Task uncertainty and communication during nursing shift handovers

Abstract

We explore variations in handover duration and communication in nursing units. We hypothesize that duration per patient is higher in units facing high task uncertainty. We expect both topics and functions of communication to vary depending on task uncertainty. Handovers are changing in modern healthcare organizations, where standardized procedures are increasingly advocated for efficiency and reliability reasons. However, redesign of handover should take environmental contingencies of different clinical unit types into account. An important contingency in institutions is task uncertainty, which may affect how communicative routines like handover are accomplished. Nurse unit managers of 80 care units in 18 hospitals were interviewed in 2008 about topics and functions of handover communication and duration in their unit. Interviews were content-analysed. Clinical units were classified into a theory-based typology (unit type) that gradually increases on task uncertainty. Quantitative analyses were performed. Unit type affected resource allocation. Unit types facing higher uncertainty had higher handover duration per patient. As expected, unit type also affected communication content. Clinical units facing higher uncertainty discussed fewer topics, discussing treatment and care and organization of work less frequently. Finally, unit type affected functions of handover: sharing emotions was less often mentioned in unit types facing higher uncertainty. Task uncertainty and its relationship with functions and topics of handover should be taken into account during the design of handover procedures.