Wallace, I Wonder: How Can We Make Shift Handoffs Better?

We’re kicking off our new clinical Q&A series, “Wallace, I Wonder,” with a thoughtful question from a hospice nurse in West Lafayette, Indiana:

 “Wallace, I wonder why shift handoffs always feel messy. We do our best, but it never seems smooth, especially when there’s equipment involved. It’s frustrating walking into a home and realizing the family is confused or the gear isn’t what we expected. How can we make shift transitions cleaner so patients and families aren't the ones feeling it?” 

Let’s walk through what’s really happening here and what your team can do to tighten the handoff, protect patient care, and feel more confident from one shift to the next.

Why Shift Transitions Break Down 

Even with the most committed hospice teams, shift changes still bring stress. Add equipment into the mix, and confusion can rise fast.  

Here are some common reasons handoffs fall apart: 

 1) No Update on Equipment Status

The previous nurse placed the order. The new nurse walks into the home, and it’s unclear whether the bed arrived, if the pump is working, or what the family was told. 

2) Families Are Left Wondering

When equipment is delayed, substituted, or not set up as expected, families often get partial answers. The next nurse inherits both the care and the cleanup. 

3) Documentation Isn’t Enough

Even with solid charting, the nuances around DME can get lost. A nurse might document that they ordered a mattress, but not that the family was worried about the delay or that a backup plan was discussed. 

4) Weekend and Night Gaps

Handoffs across weekends or after-hours shifts often rely on assumptions. If DME doesn’t arrive on Friday, it may sit unresolved until Monday. That leaves weekend teams walking into preventable problems. 

How Small Fixes Protect the Whole Care Cycle 

Hospice work is built on continuity. Each shift depends on the one before it. When nurses get clear, timely information, they feel more prepared and patients receive more consistent care. 

Here’s how to build a handoff that works, especially when equipment is involved: 

✅ Include Equipment Status in Every Handoff 

Be specific about what was ordered, expected, or delayed. Document the timeline and what the family was told. 

Example: 
“Low-air-loss mattress ordered via portal at 9:15 a.m. Vendor confirmed delivery by 2 p.m. as of 10 a.m. No delivery yet at time of handoff (4:45 p.m.). Family was told it would likely arrive today but not guaranteed. Patient currently repositioned every 2 hours, alternating side-lying.” 

✅ Note Any Concerns or Questions 

Capture what the family asked or said about the equipment. This adds clinical context for the next nurse, especially if they need to follow up. 

Example: 
“Daughter asked if Dad can stay in his recliner until the hospital bed arrives. Explained it’s okay for today but we’ll need to reevaluate if delivery is delayed. She also asked about mattress settings once it arrives, will need clear walk-through at delivery.” 

✅ Confirm What’s Working and What’s Not 

Point out current equipment issues, even if they seem minor. That way the next nurse isn’t caught off guard. 

Example: 
“Pump delivered this morning, but tubing did not fit current feeding setup. Family concerned it’s not safe to use. I paused feed and notified vendor. Family using previous pump for now. Needs follow-up in a.m.” 

 ✅ Communicate Changes in Real Time 

If anything changes between the last note and your handoff, make sure it’s updated — or passed along directly. 

Example: 
“Bed delivery confirmed as delayed until tomorrow morning due to driver issue. I called and informed family at 6 p.m. They were understanding, but requested a call when it’s en route. Please confirm delivery window before visit if possible.” 

What Families Notice Most 

It’s not just what nurses do. It’s how the transition feels to the patient and their loved ones. 

When the new nurse arrives and already knows what’s going on, especially when there’s an equipment issue, it builds trust. When they are surprised or must ask the family to explain, that trust gets chipped away. 

Every smooth shift handoff is a moment to show the family they are safe in your care, no matter who is on duty. What Teams Can Do Together 

If you’re reading this and nodding, here are a few ways to bring your team together around better shift transitions: 

• Build a shared checklist for shift reports that includes DME status 

• Add a column in your team report for open equipment issues or pending deliveries 

• Talk about handoffs in team huddles and ask what’s working or not 

• Make it okay to say, "I didn’t feel prepared” and use that feedback to improve the process 

Hospice care works best when every clinician feels set up to succeed. That includes knowing what equipment is in place, what’s still on the way, and what the family is expecting. 

Wallace’s Takeaway 

Shift transitions should feel like passing the baton, not a fire drill. Nurses deserve to walk into a home confident and clear, not playing catch-up. 

If equipment is the missing link, let’s start naming it and solving for it together. When we improve the handoff, we strengthen the care cycle from start to finish. 

🧡 Got a “Wallace, I Wonder” of your own? We’d love to hear it.

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