The nurse-manager in the unit where I work wants us to improve efficiency by working smarter. One of her initiatives is to have nurses coming on shift begin giving care as soon as we clock in, rather than waiting for report if the nurse going off shift is busy. Is this a good idea?-A.R., FLA.

Assuming a patient's care without handing off information is poor nursing practice and violates the standard of care. The Joint Commission expects caregivers to give an oral or written report whenever a patient's care is handed off to a new caregiver-even if the handoff is temporary (during a meal break, for example). You need to know the patient's condition when you assume responsibility, including when he last received his medication and how he responded. Our legal consultant notes that "failure to adequately communicate the patient's condition" could be the basis for a nursing negligence action. To protect your patients and your license, speak up.