At the moment a patient handoff is nearly completed, when the exchange of relevant information has occurred and when the opportunity for final clarification of the patient condition and situation has passed, an act that has not received much attention occurs. It is the act of the nurse accepting the patient care assignment. Here’s a closer look at some of the implications of that act.
A patient handoff has been defined as the process of transferring primary authority and responsibility for providing care to a patient from one departing caregiver to one oncoming caregiver. The moment when the nurse accepts the assignment may have some type of organizational ceremony such as applying one’s signature to a form, handing over the unit keys, or simply telling the person ending his or her shift to have a good rest of the day.
Accepting an assignment has most often been discussed in the context of the nurse’s right to refuse an assignment. Regulatory agencies offer guidelines and decision-making trees to help nurses determine their knowledge, skills, and abilities when they have concerns with a patient care assignment. The American Nurses Association’s (ANA’s) position statement “Patient Safety: Rights of Registered Nurses When Considering a Patient Assignment,” supports the RN’s rights and responsibilities for refusing a patient care assignment. Refusing an assignment can become quite entangled ethically and legally, and may entail consequences that can be personally devastating for the nurse. Once a patient care assignment is accepted, refusal to care for a patient may lead to charges of abandonment.
Thus, the act of accepting the patient care assignment needs to have proper attention and significance attached. Accepting an assignment is the nurse’s declaration and acceptance of responsibility for the patient(s). It is a sacred act that occurs hundreds of thousands of times a day, sometimes done unconsciously, without the awareness that from this point forward the receiver is expected to meet the standards of practice and standards of performance, adhere to the code of ethics, and reaffirm the contract nursing has made with society. It is the moment when the receiver promises to provide competent nursing care by using the nursing process as outlined by ANA: assess and collect comprehensive data about the patient and situation; analyze the assessment data to determine a diagnosis; identify expected outcomes individualized to each patient; develop a plan that sets down strategies to attain those expected outcomes; implements the plan developed with the patient/family; and evaluate the progress made toward outcomes.
The receiver also promises to act in a competent professional manner: practice ethically by adhering to the Code of Ethics; keep up to date in one’s chosen field of nursing practice; integrate evidence and research findings into practice; contribute to quality nursing practice; demonstrate leadership; collaborate with the health care team; evaluate one’s own practice in relation to professional practice standards, guidelines, rules, and regulations; use appropriate, safe, efficient, and effective resources in the provision of nursing care; and practice in a safe and healthy manner.
Reaffirming our commitment
Every handoff affords the opportunity to reaffirm one’s commitment to the practice of nursing as described in “Nursing’s Social Policy Statement.” It reminds us of the meaning and purpose of nursing. Accepting the assignment is affirmation of our vow to protect, promote, and optimize health and abilities; prevent illness and injury; alleviate suffering through diagnosis and treatment of human responses; and advocate in the care of individuals, families, communities, and populations. It affords us a moment to pause and to reaffirm our contract with society.
American Nurses Association. Position Statement: Patient Safety: Rights of Registered Nurses When Considering a Patient Assignment. March 12, 2009. http://nursingworld.org/rnrightsps
American Nurses Association. Nursing’s Social Policy Statement. Silver Springs, MD: nursesbooks.org; 2010.
Cohen MD, Hilligoss BP. Handoffs in Hospitals: A review of the literature on information exchange while transferring patient responsibility or control. University of Michigan. http://deepblue.lib.umich.edu/bitstream/2027.42/61498/1/Handoffs_in_Hospitals_Literature_Review_081014.pdf
Friesen M, White SV, Byers JF. (2008). Chapter 34 Handoffs: Implications for Nurses in Patient Safety and Quality: An Evidence-Based Handbook for Nurses.
Thomas L, Donohue-Porter P. Blending evidence and innovation: improving intershift handoffs in a multihospital setting. J Nurs Care Qual. 2012;27(2):116-24.
Department of Veterans Affairs. VHA Nursing Hand-Off Survey. December 2006. http://www.va.gov/NURSING/docs/Final_VHA_Nursing_HandOff06_Report.pdf
Becky Graner is a nurse consultant in Mandan, North Dakota.