| Course | NUR-4102 Leadership and Management in Nursing Scholars Track |
|---|---|
| Module | Module 4 |
| Paper type | Leadership paper: communication and handoffs |
| Length | About 1,062 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | Bachelor of Science in Nursing |
| Updated | October 2026 |
Free sample paper for NUR 4102 Module 4
The Number Nobody Mentioned: Structuring Handoffs on a Medical-Surgical Unit
Student Name
Bachelor of Science in Nursing, Thomas Edison State University
NUR-4102: Leadership and Management in Nursing: Scholars Track
Mentor Name
Month Day, Year
The Number Nobody Mentioned: Structuring Handoffs on a Medical-Surgical Unit
The Event
Mr. Thompson, an invented 72-year-old with chronic kidney disease admitted with pneumonia, had a 2 a.m. potassium of 5.4, up from 4.8 the previous day. His night nurse noticed the value and meant to pass it on, but at 6:30 a.m. she was in the middle of an admission. Her report at the nurses' station was rushed; she covered his antibiotics and oxygen and forgot the potassium. The day nurse found the result at 10 a.m., when a repeat value had reached 6.1 and his monitor showed peaked T waves. He was treated quickly and recovered, but hours had passed in which a dangerous trend sat in the chart without anyone acting on it.
Why Handoffs Fail
Leonard et al. (2004) argued that breakdowns in communication lie behind a large share of serious harm in hospitals. Part of the reason is training: nurses learn to tell the story of a patient in narrative detail, while physicians learn to want short, headline information, so the two often talk past each other. Hierarchy makes some team members reluctant to raise a concern. Fatigue, interruptions and time pressure make it easy to leave something out. The authors urged teams to adopt standard formats for communication, to use agreed assertive language when a member is worried, to brief before and debrief after care and to build a culture where anyone can raise a problem without fear.
A Shared Mental Model
Haig et al. (2006) described how one Illinois medical center made SBAR its standard format for clinicians talking about patients. The four letters stand for the current situation, the relevant background, the speaker's assessment and a recommendation. Because both people know which pieces of information are coming and in what order, SBAR gives sender and receiver the same picture of the patient, which the authors call a shared mental model. The hospital applied it to nurse-to-physician calls, to shift reports and to transfers between units, and reported better staff ratings of communication along with fewer adverse events afterward.
Evidence From a Handoff Program
Starmer et al. (2014) tested the I-PASS program in nine pediatric residency programs. In the mnemonic, I prompts the speaker to say how ill the patient is, P calls for a brief summary, A for the list of tasks, S for awareness of the situation and plans for what might change and the final S for the receiver's synthesis. The program bundled the mnemonic with training workshops, faculty coaching, a written handoff document and a campaign to make good handoffs part of the culture. Comparing the periods before and after, overall medical errors declined 23 percent, preventable adverse events fell by 30 percent and the time spent on each handoff did not grow. The study involved residents rather than nurses, but its core features, a fixed structure, a written and a spoken part and a receiver who repeats back what she heard, translate directly to nursing report.
| Source | Key point | Unit application |
|---|---|---|
| Leonard et al. (2004) | Communication failures cause harm; hierarchy and style differences contribute | Make speaking up expected |
| Haig et al. (2006) | SBAR creates a shared mental model | Use SBAR structure in handoff |
| Starmer et al. (2014) | Structured handoff program cut errors 23 percent | Combine a tool, training and receiver read-back |
Analyzing Our Handoff
Our night-to-day report took place at the nurses' station with no set format. It was often interrupted by phones and call lights, and nothing required the receiving nurse to repeat back what she had heard. Critical laboratory values had no fixed place in the report. Each of these features matches a failure point that Leonard and colleagues describe, and together they explain how Mr. Thompson's potassium went unsaid.
The Plan
We made four changes. First, report now takes place at the bedside, where both nurses can see the patient and the patient can listen, correct and add details. Second, a printed handoff sheet built on SBAR has a line that must be filled in for abnormal labs and pending results. Third, borrowing from I-PASS, the receiving nurse summarizes the key points and to-do items back, and the outgoing nurse confirms or corrects them. Fourth, during the 30 minutes of shift change, the charge nurse takes new admissions and phone calls when possible, so report is not interrupted.
Teaching the Change
The unit educator and I ran short simulations with sample patients, one of them with a climbing potassium, and coached nurses through bedside report during the first two weeks. Several nurses worried about privacy in shared rooms. We agreed that sensitive details could be shared just outside the door and that visitors would be asked to step out during report.
The Patient's Voice
Bedside report also gave patients a role. In the first month, several patients corrected details, including one who told the nurses she had not received a pain medication that had been charted as given. Patients and families can act as an extra layer of checking, and many said they appreciated knowing who their next nurse would be.
Evaluation
After two months, I audited 40 handoffs. Abnormal labs were mentioned in 37 of them, compared with 22 of 40 in an audit before the change. Patient comments mentioned feeling included in their care, and no delayed response to a critical laboratory value was reported during the period.
What Changed for the Charge Nurse
Protecting shift change changed my own routine. I now arrive 15 minutes early to review overnight admissions, pending labs and any patient whose trend is worsening, so that I can listen for those items during report. When I hear a handoff that skips an abnormal result, I ask about it at the bedside, which shows newer nurses that questions are welcome.
Limits
I-PASS was studied among resident physicians in children's hospitals, not among nurses. Bedside report takes practice and can feel slower at first. The patient and unit are invented.
Conclusion
Mr. Thompson's potassium was in the chart but not in the conversation. Leonard and colleagues explained why handoffs break down, Haig and colleagues showed how SBAR gives clinicians the same picture of the patient and Starmer and colleagues showed that a structured handoff program reduces errors. Bedside report with a structured sheet, a required line for abnormal results, a repeat-back by the receiving nurse and protected time closed the gap.
References
Haig, K. M., Sutton, S., & Whittington, J. (2006). SBAR: A shared mental model for improving communication between clinicians. Joint Commission Journal on Quality and Patient Safety, 32(3), 167-175. https://doi.org/10.1016/S1553-7250(06)32022-3
Leonard, M., Graham, S., & Bonacum, D. (2004). The human factor: The critical importance of effective teamwork and communication in providing safe care. Quality and Safety in Health Care, 13(Suppl. 1), i85-i90. https://doi.org/10.1136/qshc.2004.010033
Starmer, A. J., Spector, N. D., Srivastava, R., West, D. C., Rosenbluth, G., Allen, A. D., Noble, E. L., Tse, L. L., Dalal, A. K., Keohane, C. A., Lipsitz, S. R., Rothschild, J. M., Wien, M. F., Yoon, C. S., Zigmont, K. R., Wilson, K. M., O'Toole, J. K., Solan, L. G., Aylor, M., . . . Landrigan, C. P. (2014). Changes in medical errors after implementation of a handoff program. New England Journal of Medicine, 371(19), 1803-1812. https://doi.org/10.1056/NEJMsa1405556
What the NUR 4102 Module 4 instructions ask for
Communication and collaboration are part of TESU's catalog paragraph for NUR-4102. With no syllabus available outside the course, the fourth paper here is modeled as an analysis of handoffs. Describe a communication failure in enough detail to analyze, explain why handoffs break down, report evidence on structured tools and handoff programs and analyze your unit's current process. Then design a plan that adds structure, a read-back by the receiving nurse and protected time at shift change, train staff and measure the results. Address practical worries such as privacy at the bedside, and consider what patients can add when they hear report. Some sections focus on nurse-to-provider calls instead. Ask whether your handoff sheet should be attached as an appendix.
How the NUR 4102 Module 4 example is put together
A rising potassium in a 72-year-old patient on Dana Ruiz's floor goes unmentioned at shift change until a repeat value shows 6.1. Leonard and colleagues' analysis of communication failures, Haig and colleagues' description of SBAR and Starmer and colleagues' I-PASS study are set out with unit applications in a table. The unit's handoff is analyzed, and a plan moves report to the bedside with a structured sheet, a required line for abnormal results, a read-back and protected time. Simulation training, the privacy concerns raised by staff, a section on patients who corrected their own details, a 40-handoff audit, limits and a conclusion follow.
Where the marks sit in the NUR 4102 Module 4 rubric
Handoff papers are strongest when they analyze a specific failure, explain its causes with research and design a plan with concrete features, such as a required field for abnormal results and a read-back by the receiving nurse. Readers value attention to culture, so that raising a concern is expected, and to practical worries such as privacy at the bedside. Training through simulation and an audit before and after the change show that the plan was carried out and checked. Noting that I-PASS was developed among resident physicians shows careful transfer of evidence. Giving patients a voice in bedside report shows the writer sees them as part of the safety system. An audit count, such as how many reports mentioned abnormal labs, gives the evaluation weight.
NUR 4102 Module 4 help: mistakes that cost marks
Handoff papers often recommend a tool without saying how staff will learn it or how anyone will know it works. Describe the failure, explain why handoffs break down, report the evidence and build in a read-back by the receiving nurse. Protect time at shift change, plan for privacy at the bedside and train staff with practice cases. Audit handoffs before and after to show the effect, and include the patient's role at the bedside. Tell us your module prompt and describe your unit's handoff problem, and we can write a free first draft built on that description.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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NUR 4102 Module 4 questions, answered
Where can I find a free NUR 4102 Module 4 sample paper?
The handoff communication paper by an invented Cherry Hill charge nurse, from SBAR to I-PASS, is available here.
What does SBAR stand for?
Situation, background, assessment and recommendation, a structure that creates a shared mental model for communication.
Do structured handoff programs reduce errors?
Yes; in Starmer and colleagues' I-PASS study, the error rate fell and preventable adverse events became less common, without longer handoffs.
Why do handoffs fail?
Differences in communication style, hierarchy, fatigue, interruptions and time pressure all contribute.
What is receiver read-back?
The receiving nurse summarizes key points and actions back to the giving nurse, who confirms or corrects them.