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Care Transitions: Transfer of Accountability

I’m a nurse working on an in-patient medical surgical unit. We have decided to focus on improving communication during shift report, including when a nurse goes on a break. What are nurses’ accountabilities when giving reports? 

Nurses are accountable for facilitating, advocating and promoting the best possible care for clients. Nurses must also take action if client safety and well-being are compromised. These are important accountabilities stated in the practice standards, Professional Standards, Revised 2002 and Therapeutic Nurse-Client Relationship, Revised 2006

Care transitions involve the process of communicating client-specific information from one caregiver to another, or from one team of caregivers to another, to ensure continuity of care and client safety. Transfer of accountability — or providing “report” or “handover” — is a crucial component of the care transition process.  

Care transitions happen often, such as when a client experiences a change in location or health care providers. They also include when shifts end, or when nurses go on break. 

During the transfer of care or “handover,” there is a potential for miscommunicating client information. To minimize this risk, each time care is transferred, nurses must communicate client-specific information to a colleague that is clear, client-focused, and comprehensive. This accountability is outlined in principle 4.2 of the Code of Conduct

During care transitions, nurses must ensure that they do not discuss client information in public places such as elevators, cafeterias or hallways. For more information, see the Confidentiality and Privacy: Personal Health Information practice standard. 

When communicating to another care provider when transferring accountability, ask yourself:

  • What information does another care provider need to know to provide safe care?
  • Is the information I am providing clear, client-focused and comprehensive?
  • Have I worked with the client and the health care team to develop a care plan that promotes client safety and continuity of care during the care transition?
  • How does our current practice contrast with best practice evidence, such as RNAO’s Care Transitions best practice guideline? 

CNO expects all nurses to be aware of relevant organizational policies and procedures regarding care transitions, including transfer of accountability. If the need exists, nurses may wish to work with their employer to develop such policies in the interest of client safety. 

All members of the health care team have a shared accountability to advocate for quality practice environments that support nurses’ abilities to provide safe care. 

If you have any practice-related questions, visit Practice Support.

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Page last reviewed August 21, 2018