Elevating Clinical Shift Success at Handover - Culture setting
- naomi620
- Oct 14
- 4 min read
Updated: Oct 16
Leadership is not about being in charge it is about taking care of those in your charge. - Simon Sinek
“Alright team—ten minutes. Let’s make them count.”
That’s how a great shift begins. Not with a lecture. Not with a download. With a quick, human conversation that sets how we work before we dive into what we do. To Simon Sinek’s point, leadership isn’t about holding the clipboard. it’s about holding the people. On a ward, in ED, or on the birthing suite, the first minutes of a shift decide whether your team feels protected, clear, and ready....or alone with a list. Skilled leaders use that time to care for the people who will care for patients.
Think of culture like the air in the room: you don’t notice it until it’s stale. Edgar Schein reminds us that culture shows up in what we do, what we explain, and what we tolerate. So, at handover, show—don’t just tell. Make the invisible visible.
Most of us, as we step into Team Leader, Educator and Manager Roles, feel like we need to demonstrate we are a good leader, by giving the wise advice and believing success equals a perfect checklist: tidy allocation, stock sorted, breaks on time. Useful, yes—but not the purpose.
Your purpose is to create and manage culture. As Edgar H Schein describes, your purpose as a leader is to "create and manage culture” and “if you do not manage culture, it manages you.”
Yes, your team values their tea break—and it helps make space for learning later in the shift. But when things get busy, teams will skip a break if they feel supported, appreciated, and know the work matters. They’re more willing to step in when they trust that everyone usually gets their break and that their effort won’t go unnoticed.
We work in healthcare, a complex adaptive system that is filled with risk, compromise and challenge. Healthcare without risk does not and cannot exist. I’m sure this will be a blog of it’s own soon enough, in the meantime it is important to note as managers of the shift our role is not to remove all risk, it is to understand the risks and enable our team to navigate risk.
As the leader you set the tone of the shift.
Are you reactive or do you have a plan that is responsive, calm and considered?
Will team members be supported if they become overwhelmed or is there inequity in workload that is not addressed?
Is the team aware of likely challenges during the shift?
Do the team know who to go to escalate care, or do you appear too busy to help?
Rich Patient Handover
The rich clinical handover is best held nurse-to nurse and use the group huddle for safety flow and team co-ordination. It occurs best at the bedside with the patient and typically takes 3-7minutes per patient. Ensure key alerts, assessments and plans for the patient are handed over, medication charts checked with both nurses attending.
Allocation
Staffing decisions influence safety, missed care, nurse wellbeing, and retention. Large multi-country studies and reviews link better nurse staffing and higher RN skill-mix with lower mortality and fewer adverse events; missed care often mediates the link between staffing and outcomes.
The allocation also needs to be considered beyond the management of the shift – how can you develop the team in today’s shift so that next week they are better able to manage a more complicated workload. Too many leaders assume that reducing risk today is the best strategy.
It is important to consider each shift which members of the team can be supported to develop in some way today.
Continuity helps when complexity, rapport, or discharge planning are central. But automatically copying yesterday’s allocation can entrench inequity and miss overnight changes in risk. Re-score acuity at the start of every shift; keep continuity only when it reduces risk or accelerates progress, otherwise re-match.
A healthy system grows capability without compromising safety:
Link novice or new staff with a preceptor or buddy
Make learning goals visible
Protect preceptor time
Some jurisdictions legislate ratios, complementing local workload tools. Early evaluations link under-staffing with worse outcomes and support standardising minimums while still using acuity tools for day-to-day allocation. Know your local instrument and how it interacts with ratios or nursing hours per patient day.
Update board data: estimate patient need
Map skill-mix & capacity: who has the critical skills today who is precepting, fatigue/return-from-leave.
Allocate to risk: distribute workload; protect RN assessment time; keep continuity only where it reduces risk.
Name supervision & learning: explicit buddy pairings and a timed learning bite; ensure novice nurses have reachable support.
State fairness criteria: tell the team how decisions were made (acuity + skill + capacity + continuity if beneficial); invite safety concerns before you “go live.”
Plan dynamic review: set a mid-shift check (e.g., 11:00) to re-balance based on admissions/discharges and staff capacity; redeploy float/support roles to hotspots.
It is ok to change allocation mid shift. Don't make this routine, but if the requirements have changed, change the allocation. Explain why to those involved – let them input as to how the changes are made.
Key takeaways for Team Leaders
Treat allocation as a clinical safety and patient experience decision, not a clerical task.
Measure demand and capacity, then match; review mid-shift or as required.
Skill-mix matters: ensure the right people are doing the right work.
Continuity is a tool, not a rule: keep it when it lowers risk.
Make fairness criteria visible and supervision explicit.
All of this fits in ten minutes. Safety and purpose, clarity and roles, norms and fairness, help-wanted and recognition. No monologue. Just a brief, human conversation that says: I’m taking care of you, so together we can take better care of them.
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