill of health to go home? Looking ahead will help caregivers a chance to formulate an appropriate plan of care to reach the goal.

  10. Endorse your patient’s preferences or requests (if there’s any). Some patients may ask not to disturb them during sleeping time, or to limit their visitors any time of the day, or if they have their food preference that should be reported.

  11. Never forget to notify the incoming nurse if the patient has advance directives. Endorse all the legal forms which the patient or folks had signed to avoid any misunderstanding during emergency.

  12. Enlighten the incoming nurse regarding patient’s cultural beliefs (if there’s any). Patients come from different parts of the world; therefore, it is important to respect their own culture and religious beliefs.

  13. Highlight any procedures that the incoming should carry-out during their shift.

  14. ALWAYS bring a cheat sheet with you. All of these strategies will work better if you note down anything significant that goes on within your shift. Evelyn McLaughlin, a nurse in Torrance Memorial Medical Center, emphasizes the need to have a sheet where you can note down physician’s comments regarding a patient’s complaint or treatment, pertinent laboratory results and to track important developments.

Although these suggestions may not be the most clear-cut way to the best endorsement, it will save you time and offer the most effective way to hand over the necessary information to the next shift. It may take some getting used to at first, however, in the long run, it will help make the shift go a bit smoother, and the workload a bit lighter.

References

  • Dinsmoor, R. (2006). Injection Site Rotation. Retrieved from http://www.diabetesselfmanagement.com/diabetes-resources/definitions/injection-site-rotation/
  • Solet, D. et al. (n.d). Lost in translation: challenges and opportunities during physician-to-physician communication during patient handoffs. Academic Medicine, 205, 80:1094–1099. As cited in Communication During Patient Hand-Overs (May 2007). Retrieved from http://www.who.int/patientsafety/solutions/patientsafety/PS-Solution3.pdf
  • Stringer, H. (n.d). Tips for A Smooth Nursing Shift Change. Retrieved from http://www.monster.com/career-advice/article/nursing-shift-change-tips
  • Ward, J. (2012). Making an Effective and Professional Nursing End-of-Shift Report. Retrieved from http://www.nursetogether.com/making-effective-and-professional-nursing-end-shift-report
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Rina Malones is currently working as a critical care/acute stroke nurse. Besides from blogging, she's also studying International Health at University of the Philippines Open University.
  • Grateful RN

    These tips are great! Used them for my shifts and I go home not worried about omitting something important during endorsement. This isn’t 100% foolproof, but it’s a good guide.