NUR 4103 Module 3 Communication Plan Example

Say It Twice and Close the Loop: A Communication Plan for a Travel Nurse's First Five Shifts on an Unfamiliar Telemetry Unit

Student Name

American College of Education

NUR4103: Professional Skills to Thrive as a Travel Nurse

Module 3 Assignment

Instructor Name

January 22, 2029

Why the First Five Shifts Are Risky

A traveler's first shifts combine every condition that makes communication fail. The traveler does not know the people, the unwritten rules, who to call for what or what the unit's abbreviations mean. The electronic record may be unfamiliar, so information the traveler would normally find in seconds takes minutes. And the traveler, wanting to appear competent, may hesitate to ask. Poor handoffs sit behind a large share of the serious events reported to the main hospital accreditor, which urges hospitals to make handoffs standardized and two-way (The Joint Commission, 2017), and nobody on a unit is more exposed to a weak handoff than a traveler in week one. This plan covers the first five shifts of the thirteen-week telemetry contract, after which I expect the unit's patterns to be familiar.

Before the First Patient

Some communication must be learned before it is needed. During orientation, I will write on a pocket card the unit's rapid response number and criteria, the process for paging the hospitalist and cardiology at night, who the house supervisor is and how to reach them, the telemetry technician's extension and the steps for reporting a critical laboratory value. I will ask the charge nurse which providers prefer a call and which a secure message, and which messages the unit sends through the record rather than by phone. I will learn the unit's abbreviations for common orders, since misreading a local shorthand is an avoidable error. The worst time to learn who to call is when a patient's pressure is falling.

Receiving and Giving Handoffs

At the start of each shift, I will receive report at the bedside where the unit permits it, using the unit's handoff tool. Because I do not yet know the unit, I will ask two questions of every outgoing nurse: is there anything about this patient that I would not find in the chart, and is there anything about how this unit handles this situation that I should know. Before the outgoing nurse leaves, I will summarize the plan for each patient back to them, including any pending results and when they are due. At the end of the shift, I will give report in the same structure, and I will say explicitly when something was done differently from the unit's usual practice because I was still learning it, so that the next nurse can check it.

Read-back is the key habit. It feels slow and slightly awkward in a busy handoff, but it is the one step that catches the misunderstanding before it reaches the patient, and it signals to the permanent staff that the traveler takes their information seriously.

Calling Providers

I will use SBAR for every call to a provider, because providers on a new unit do not know me and will judge my assessment by how clearly I present it. One review of eleven SBAR studies judged the evidence moderate that the tool makes care safer, with its clearest benefit in calls made by telephone (Müller et al., 2018). A call about a patient with new atrial fibrillation might sound like this: This is the travel nurse caring for Mr. B. in room 14. Situation: his heart rate went to 138 in atrial fibrillation fifteen minutes ago. Background: he is two days after a pneumonia admission, with no history of atrial fibrillation, and his potassium this morning was 3.3. Assessment: his blood pressure is 104 over 68, he is mildly short of breath and his oxygen saturation is 94% on two liters. Recommendation: I would like you to see him, and I am asking whether you want potassium replaced and a 12-lead electrocardiogram now. Before I hang up, I will read back any orders.

Stating that I am a travel nurse is deliberate. It tells the provider that I may not know local preferences and invites them to tell me, and in my experience it makes providers more patient, not less.

Closing the Loop and Asking Questions

In urgent situations, I will use closed-loop communication: when someone gives me a direction, I repeat it back and say when it is done, and when I give a direction, I address a named person and wait for the repeat. In a study of 387 verbal orders during pediatric trauma resuscitations, orders given with closed-loop communication were completed about 3.6 times sooner than orders without it (El-Shafy et al., 2018). A rapid response on an unfamiliar unit is precisely when orders get lost, because the traveler does not know who will do what.

Finally, I will ask questions in a way that protects both patients and credibility. Instead of asking whether something is right, which invites a quick yes, I will say what I intend to do and ask whether the unit does it differently: I am going to give this dose of metoprolol now because his rate is controlled and his pressure is 118; does this unit hold it for any other parameters? This shows my reasoning, lets a colleague correct me without embarrassment and teaches me the local practice.

Communicating With the Rest of the Team

The plan so far covers nurses and providers, but a telemetry unit runs on other people too, and a traveler's first shifts go more smoothly when they are included. The telemetry technician watches every patient's rhythm and will call about alarms; I will introduce myself to the technician at the start of each shift, confirm the patients I am responsible for and ask how the technician prefers to be called back, because a missed callback on an unfamiliar unit is an easy way for an arrhythmia to be overlooked. The nursing assistant sharing my patients needs clear, specific delegation: which vital signs, at what times, and which values to report immediately. I will state those parameters out loud at the start of the shift and check halfway through, rather than assuming the assistant knows my expectations from another nurse. Pharmacists, respiratory therapists and case managers will each need a slightly different kind of message, and on a new unit I will ask the charge nurse who covers which patients before paging anyone. Finally, patients and families need to know who I am. I will tell each patient at the first contact that I am a travel nurse new to the hospital but not to nursing, which answers the question many are too polite to ask and gives them a reason to speak up if something seems different from what the regular staff do.

Checking the Plan

At the end of the fifth shift, I will review the plan with the charge nurse I have worked with most, asking two questions: has anything I communicated been unclear or incomplete, and is there anything about how this unit communicates that I still seem to be missing. I will also count, from my own notes, how many handoffs I received with a complete read-back and how many provider calls followed SBAR, aiming for all of them. Anything that did not work will be changed for the rest of the contract and carried into the next one.

References

El-Shafy, I. A., Delgado, J., Akerman, M., Bullaro, F., Christopherson, N. A. M., & Prince, J. M. (2018). Closed-loop communication improves task completion in pediatric trauma resuscitation. Journal of Surgical Education, 75(1), 58-64. https://doi.org/10.1016/j.jsurg.2017.06.025

Müller, M., Jürgens, J., Redaèlli, M., Klingberg, K., Hautz, W. E., & Stock, S. (2018). Impact of the communication and patient hand-off tool SBAR on patient safety: A systematic review. BMJ Open, 8(8), Article e022202. https://doi.org/10.1136/bmjopen-2018-022202

The Joint Commission. (2017). Inadequate hand-off communication (Sentinel Event Alert, Issue 58). https://www.jointcommission.org/resources/sentinel-event/sentinel-event-alert-newsletters/sentinel-event-alert-58-inadequate-hand-off-communication/