Magazine article American Nurse Today

Transforming Nursing Shift Reports into Educational Sessions

Magazine article American Nurse Today

Transforming Nursing Shift Reports into Educational Sessions

Article excerpt

As an instructor working for a large urban university, I continually strive to make students' clinical experiences as meaningful as possible, paying close attention to how every assignment and interaction can help prepare students for their first real-world nursing jobs.

[ILLUSTRATION OMITTED]

My former tenure as a nurse manager has served me well in this endeavor. During the 3 years I managed a nursing division, at least 20 groups of students from no less than five nursing schools rotated through our unit in rapid and seemingly endless succession. The "good" student groups led by thoughtful, innovative clinical instructors stood out the most and had the greatest impact on our workplace, my management practice, and ultimately the daily work lives of nursing staff. I watched carefully as these instructors skillfully guided students on a journey of learning and self-exploration. During those 3 years, I noticed the best instructors made learning an engaging group process.

Sometimes, though, learning was a private, introspective journey. I was particularly fascinated by the instructors' use of pre-and postconference meetings as a way of starting the day in a professional, positive manner. They gave students "report" on their patients and used the rest of their preconference time to promote meaningful peer-group discussions. Because my office was adjacent to the students' report room, I learned much from these discussions. In fact, I structured my time so I could be in my office to listen.

Adopting concepts for end-of-shift reports

As a manager, I immediately recognized the potential of transferring many of the concepts used in students' preconference meetings to our staff end-of-shift reports. My goal was to transition to a model that promoted more than just the usual obligatory exchange of clinical information. Our designated time for staff report was limited to 30 minutes--a bit less than the students'. At the beginning of that allotted time, staff nurses discussed their patients. As they focused on their daily report sheets, they assumed dutiful, attentive postures while diligently recording information on each patient's condition, orders, and lab values. But after 15 minutes or so, I saw those postures ease into relaxed "at-home" poses. Coffee was served and laughter broke out as conversation drifted toward gossip, complaints about workload, and the daily news.

[ILLUSTRATION OMITTED]

Although I recognized that staff nurses need time to fortify themselves before the stress of the workday, I reflected on the untapped potential of this precious time when staff from two shifts were present in the same space. After about a week, my mind and my legal pad were bursting with possibilities ranging from enhanced communication and education to performance improvement and increased patient satisfaction. At our medical center, procedures for nursing staff evaluations and promotions focused heavily on several of these domains, so I thought it worth a try to promote the use of this time for more productive purposes.

From management training, I recalled the importance of engaging staff. So I presented my ideas to a few key nursing staff members who happened to be informal leaders in the division. Over a few weeks, I had informal conversations with them, consisting mainly of "what if" situations. I told them I'd recently visited (I didn't tell them the "visit" was strictly in my imagination) a unit where the staff signed up to present brief educational sessions to each other during morning report. …

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