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A Proposal Concerning Shift to Shift
Report on a Medical Surgical Unit
At
Ennis Regional Medical Center
To the Executive Team
December 11, 2009
Presented by:
Kiva Bostick
Erin Burchard
Kessie Campbell
Amanda Clamon
Justin Hale

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A. Table of Contents
I. Introduction
II. Review of Literature
III. Survey Results
IV. Recommendations
V. Bibliography
VI. Appendix

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Introduction
The purpose of this project is to review the evidence based literature and make
recommendations regarding nursing shift change report on a busy medical-surgical unit at Ennis
Regional Medical Unit. This project began from a simple observation by the new TVCC student
group, i.e. the nursing shift report “seemed to be” a bit long. As new students, we acknowledged
our lack of knowledge and experience concerning unit operations, giving and receiving report.
Therefore, we felt a (limited) review of the literature regarding shift report was warranted before
proceeding. Our recommendations stemmed from that review and associated survey results.
Our research did not discover an existing written procedure for giving report here at
ERMC. However, after talking with several nurses, we concluded that current report format
utilizes the Kardex on a limited basis and the primary exchange is from off-going shift nurse to
on-coming charge nurse and staff nurses.
Survey Results
To complement this research, we surveyed ten medical surgical nurses about the
efficiency and contentment with the current report format. Eighty percent of staff nurses
surveyed agreed change of shift report is lengthy. A large percentage of nurses also conveyed
that all pertinent data required for patient care was not always provided, yet nonessential
information was expressed 100% of the time in shift report. Fifty percent of nurses surveyed
indicated they did not follow any standard report format or policy. The staff nurse’s surveyed
agreed report is not given in a timely manner and 100% acquire overtime due to lengthy shift
reports. Survey data indicated 90% of staff nurses surveyed agreed that change would be
beneficial.

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Review of Literature
The review of evidence surrounding shift reports suggests standardized shift reports
improve communication and promote client safety. Standardization of shift report is one of the
2006 National Patient Safety Goals established by the Joint Commission on Accreditation of
Healthcare Organizations (JCAHO) (Schroeder, 2006). According to JCAHO’s research 70% of
sentinel events are caused by communication breakdown (Fahey & Schilling, 2007). Our
analysis of the literature suggests “standardization” can mean different approaches to different
situations. “One size does not in fact fit all”. The important concept is to adopt a standardized
approach and stick with it until a need to “tweak” or change arises. Poorly performed report can
have negative effects to a unit. Research indicates poorly performed shift report has the potential
to affect staff retention and the quality of patient care (Speas, 2009). Structured report helps to
provide a safe efficient handoff (Roberts, 2007).
Recommendations
We reviewed several styles and formats of shift report and will present two options. Both
options recommend a nurse to nurse, charge to charge set up. Each should present a routine set of
information required for an adequate handoff without nonessential information. The first option
involves a written handoff with use of a standard template paper that is transferred from off-
going to on-coming nurses. This is only a report tool for the nursing staff to assist in ongoing
evaluation and needed interventions. It should not be part of the patient’s permanent record. Staff
nurses can utilize the provided template in order to ensure standard information is routinely
provided. This can assist in communication and reduces the nurses need to rely on memory. In
order for the charge nurse to have all pertinent patient information the staff nurses should write a

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brief report for each of their patients on the current census prior to shift change. A negative
aspect of this option is losing the paper. The second option involves a verbal handoff consisting
of routine information from nurse to nurse. The use of routine information can improve
communication techniques and shorten report length. This option does not require the nurse to
update a paper throughout the day. It also allows more time for the nurses to have face to face
interaction. A negative feature is that this option requires more reliance on memory. Each option
can provide more time efficiency and structure to the shift report system.
Our recommendation for revising the change of shift report format is to implement a
mixture of both written and verbal techniques after testing this method during a trial period. The
implementation approach should include informing the nursing staff of the change and new
guidelines. Request the staff to sign a teamwork expectation agreement. While not legally
binding this can support the expectation of following the new format and influence the receipt of
feedback from the group. (Speas, 2009) Our suggestion is implementing both options
congruently for a period of 90 days. All medical surgical RN’s and LVN’s should utilize the new
system. A survey nursing staff at the 45 day and 90-day mark of the trial period should be
completed to evaluate overall benefits and effects of the change. At the end of the trial period the
medical surgical nursing staff should be required to participate in an in-service meeting to decide
if this integration of options suits them and if it will be permanently implemented. Improving the
efficiency of shift change report can affect the nurses’ contentment with workload. It can also
improve the patients’ satisfaction with care and the overall hospital stay.
Bibliography
Fahey, L., & Schilling, L. (2007). Nurse Knowledge Exchange: Patient Handoffs.
www.aaacn.org , 6-8.

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Roberts, D. (2007). Clear communications Accept nothing less. MEDSURG Nursing , 142.
Schroeder, S. (2006). Picking up the PACE: A new template for shift report. Nursing 2006 , 22-
23.
Speas, J. (2009). Bolster staff relations with shift report. www.nursingmanagement.com , 82-83.
Appendix

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I. Shift report survey
II. Shift report survey with results
III. Template for nurse to nurse