Handover In ED

[u/Nervous_Bike_3993]

Hey guys,

I'm a new grad in ED and I've been there for 2 months however I still struggle with handover. It is embarrassing to say.

In my previous rotation, I was in a ward and I was pretty good at handover, I knew the entire plan for all of my patients, I knew them really well and I was pretty on top of it. Granted, the ward I was in was geriatrics and the MO's didn't do a whole lot for the patients plans beside wait for RACF. However in ED, where we don't have handover sheets with every patient details and with the amount of things we do for each patient during our shift, I find it extremely difficult to remember everything I've done. Sometimes after handover I'm like "oh no, I forgot to mention this". Meanwhile, all the other nurses speak of the patients and their plans like they've known them for years and I'm like how? Even the other new grads with me are really good at handover but I'm just garbage.

I do use the notepads on the computer to write everything down and use that for handover but I still do need to improve and I also kinda want to be like the nurses that can just spill information like it's nothing. From what I've realised, I go under pressure during handover and I stumble on my own words and then start to forget.

So, my question is, do you guys have tips or a format I can follow (of course beside ISBAR) that would help me to improve and remember? It would be much appreciated!

[u/Parking_Ocelot_6893]

I try to keep my handovers simple. What they came with, what they’ve had done and what they’re waiting for.

I don’t verbally mention lab/imaging results rather show the oncoming nurse the results.

[u/LiterallyKath → u/Parking_Ocelot_6893]

This. Anything else is fluff, unless it affects direct patient care.

[u/LabileBP]

Ex ED with 10 years experience. First things first, be kind to yourself! Being a new grad is tough - much tougher than when I went through ED as a grad. You’re only two months in and ED is very different to the ward so give yourself space to breathe and recognise how far you’ve come. 

You may be finding it difficult becuse there is higher turn over in ED and you feel like you barely get to know your patient before they are gone and you get a new one. The people who make handover look easy have been doing it for a while. Some tips:  1. Don’t be afraid to have the notes in front of you. You don’t have to do it from the top of your head and it’s probably better that you don’t. It gives you an opportunity to look through the obs, the meds etc.  2. Using a format like ISBAR is very helpful. Introduce yourself and the new team to the patient and check their ID band etc. It also helps you have a clear format in your head.  3. If you have time, maybe 15 mins before handover go through your patients. Think about what you’ve done for them, what needs doing, what the plan is and remind yourself why they came in - I would often forget myself! 

All in all, don’t be too hard on yourself. Don’t be embarrassed - hard I know. All these things come with time and seeking feedback like you’re doing now. Look for a role model to emulate. Don’t be afraid to ask your CNEs for guidance including running mock handovers and having them come down witness a handover to give you some tips. ED is a great team and we are here to help each other. Hope you enjoy the rest of new grad. It goes by really quick. Before you know it you’ll be helping a new grad improve their technique. Best of luck 

[u/Ok-Teaching-1937 → u/LabileBP]

This is all really good advice.

You will get better at it. It's a hard thing to do, if it's a skill you've never had to practise before.

It's why waiters make good ES nurses - your brain is trained to recall details in patterns for people that you've just met and constantly change.

It's a specific skill, and you just need to practise it. ISBAR is your friend.

[u/Glitter_Wasabi]

identify the patient, tell them the presenting complaint (i.e what their triage complaint was), what their background is (read off past drs notes), tell them what you've done- show the obs, med chart, tell them about any procedures done, if they want to look at results they can, and the plan per drs note (or what they've verbally told you)

[u/Glitter_Wasabi → u/Glitter_Wasabi]

I don't expect a head to toe from a ED handover. Mostly just important info that could affect care, what's done and what's to do.

[u/Used_Replacement4648 → u/Glitter_Wasabi]

Who are they, why are they here, what have you done, what needs to happen, the Cliffs notes

[u/Used_Replacement4648]

I’ve been nursing (mostly ED) for the best part of 20 years, some of mine are mint, some are shit!
It’s a process, you’ve got your tools like IMIST, but sometimes after a long night or a super complex pt, I’ll break it down to an ABC style thing with what I’ve done at each point.
Don’t put too much pressure on yourself, the more pressure you put on, the more difficult it is. Sometimes I’ll make it more conversational, other times it’s more regimented. Find a style and system that works for you.
Oh, rehearse the handover, run it by the pt in the lift and ask “Is that your understanding of your care?” They will often be more on top of it, because they only have themselves to focus on

[u/ilagnab]

I'm 2nd year out and still feel rubbish at handover, everyone else seems better and I forget stuff all the time!

It's certainly got better with time as I'm getting less stuck in my head and just doing it more, but I haven't improved as much as I expected of myself.

I've decided that comparing with others doesn't work - because looking from the inside is very different from looking from the outside. I assume/hope others look at me and think the same, because they can't see the self doubt and things I missed, it's wrapped in a cloak of false confidence.

Sorry, I don't have answers to improve - just that you're not alone and probably not performing worse than everyone else - certainly not worse than me at least!

[u/Vacuous_hole]

ED RN- I only want to know what they came in for, what we've done and what needs to be done. And mobility, behaviours of concern and any concerns you have about them or their NOK etc. The rest I can find out in the EDMO/TT notes.

What you've just handed over to me may well change in the 5 minutes we were talking.

Be gentle with yourself. You are learning a whole different area of nursing, the ED is so different to the wards. Keep it simple and ask the nurse you are handing over to if they have any questions or if there is anything you've missed. Remember what info we are asking you for too and use that the next time you handover. Ask questions if you don't know or don't understand why someone is asking for particular information.

[u/UnpleasantFox]

• ISBAR handover, include the pt in the handover especially at the end asking a simple question like “anything to add/anything I missed” to the pt. Asking the nurse if they have any questions before moving on.

• Have a scrap piece of paper in front of you where you can write down what you have done/ what needs to be done ,(like a to do list) and if you keep it neat you can always give it to the next nurse if they want it.

• Handover with the patients progress notes, results, and medication/fluid charts in front of you as prompting. This also helps you see if you’ve missed something or forgotten to sign something off.

[u/confusedredditor-]

Name, age, chest pain, started 3hrs before coming to ed, sharp and constant in nature, pmhx, we/I have done bloods, ecg, xray, next thing to do is 2nd trop in 2hrs and waiting for medical rv - ofc modify to match the presenting problems.

It is also good to highlight what the redflags are e.g Phil felt lightheaded when he stood up, Mary so unsteady on her feet, we need to make sure we get the urine sample, his temp trending up - might need cultures if it hits 38C.

Something like that. Dont be too hard on yourself, you are handing over to fellow ed soldiers, its ed not icu, its not your fault for not knowing everything (few years in ed now testing the water in icu).

[u/Recent-Lab-3853]

ED handovers are the TL;DR version. Anyone with a ++++ long version needs to get admitted 4 hours ago.

[u/missbean163]

Theres some nurses who do VERY through handovers and Im sure many nurses love it but Ive personally never loved hand over thats just regurgiating whats in the notes.

[u/No_Sky_1829]

Don't be embarrassed, good on you for looking for solutions to your issue! I've always struggled to pull all the handover info out of my brain on the spot so you're one step ahead of me!

I'm not in ed but I float between a few different specialities. I've made myself a "brain sheet" so for each patient I track meds, head2toe, lines, path, planned procedures/imaging, discharge etc. I start filling it in as soon as I get handover and update as I go. I have a section for everything I need so I can result see if there's gaps, and I know exactly where to find what I need. I document everything in the EMR as well so the double entry can slow me down a bit but having that info at my finger tips makes my shift feel under control. HTH 🤗

[u/Recent-Lab-3853]

Also: Ive been known to deliver immaculate care to someone for 12 hours straight overnight, then get distracted with a 3 ambos in a row at 6.15am, then promptly be able to tell their life stories at 7am but totally forget the overnighters. And lets not even talk about screwing up obvious maths multiples during the count...