The Nurse’s Temptation to Fill in the Patient Handoff Narrative
The limitations of handoff report
In bedside nursing, the nurse enters the story of the patient’s life at the point where the handoff report ends.
“Pt is an 8 mo old female, history of hypoxic ischemic encephalopathy (HIE), baseline 2L oxygen at home. Admitted to the unit for respiratory distress.”
Handoff report then goes through a systemic description of the patient’s current state: neurological, cardiovascular, respiratory, GI/GU, skin, and finally, psychosocial. The report is thorough but brief, never truly complete.
The oncoming nurse takes report and seeks to develop an accurate picture of her patient’s physiological state in order to anticipate emergencies and prioritize nursing interventions. But as any experienced nurse knows, no report can replace thorough and ongoing assessments—patients can change, and even the most expert nurses who have previously cared for this patient can miss details.
This holds true both in terms of a physiological assessment and a psychosocial assessment. What the nurse receives during handoff in terms of the patient and family’s psychosocial status is typically brief. “The patient’s parents are involved. Dad is a little more anxious and doesn’t stay at the bedside for long. Mom has a lot of questions, and she likes to help a lot with the hands-on care.”