Earlier in my nursing career, I didn’t fully appreciate bedside handoff. Report in the pod or just outside the room sometimes seemed faster and less disruptive. A clinical experience changed my view. I learned that the words used to describe a patient can sound reassuring—or misleading—until we see that patient for ourselves.
Bedside handoff gives the incoming and outgoing nurses a chance to compare report with the patient’s condition, clarify what remains to be done, and invite the patient into the conversation. It’s a brief but important opportunity to notice a change before it becomes an emergency.
When agitation signaled something more
During report, I learned that a patient’s behavior had changed. The change had been interpreted as agitation, and the patient had received medication for anxiety. At the bedside, the patient’s appearance concerned me. They were diaphoretic, pulling off clothing, becoming less responsive, and speaking in garbled words. This didn’t look like simple agitation.
The previous blood glucose reading had been in the 70s at about 9 pm. I checked it again: 34 mg/dL. We administered I.V. dextrose, and the patient became somewhat more alert, but the altered mental status didn’t resolve. Neither an oral nor a tympanic thermometer could register a temperature. A rectal temperature measured 91.9°F (33.3°C). We began warming measures and activated the medical emergency team. After further evaluation, including laboratory testing and an emergent head CT, the patient was transferred to a higher level of care.
I can’t know precisely how the shift would have unfolded if I’d taken report outside the room. I do know that seeing the patient prompted me to assess and act immediately. A report sheet could tell me that the patient had been agitated. It couldn’t show me the diaphoresis, declining responsiveness, or change in speech at that moment.
Compare the report with the patient
The Agency for Healthcare Research and Quality describes bedside shift report as a way to support a safe handoff while involving patients and families. At the bedside, I can ask whether the reported baseline matches the person in front of me. I can check alertness, speech, breathing, oxygen and telemetry, confirm that the call bell is within reach, and hear a concern the patient may not have voiced earlier.
In an evidence-based quality improvement project published in OJIN, McAllen and colleagues trained nurses to use ISBARQ: introduction, situation, background, assessment, recommendation, and questions. Their bedside process began with an introduction and included an assessment of the patient and room, review of relevant treatment and follow-up, and an invitation for questions. This structure makes space for both a clinical check and patient participation.
A 2025 systematic review by Maher and colleagues examined 30 studies of handovers that included patients or carers. The studies reported benefits for patient engagement, satisfaction, and information exchange, but findings for outcomes such as falls were inconsistent. Time pressure and staff workload also made bedside handover harder to sustain. That evidence supports a purposeful handoff without promising that bedside report alone will prevent every adverse event.
A description such as “agitated” can be useful, but it shouldn’t close off assessment. Hypoglycemia, hypoxia, medication effects, infection, or a neurological change also may affect behavior. The incoming nurse needs to see what;s changed, ask questions, and use clinical judgment. The outgoing nurse can help by distinguishing what was observed from what was assumed.
Verify high-risk care and unfinished work
Bedside handoff also creates a moment to verify treatment. For a continuous high-alert infusion, nurses can compare the medication, concentration, and programmed pump rate with the current order and medication administration record, following their organization’s verification policy. They can identify monitoring that’s due, pending laboratory results, and the action required when those results return. A rate displayed on a pump and a rate documented in the record shouldn’t be treated as the same thing without checking.
Not every shift ends with every task complete. A medication may still be due, a laboratory result may need follow-up, or a treatment may require completion. That’s part of continuous care. What matters is saying clearly what remains, how urgent it is, and who will take responsibility after the handoff. Both nurses should have the opportunity to question an inconsistency and resolve it or escalate it according to policy. Shared accountability means protecting the patient, not assigning blame.
Make room for the patient and for privacy
Bedside report also can give the patient a voice. Introducing the incoming nurse and inviting the patient to correct or add information helps establish continuity. A patient may mention a new symptom, an unanswered question, or a treatment concern that wasn’t part of the verbal report.
That voice matters beyond catching an error. Patients and families know what the patient was able to do yesterday, which symptom is new, and whether an explanation has made sense to them. During handoff, a family member might say that confusion began after a medication change, or a patient might say that pain discussed on rounds hasn’t improved. The nurses can assess the concern, clarify the plan, and bring the information to the provider.
A provider can’t be present for every change over a 24-hour stay; inviting the patient and family to speak helps the team recognize gaps and respond together. AHRQ’s communication guidance encourages patients to share information, ask questions until they understand, and identify who should be involved in their care.
The approach should fit the situation. Sensitive details can be discussed privately before entering the room. Nurses can ask the patient whether visitors should remain and avoid waking a sleeping patient unnecessarily when a focused safety check will suffice. Bedside handoff works best when it’s purposeful rather than a scripted recitation of the chart.
A practice I now view differently
I once thought of bedside handoff chiefly as a policy. Now I see it as an early assessment and a chance to make the transfer of care visible. It helped me recognize a patient who needed urgent attention, and it reminds me to verify high-risk treatments and unfinished work before I take over an assignment.
The work doesn’t stop when a shift changes. Sometimes the oncoming nurse will complete a medication pass, follow up on a lab, or continue a treatment begun by the outgoing nurse. A clear handoff lets that work continue safely. Before accepting that a patient is stable, we should see the patient, compare the report with our assessment, and speak up when something doesn’t fit.
Lesline Rostick is an RN and charge nurse in the cardiac/neurology unit at Berkshire Medical Center in Pittsfield, Massachusetts.
References
Agency for Healthcare Research and Quality. Strategy 2: Communicating to improve quality. December 2017. ahrq.gov/patient-safety/patients-families/engagingfamilies/strategy2/index.html
Agency for Healthcare Research and Quality. Strategy 3: Nurse bedside shift report. December 2017. https://www.ahrq.gov/patient-safety/patients-families/engagingfamilies/strategy3/index.html
Maher A, Hsu H, Ebrahim MEBM, Vukasovic M, Coggins A. Implementation of bedside handover that includes patients or carers in hospital settings: A systematic review. J Eval Clin Pract. 2025;31(6):e14223. doi:10.1111/jep.14223
McAllen ER Jr, Stephens K, Swanson-Biearman B, Kerr K, Whiteman K. Moving shift report to the bedside: An evidence-based quality improvement project. Online J Issues Nurs. 2018;23(2). doi:10.3912/OJIN.Vol23No02PPT22
