Inefficient Nursing Handover Processes
Introduction
Nurses play a role in the providing healthcare and are the first point of contact
between individuals and the healthcare system. Different hand over processes in healthcare
institutions have been developed to aid in the reduction of inefficiencies, minimize the
workload, and to ensure the quality of healthcare and patient safety. Handing over processes
are prone to poor communication leading to medical errors which compromise the safety of
the patient. As such, there should be a standard hand over process between nurses changing
shifts (Pascoe, Gill, Hughes, & McCall-White, 2014) . Moreover, some of the facilities do not
have a structured, formal handover process which leads to variables that lead to errors and
increase the workload for the nurses and duplication of processes and hence wastage such as
overproduction, over-processing, underutilized or overworked human potential, inventory
and waiting. As a result, there is are incorrect treatments and delayed diagnosis leading to
poor prognosis for the patients. It also increases the workload for the nursing practitioners
leading to poor nursing satisfaction and burnout. Inefficient nursing handover processes
(Watson, Manias, Geddes, Della, & Jones, 2015) . Therefore, there is need to improve the
quality of nursing handover processes to ensure effectiveness and efficiency and to improve
on the patient and nursing outcomes leading to quality healthcare and patient safety.
Inefficient Nursing Handover processes
Handover processes are vital in the provision of information for the incoming nurses
and physicians at the end and beginning of a new shift, and it involves the interaction and
communication of the patient’s needs and treatment protocols for the patients in a given ward,
for example, the surgical wing between the healthcare personnel. Errors occurring in pre and
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post-surgical ward have a detrimental effect on the patient and are life-threatening, resulting
in fatalities (Eggins & Slade, 2015) . Poor communication is an inefficiency noted among the
healthcare personnel during handover. It resulted when there are interruptions in the process
and exacerbated by a lack of a formal and structured handover system which will invariably
result in the breakdown of information dissemination. As such, there is a risk of the
occurrence of errors in the diagnosis, duplication of tests, treatment, and surgical intervention
on a given patient.
Inefficiencies in nursing hand over processes also result from a lack of formal systems
to institute it as it occurs between two groups of nurses. The procedures are lacking and have
not been clearly outlined, and hence, there is no set standard to follow. Therefore, the
information that is required to be in the disseminated to the incoming group is not
standardized. It leads to an emergence of errors, which lead to an increase in the workload,
overproduction, and resource wastages (Minas, Geddes, Bernadette, Jones, & Della, 2016) .
Furthermore, there are no clear guidelines and checks and balances which would be used to in
the implementation of nursing handoff leading to inefficiencies. Thus, there is a need to
formulate and execute a standardized plan of action for handoff. It would ensure that quality
measures required are implemented. Ultimately it would lead to better outcomes and
minimizes the occurrence of errors. It would also be instrumental in ensuring and raising the
quality of care for the patients and communication between the nurses during handover.
Additionally, for the handover process to be effective, there must be proper
communication amongst the nurses from different shifts. Patient reports are passed on from
one nursing team to the incoming team, which ensures that there is proper information
dissemination (Jones & Johnstone, 2019) . Furthermore, strategies to improve the handover
process have been instituted with research conducted on the importance of bedside shift
nursing report, which is an evidence-based intervention that has been implemented. It also
INEFFICIENT NURSING HANDOVER PROCESSES 3
provides the required framework for execution of the handover process through the provision
of the required guidelines. Moreover, there is proper planning for the handover process,
which leads to the manageable workloads and minimizes the burnout. Patient safety is also
improved through the dissemination of information. Strategies which have been used to
change the behavior nurses have been used to change the perception of the nurses (Boryana,
2018) . It will also encourage the use of guidelines and checklists to reduce the occurrence of
errors. Structured documentation of the handover process will allow for proper planning of
the various duties and responsibilities for the incoming nurse and thus reduce the workload
and burnout.
The evaluation of the strategies implemented to reduce the inefficiencies includes the
use of patient and nursing outcomes such as safety, satisfaction, and nursing workload.
Effective and efficient communication allows for the dissemination of information from one
shift to another and ensures that the patient’s needs and concerns are addressed (Boryana,
2018) . Also, the occurrence of errors is reduced, resulting in improved patient safety. Nursing
satisfaction is also assured through the interaction of with colleagues, physicians, and
patients. There is the development of interpersonal relationships between healthcare
providers and the patients, which are cultivated through the bedside shift reports (Gausvik,
Lautar, Miller, Pallerla, & Schlaudecker, 2015) . Consequently, there is an improvement in the
quality of care for the patients by eliminating inefficiencies of handoff procedures.
Literature Review
The handover process among nurses and its implication in healthcare has been well
researched and studied to provide evidence which has been implemented as best practices.
The effects of inefficient nursing handover processes and their significance on healthcare
outcomes have also been well documented (Shahid & Thomas, 2018) . Patient safety reduces
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with an inefficient hand over procedures and is exacerbated by a shortage of nursing staff.
Moreover, it causes an increase in the workload on the nurses who are stretched thin by
inadequate human resource. As such, there is the likelihood of the occurrence of errors which
result in adverse effects on the patient. It also leads to poor nursing outcomes and leads to an
increase in the turnover of the nurses in the organization. Patient safety is compromised with
an increase in the number of adverse cases and fatalities resulting from preventable situations
and factors in an institution increasing drastically (Piper, Lea, Woods, & Parker, 2018) . The
number of errors reported due to miscommunication among the nurses during the shift
change is high without a formal, structured, and documented process which leads to
inefficiencies.
The causative factors of ineffective communication during handover leading to an
increase in the workload, deterioration of the quality of healthcare provided and patient safety
include a lack of a proper framework and guidelines for shift change communication (Brady,
et al., 2017) . Hence, the systems and procedures used are not effective and lead to an increase
in the workload and poor outcomes. Additionally, perception of the nurses and patients to the
handover protocols in place lead to inefficiencies. In some instances, there is poor awareness
and attitude on the importance of hand over the process leading to poor communication
(Roslan & Lim, 2017) . Personal communication problems have also been attributed to
inefficient communication among the nurses and the teams involved. There is too much
information provided too quickly, leading to a breakdown in the communication among the
healthcare providers leading to misdiagnosis, wastes such as time, and wrong treatment
procedures instituted. Moreover, inefficient and ineffective communication is seen in
organizations with poor cultures, which results in the hierarchal breakdown of
communication as the nursing employees fear to give information to their superiors (Novak
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& Fairchild, 2012) . As such, there is poor planning leading to overworked staff and reduced
quality of service provision, nursing, and patient outcomes.
The remedy for ineffective communication by nurses during the hand over process is
the inclusion of guidelines and frameworks adopted and implemented through nursing
theories and models (Birmingham, Buffum, Blegen, & Lyndon, 2015) . They provide an
insight into the execution of evidence-based practices, which include the change in
perception among the nurses, patients, and caregivers. One such strategy used is the shift
from the tradition nursing station change of shift reporting to bedside shift reports with nurses
encouraged to interact with the patients. It creates an interpersonal relationship which allows
for the flow of disseminated information leading to improved outcomes and a reduction in the
workflow (Novak & Fairchild, 2012) . Moreover, it minimizes the risk of errors as the care
provided in patient-centered. Additionally, there is the provision of checklists and guidelines
to the handing over process that instills a documented structure leading to the effectiveness of
the communication and flow of information.
Clinical Practice Guidelines
Clinical practice guidelines have been used to provide evidence-based frameworks for the
elimination of ineffective communication in the nursing handover, which leads to an increase
in the nursing workload in health institutions (Boryana, 2018) . It also provides the
framework for the execution and implementation of the intervention measures and strategies
to minimize wastage and thus an improvement in the communication among nurses and the
patients leading to improved outcomes. Moreover, it aims at changing the attitude of the
nurses on the implementation of evidence-based practices which enhance the quality of
healthcare and communication (Foronda, MacWilliams, & McArthur, 2016) . Research had
been used to provide the various evidence and included the benefits of bedside shit reporting
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as a replacement strategy for the traditional nursing station reporting, which was marred by
the interruption. It was also not patient-centered hence difficult to implement patient-based
care by the nurses at a personalized level. Moreover, there was missed information and
miscommunication, leading to error (Tobiano, Bucknall, Sladdin, Whitty, & Chaboyer,
2018) . Therefore, the evidence provided and implemented through nursing models and
theories is important in ensuring patient safety and enhancing communication among the
nurses.
Proper planning and communication of duties to the nursing teams is important in ensuring
that the nurses are aware of their workload and hence reduction in overproduction, time and
over-processing wastes which hurt the patients and their outcomes (Al Sayah, Szafran,
Robertson, Bell, & Williams, 2014) . The guidelines are aimed at providing guidelines to
effective and efficient communication among the nurses during shift change and therefore
improve the outcomes and quality of care provided. Various strategies have been used to
document the process and are developed from evidence generated from studies and research
conducted on the topic (Ballantyne, 2017). The strategies include the use of identification,
situation, background, assessment, and response (ISBAR), records input in the electronic
medical records (EMR), group and bedside shift change reports. They also aid in the
management of the process with patient care ongoing during the handover process. It also
details the various requirements and prerequisites for the process leading to the patient
allocation of the nurses according to competency and provides them with the required
information. It also leads to the limitation of the exchange of information to that which
affects the patient and the provision of quality and safe healthcare.
Australian Safety and Quality Framework
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The Australian quality and safety framework have encompassed three principles,
which include consumer-centered, information-driven, and ensure the safety of the patients. It
has been used by the Australian government as the strategy for the implementation of quality
care and operational efficiency (Greenfield et al., 2015). Additionally, it seeks to ensure that
there is a collaboration between the various stakeholders who are pertinent in the provision of
quality healthcare and hence its improvement. Therefore, its implementation offers checks
and balances which are paramount for the improvement of quality of healthcare. As such,
there is the development of a collaborative effort and partnership with patients and healthcare
provides to ensure the dissemination of information and shared responsibility of informed
decision making (Dixit & Sambasivan, 2018) . Quality is improved through culturally
competent healthcare service provision and thus improve communication among the nurses
and also reduce their workload. Moreover, patient and nurse outcomes are impacted
positively.
Consumer or patient-centered healthcare seeks to address the needs of the patient in
an effective manner which improves and upholds the quality of care provided, reduces the
nurse’s workload by eliminating wastes and ensures patient safety (Magid, Murphy,
Lankiewicz, Lawandi, & Poulton, 2018) . It is tailored to suit individual needs and is a
personalized form one patient to another. Therefore, the framework offers a guideline through
which the patients and nurses are integrated into the healthcare system through effective and
efficient communication. It also leads to the development of the interpersonal relationship
between collaborating nurses and patients, making communication more effective (Delaney,
2018) . Additionally, the framework aids in the improvement of the workload through the
elimination of wastes, which lead to the unnecessary workload for the nurses through the
delegation of their duties. It also led to an increase in quality improvement in patient safety
and outcomes.
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Information dissemination is also enhanced through the framework as there are
collaboration and teamwork in the provision of healthcare. Multidisciplinary teams have been
utilized in healthcare to ensure the patient gets round the clock care an also allows for the
different teams to provide their services, leading to better patient outcomes (Radtke, 2013) .
However, the efforts may be hindered due to a breakdown in the communication. Also, it
hampers the development of collaboration amongst the individual members of the
interdisciplinary team and affects the patient and nursing outcomes. Workload also increases,
leading to fatigue and burnout in nurses resulting in errors. As such, the framework has been
implemented as a strategy to prevent and mitigate against such occurrences and thus leads to
positive outcomes (Burston, Chaboyer, & Gillespie, 2013) . Quality of healthcare is improved
through effective communication amongst the various team members and therefore assures of
patient involvement in decision-making and safety.
Patient safety can be used as a quality indicator in the provision of healthcare. The
number of preventable incidences with adverse effects and fatalities, which result from
medical errors should be minimal if any cases are reported (Ong & Colera, 2011) . Errors such
as misdiagnosis, wrong medication, missed issues result from miscommunication among the
nursing and is most likely to occur during the handover process. A breakdown in the
communication between shift and between the patients and the nursing team leads to poor
outcomes for the two (Aitkin & Edgar, 2013) . As such, there should be a systematic guideline
such as the one provided by the Australian quality and safety framework which provides the
nurses with a structure on how to perform a handover competently and effectively. It results
in the reduction and occurrence of errors and also leads to better outcomes for the patient
through improved safety measures (Thomas & Donohue-Porter, 2012) . Additionally, the
guideline requires the nursing staff to have regular training on the same, which will result in
the enhanced skills and capabilities of the nurses.
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Discussion
Inefficient nursing hand over processes result from an array of the cause, which led to
a breakdown in the communication among the various healthcare providers and may also
involve patients. The most commonly seen is the miscommunication among the nursing team
in the handover, which leads to the provision of too much information too quickly leading to
misunderstandings of the disseminated information. It also results in missing information that
may lead to a misdiagnosis, thereby endangering the health and life of the patient (Ong &
Colera, 2011) . Moreover, it contributes to the increase in nursing workload as relevant
information is missed or omitted during the process leading to duplication and ultimately
wasted. It also leads to poor outcomes for the patient through the occurrence of errors leading
to adverse reactions and fatalities. Furthermore, there is a need to have clear and coherent
communication among nurses to prevent it.
Communication failure that leads to ineffective and inefficient handover process
should also be addressed through the use of continuous education for the nurses. They are
equipped with the required communication skills which enhance their capacity and
capabilities in the performance of their duties (Staggers & Blaz, 2013) . It also leads to an
increase in interpersonal communication and thus provides an excellent avenue for
collaboration among the nurses. Furthermore, a structured and documented handing over the
process will reduce the occurrence of error as relevant information limited to the patient-
centered care will be disseminated from one nursing shift to another (Leonard, 2017) .
Strategies that have been instituted include bedside and group shift reports, use of ISBAR,
and records updated on the EMR to ensure that is it available and accessible for all the
nursing teams (Wentworth et al., 2012). It also provides the required framework and
guidelines to allow for a smooth transition during the handover process with minimal
disruption to the provision of healthcare services for the patients.
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It is also paramount that training on the various handover processes and the
inefficiencies which may occur during the process is conducted regularly. It helps create the
awareness and sensitize the nurses on its need and importance in assuring quality and safety
of the patients in the healthcare system (King et al., 2013). In addition, it also imparts and
motivates the development of communication skills relevant in nursing practice, which leads
to better cohesion and collaboration among the nurses. Competency-based allocation of
patients to nurses allows for the most qualified nurse in a given field to be assigned cases
relevant to her strengths which also leads to enhance personalized care for the patients
(Wentworth et al., 2012). Ultimately there is an increase in the quality of care provided and at
the same time manages the nursing workload preventing burn out and occurrence of errors.
Conclusion
Inefficient nursing handover processes has detrimental effects, which may lead to
poor outcomes for the patient and the nurse practitioner. They compromise the quality of care
providers and patient safety. Moreover, they are a contributing factor to the increase in the
nursing workload in health facilities. The most important factor that determines efficacy and
ineffective handover process is communication between the nurses (Burston, Chaboyer, &
Gillespie, 2013) . The hand over process involves a group of nurses changing shift and hence
are required to provide the relevant information to the incoming nurses in regards to the
patient and care instituted. Poor communication leads to a breakdown in the dissemination of
information and the development of an interpersonal relationship between the nurses and the
patients (Novak & Fairchild, 2012) . The quality of care and patient safety are compromised
due to inefficient hand over processes, there is evidence to support the importance of shift
handover in nursing, and they lead to the implementation of the recommended evidence-
based practices as guidelines to assure quality through the development of quality and safety
frameworks.
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References
Aitkin, L., & Edgar, S. (2013). Collegial relationship breakdown: A qualitative exploration of
nurses in acute care settings. Collegian, 20(2), 115-121.
Al Sayah, F., Szafran, O., Robertson, S., Bell, N., & Williams, B. (2014). Nursing
perspectives on factors influencing interdisciplinary teamwork in the Canadian
primary health care setting. Journal of Clinical Nursing, 19-20, 2968-2979.
Ballantyne, H. (2017). Undertaking effective handovers in the healthcare setting. Nursing
Standard, 34(8), 53-62.