Nurses' experience of handoffs on four Canadian medical and surgical units : a shared accountability for knowing and safeguarding the patient

Abstract

Aims: To explore nurses’ experience and describe how they manage various contextual factors affecting the nurse-to-nurse handoff at change of shift. Design: Qualitative descriptive study. Methods: A convenience sample of 51 nurses from four medical and surgical care units at a university-affiliated hospital in Montreal, Canada, participated in one of 19 focus group interviews from November 2017 to January 2018. Data were analyzed through a continuous and iterative process of thematic analysis. Results: Analysis of the data generated a core theme of “sharing accountability for knowing and safeguarding the patient” that is achieved through actions related to nurses’ role in the exchange. Specifically, the outgoing nurse takes actions to ensure continuity of care when letting go, and the incoming nurse takes actions to provide seamless care when taking over. In both roles, nurses navigate each handoff juncture by mutually adjusting, ensuring attentiveness, managing judgments, keeping on track, and venting and debriefing. Handoff is also shaped by contextual conditions related to handoff norms and practices, the nursing environment, individual nurse attributes, and patient characteristics. Conclusions: This study generated a conceptualization of nurses’ roles and experience that details the relationship among the elements and conditions that shape nurse-to-nurse handoffs. Impact: Nursing handoff involves the communication of patient information and relational behaviors that support the exchange. Although many factors are known to influence handoffs, little was known about nurses’ experience of dealing with these at the point of care. This study contributed a comprehensive conceptualization of nursing handoff that could be useful in identifying areas for quality improvement and guiding future educational efforts.