What Psychiatric Nurses Do (Part Three – Handovers and Shift-leading)

This is part three of the series on What Psychiatric Nurses Do. Here are part one and part two.

Every shift needs a leader – someone to plan what will be done and generally take charge. On the ward I worked on nurses would take turns to lead the shift. It’s one of the most difficult aspects of the job, with lots of responsibility, and demands a lot of work on the part of the nurse. Needless to say, shift-leading isn’t popular, and I have spent many many hours complaining about having to do it too often, or coming back from annual leave or sickness to have to lead a shift.

Shift-leading begins with the handover from the previous shift-leader to the on-coming team. In theory hand-overs are supposed to be quick and concise, but as it’s often the only time nurses get to sit down together and discuss care, they also end up being care-planning sessions, time for rants and receiving support, and general gossip sessions ;).

So in theory the handing-over nurse goes through the printed sheet of patients, discussing how the patients have been over the last shift or two. They’ll identify any changes to the plan of care, the outcome of any meetings, any incidents or issues, and any outstanding jobs. As you can imagine, with 22+ patients on the books, hand-overs can be lengthy, especially if there have been a few admissions or a serious incident. The job of the on-coming shift-leader is to record all this information, quickly and in a legible form, on the sheet for future reference, and formulate a list of outstanding jobs.

Once handover is over, the new shift-leader allocates jobs to the other members of the team (usually made up of 5 staff – usually 3 nurses and 2 support workers), and basically plans the shift. It can be a tricky business trying to delegate tasks around everything that needs to be organised. For example, you have 5 staff and need to organise who will do the hourly observations at each time period, who will do medication, who will do ward round, who will be on-duty in the dining room at meal times, who will respond to the alarm (can’t be the same person who does medication or ward round), who will answer the fire alarm (can’t be the same person who does medication or the dining room or ward round), etc… Sometimes it’s a nightmare.

Once all this has been organised, the shift-leader then has dozens of miscellaneous little jobs to do, such as figuring out the number of patients in beds and whether there are upcoming transfers or discharges, allocating breaks around everything else, handing over to the Occupational Therapy team, discussing upcoming patient movements with the Crisis Team, speaking to the Pharmacist about medications that will need to be ordered, etc. It can be well over an hour into the shift before you actually get to check the diary and make a list of jobs that need to be done for the day. There are always inevitably plenty of phone calls, referrals, medication changes and other general tasks to be done. The shift-leader tends to make a long list of jobs, and the staff work through them, ticking them off as they go.

But I guess the hardest part of being shift-leader is that you’re generally in charge of the ward for those few hours. Whether a patient can or cannot go out is your decision. Admissions are agreed by you. Patient and family complaints are directed at you. All enquiries about everything are directed at you. If an incident occurs, it’s you who is expected to make the quick decisions and take the lead in any action. You have to know what is going on at all times. Sometimes you get it right and you feel on top of everything – like keeping a dozen plates spinning perfectly. But sometimes it will overwhelm you, and everything will come crashing down!!! It’s a lot of responsibility and a lot of stress. And shift-leading if you’ve been off for a few days is very difficult.

Of course, once the shift is over it’s your turn to hand-over to the next leader, and try to recall every single thing that has happened. Any outstanding jobs can be communicated to the next team.

So that’s shift-leading, the most difficult job a Band 5 nurse does. Next time I’ll discuss ward rounds; the second most difficult job.


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