Essentials of Nursing Leadership and Management, 5th Edition

chapter 6 | Getting People to Work Together 77

without intending this to happen. Consider the fol-
lowing example:

A respiratory therapist and a department adminis-

trator at a large health-care institution were

engaged in a relationship. They started sending each

other personal notes over the company e-mail sys-

tem. One day, one of them accidentally sent one of

these notes to all the employees at the health-care

institution. Both were f ired. The moral of this story

is simple: Do not send anything by e-mail that you

would not want published on the front page of a

national newspaper or hear on your favorite radio

station tomorrow morning.

Although voice tone cannot be “heard” in e-mail,
the use of certain words and writing styles indicates
emotion. A rude tone in an e-mail message may
provoke extreme reactions. Follow the “rules of neti-
quette” (Shea, 2000) when communicating through
e-mail. Some of these rules are listed in Box 6-3.

Reporting Patient Information

Change-of-Shift Report

It is important to understand exactly how your day
at work will begin. Regardless of which shift an indi-
vidual works, some things never change. Nurses
traditionally give one another a “report.” The
change-of-shift report has become the accepted
method of communicating patient care needs from
one nurse to another. In the report, pertinent infor-
mation related to events that occurred is given to the
individuals responsible for providing continuity of
care (Box 6-4). Although historically the report has
been given face to face, there are newer ways to share
information. Many health-care institutions use
audiotape and computer printouts as mechanisms

for sharing information.These mechanisms allow

the nurses from the previous shift to complete their

tasks and those coming on duty to make inquiries

for clarification as necessary.

The report should be organized, concise, and

complete, with relevant details. Not every unit uses

the same system for giving a change-of-shift

report. The system is easily modified according to

the pattern of nursing care delivery and the types of

patients serviced. For example, many intensive care

units, because of their small size and the more acute

needs of their patients, use walking rounds as a

means for giving the report. This system allows

nurses to discuss the current patient status and to

set goals for care for the next several hours.

Together, the nurses gather objective data as one

nurse ends a shift and another begins. This way,

there is no confusion as to the patient’s status at

shift change. This same system is often used in

emergency departments and labor and delivery

units. Larger patient care units may find the “walk-

ing report” time-consuming and an inefficient use

of resources.

It is helpful to take notes or create a worksheet

while listening to the report. A worksheet helps

box 6-3

Rules of Netiquette

1.If you were face-to-face, would you say this?

2.Follow the same rules of behavior online that you follow

when dealing with individuals personally.

3.Send information only to those individuals who need it.

4.Avoid flaming; that is, sending remarks intended to

cause a negative reaction.

5.Do not write in all capital letters; this suggests anger.

6.Respect other people’s privacy.

7.Do not abuse the power of your position.

8. Proofread your e-mail before sending it.
   Adapted from Shea, V. (2000). Netiquette.San Rafael, Calif.: Albion.

box 6-4

Information for Change-of-Shift Report

• Identify the patient, including the room and bed numbers.


• Include the patient diagnosis.


• Account for the presence of the patient on the unit. If the
  patient has left the unit for a diagnostic test, surgery, or
  just to wander, it is important for the oncoming staff
  members to know the patient is off the unit.


• Provide the treatment plan that specifies the goals of
  treatment. Note the goals and the critical pathway steps
  either achieved or in progress. Personalized approaches
  can be developed during this time and patient readiness
  for those approaches evaluated. It is helpful to mention
  the patient’s primary care physician. Include new orders
  and medications and treatments currently prescribed.


• Document patient responses to current treatments. Is the
  treatment plan working? Present evidence for or against
  this. Include pertinent laboratory values as well as any
  negative reactions to medications or treatments. Note
  any comments the patient has made regarding the
  hospitalization or treatment plan that the oncoming staff
  members need to address.


• Omit personal opinions and value judgments about
  patients as well as personal/confidential information not
  pertinent to providing patient care. If you are using
  computerized information systems, make sure you know
  how to present the material accurately and concisely.