From Chaos to Clarity: Bedside Handoff in Obstetric Nursing
Submitted by Elizabeth Lester
Tags: obstetric patient safety pregnancy reporting
Nursing in obstetrics is not for the weak. Every nursing specialty believes they are the best, but only in obstetrics are you skilled enough to care for a patient you cannot physically touch. In addition, the obstetric nurse is expected to be competent in a wide range of skills, including triage, caring for high-risk mothers receiving critical care medications (i.e., Magnesium Sulfate), labor support, assisting with delivery, neonatal care, pre-operative preparation, circulating cesarean sections, post-operative recovery, postpartum care, and lactation support. This expansive responsibility requires the obstetric nurse to constantly process information, anticipate rapid changes in patient condition, and communicate effectively across multiple disciplines. A single shift may involve caring for several patients at differing stages of labor or recovery, each with unique risks and priorities. With all of this encompassed, incomplete or unclear communication can have poor patient outcomes.
Obstetric (OB) nurses must remain calm when chaos erupts. We have all heard the phrase, “It’s better to be proactive than reactive.” One of the most effective ways a nurse can be proactive is by having complete and accurate information before that chaos begins. Being proactive in obstetrics means anticipating potential complications before they arise and ensuring the oncoming nurse has a clear understanding of the patient’s current status and potential risks. This includes being aware of the fetal heart rate trends, labor progress, medications, and any other emerging concerns that may escalate. Bedside handoff has been standardized in many organizations across the country, but are nurses truly participating? And more importantly, are patients actually being included in the handoff process?
The obstetric specialty carries one of the highest legality risks in healthcare, and communication failures are a known contributor to patient harm. Anytime care is handed off from one caregiver to another, patient safety and satisfaction are at risk. Traditional nurse-to-nurse handoff conducted at a busy nurses’ station can be distracting and may lead to critical information being missed or miscommunicated. Transitioning handoff to the bedside allows nurses to improve communication while enhancing the patient experience.
¹Patients who are included in bedside handoff report higher satisfaction and a stronger sense of trust in their nurse. The benefits extend to nurses as well. Beginning a shift at the bedside allows the oncoming nurse to verify IV fluids, high-risk IV medications such as Oxytocin or Magnesium Sulfate, IV pump settings, Foley catheter output, room readiness, and overall patient status in real time with the off-going nurse present. As nurses, how often have we entered a patient’s room at the start of a shift only to find near-empty IV fluids or an overfilled Foley catheter bag? These issues can often be addressed immediately when identified during bedside handoff. This shared visualization supports clinical judgment and reinforces accountability between nurses. ³ Studies have shown that nurse-to-nurse bedside handoff significantly improves accountability, medication reconciliation, and the ability to communicate promptly with physicians regarding patient care.
If bedside handoff has not been implemented as standard practice within your unit, department, or organization, consider becoming the champion for change. Bringing evidence-based research to a unit-based council or hospital leadership is an important step in advocating for improved nurse-to-nurse communication and, ultimately, safer patient care.
In obstetrics, communication is not optional, it is lifesaving.
References
- White-Trevino, K. & Dearmon, V. (2018). Transitioning Nurse Handoff to the Bedside. Engaging Staff and Patients. Nursing Administration Quarterly, 42(3), 261 – 268. DOI: 10.1097/NAQ.0000000000000298
- Franco Vega, M.C. et al. (2024). Enhancing Implementation of the I-PASS Handoff Tool Using a Provider Handoff Task Force at a Comprehensive Cancer Center. Joint Commission Journal on Quality and Patient Safety, 50(8), 560 – 568. DOI: 10.1016/j.jcjq.2024.03.004
- Maxon, P., Derby, K., Wrobleski, D. & Foss, D. (2012). Bedside Nurse-to-Nurse Handoff Promotes Patient Safety. MedSurg Nursing, 21(3), 140 – 144.