How do nurses learn? As a clinical nurse on a surgical acute care unit in a large academic hospital for more than 11 years, I had a sudden reflection on this question and our learning opportunities.

Other professional care team members have routine opportunities for individual and interprofessional learning. In the morning, physicians and advanced practice providers round on patients individually and assess them as a team. Physical therapy and occupational therapy work together with a patient for an initial evaluation. For patients with complex issues, case management may involve their directors or combine with social work for additional resources. All of these interprofessional interactions result in shared learning and developing skills to care for the patient.

Unless an issue arises where a charge nurse needs to intervene, there is not much co-interaction with other nurses in the care of the patient. So, how do nurses routinely collaborate with other nurses for shared learning and continuous improvement after orientation? The opportunity is not as frequent as it is for other care practitioners.

Since time and nursing staff resources can be constrained, the importance of a “hands-on” bedside shift change report between the oncoming and outgoing nurses can be critical. Rather than building nurses’ expertise through formal education that requires a strict order of operations, this can be done through shared observation of nursing interventions. For example, if the patient is not taking deep breaths and is experiencing abdominal pain, there may be a need to loosen their abdominal binder, if clinically appropriate. If this intervention is effective, the nurses may need to apply a better-fitting binder. In another example, if a patient’s oxygen level is lower than expected for their clinical presentation, nurses may try repositioning them in the bed to see if the oxygen level improves. Essentially, bedside shift change report can be a brief period of co-learning and collaborative consultation that can improve nursing knowledge and transform patient care. Often this type of shift change report takes 10 minutes or less.

Bedside shift report initiatives have been introduced by leadership at our hospital with emphasis on including the patient in their plan of care. As with all changes implemented in daily routines, there has been pushback. In speaking with the nursing staff, we found some common barriers to transitioning to bedside handoff as opposed to sitting at a computer desk away from the bedside. Some of these barriers with recommended solutions are:

1. Discomfort in speaking in front of the patient and/or other nurses — remind the nurse that this, like all skills, takes practice. It will become fluid with practice.
2. Speaking without the guide of written information — suggest to the nurses to start at the top of the head and work their way down with abnormal findings.
3. Not fully understanding the patient’s illness — rely on hospital resources and the entire multidisciplinary team to increase nursing knowledge. Focus on nursing interventions and individualized care needs. Nurses can discuss with each other for better comprehension of patient care needs.
4. Fear of revealing something the patient may not have known — often patients are aware of why they are in the hospital, but try to use terms that the patient can understand, such as "abdominal mass" versus "tumor," or simply say "abdominal pain" if it is before a diagnosis. Pre-think how you will introduce the oncoming nurse and the reason for their presence in the hospital, then start at the top of the body.

To summarize, bedside shift report between nursing staff helps to develop and enhance nursing expertise. It also gives attention and information to the patient and helps ensure that accurate, quality care is provided.