[tatgirl]

yesterday at work I was handed an article on hourly rounding studies that were done in the hospital and how hourly rounding can cut down on call-lights and falls. The study sounded reasonable as it had been done on med-surg units, but not in the nursing home. I am a charge nurse on a unit with 46 residents. There is me and another charge nurse, and on a good night 4 cnas. The manager who handed me the article said our unit had the most falls last month. I answered "Yes we did, because all last month on 3-11 we only had 3 cnas, and you cant expect us to be everywhere at the same time". When I am doing my med-pass, I answer call-lights, get residents blankets or water etc. When we are short I pitch in and help feed, put people to bed, and change their briefs. What in the world is mgt thinking? I dont get a lunch break anymore, I barely take 10 minutes to scarf my dinner down, and then it is back on the floor working my tail off. I am so frustrated and am seriously considering leaving ltc nursing for good. I have been physically assualted, threatened by family members. Management doesnt stand up for us at all.

Wendy
LPN

[racing-mom4]

Yes hourly rounding is GREAT in theory. But with 46 patients you would start at bed 1 and it would take you an hour to be at bed 46!
I have no solution. My only thought is change need to take place, but it must start at the top, with STAFFING.

I did my 1st clinical at a nursing home that I was impressed with. Granted I was only there during the day, but the thing I loved the most was at meal times. Every person in the facility from the cleaning crew to the head administrators helped feed. For 1 hour basically every employee was either in the dining hall or gathering patients to take to the dining hall or returning patients from the dining hall back to their rooms. It was incredible. The residents actually ate full hot meals because the feeding ratio was no more than 3:1. Mostly 2 feeders to a staff.

The nursing home I worked at, I would have to feed 6 people at a time. Do you know how cold their food got? Or how little they would eat because they basically got tired from waiting for the next bite.

[Blackcat99]

I use to work LTC-never again I hope. Yes, it would be nice to be able to do hourly rounds but when you're so short-staffed how can you possibly do it? I left LTC for good because I got sick and tired of being verbally abused by family members. I was told that the nurse who replaced me spends all of her time outside having "smoke breaks." I worked so very hard at LTC and all I got was abuse from both management and family members. LTC is a no-win situation for any nurse.

[tatgirl]

That is the key word "Staffing". When they worked us short all last month, the head honchos never gave us a thought as they left at 5pm to go home. The study worked well because it was done in the hospital where the nurses dont have the pt load that ltc nurses do. I have 24 residents on my front end alone, and 2 cnas that have 12 people apiece. Most of these folks are total care that can not do a thing for themselves. Add to that the frequent fallers who manage to take off their bed alarms, and crawl over their side-bolsters!!! Most nights I feel like I am working in chaos, and no matter how hard I work, I cant do enough....

Wendy
LPN

[RN1989]

Guess what? LTC has as many horrid problems as every other kind of nursing. They ask you to do ridiculous things without the proper tools. All you can do is the best you can or get out of nursing altogether.

[Drifternurse]

Originally Posted by Blackcat99

I use to work LTC-never again I hope.... LTC is a no-win situation for any nurse.

My sentiments exactly!!!! It always felt to me like I was beating my head against the wall for 8-10 hours.

[ltcconsultant]

I actually addressed this in my blog back in 2007
The basic premise behind hourly rounding in the nursing home is that you check in on each resident about every hour (every two hours during nocs) and check on 3 things: Position, potty, and pain. You see if they need to be repositioned, you take them to the toilet or change them, if necessary, and you ask them if they are in pain. These 3 things are contributing factors to quite a few falls, and so if you check on these things frequently you thereby lessen the risk of a resident falling. Since there is a good chance that a good number of people aren't going to need anything when you check on them, this can actually be a more efficient way to accomplish dry rounds, by spreading it out, so to speak. You could take the lean approach and only use this for people who hog the call light or are at high risk for falls. I have worked with a facility to implement hourly rounding and it wasn't as bad as they initially thought. It really isn't as demanding on staff as one might imagine.

[michelle126]

Originally Posted by ltcconsultant

I actually addressed this in my blog back in 2007
The basic premise behind hourly rounding in the nursing home is that you check in on each resident about every hour (every two hours during nocs) and check on 3 things: Position, potty, and pain. You see if they need to be repositioned, you take them to the toilet or change them, if necessary, and you ask them if they are in pain. These 3 things are contributing factors to quite a few falls, and so if you check on these things frequently you thereby lessen the risk of a resident falling. Since there is a good chance that a good number of people aren't going to need anything when you check on them, this can actually be a more efficient way to accomplish dry rounds, by spreading it out, so to speak. You could take the lean approach and only use this for people who hog the call light or are at high risk for falls. I have worked with a facility to implement hourly rounding and it wasn't as bad as they initially thought. It really isn't as demanding on staff as one might imagine.

I work on a 48 bed unit...Me and an LPN with 3-4 CNAs (would love to have the 4, but most times it is 3) Hourly rounding is done in my facility. Might not be the check everything type of round, but me or the CNAs really do see all of the residents just about every hour. No, I'm not physically touching or assessing every resident every hour, but in between the running up and down the halls, answering the phones, med pass...etc they are getting checked on my me or the CNAs down my hall.
I do notice a decrease in accidents/ incidents when this is done. Some nurses that I have worked with don't spend as much time down the hall as I do(I'm not sure what they are doing)...that hall does have a bit more accidents, complaints or call bells going off all the time and not answered.

So yes....it does work, just might not be done the way "they" are saying it should be done.

[nightmare]

In your facility do you have to keep the room doors closed all the time? We have been told we have to keep the doors closed because of fire safety.This means that to physically see a resident you have to open the door,in days gone by a quick glance through an open door as you were passing told you if the resident was safe or not.At night they also close all the corridor fire doors so that you can't hear movement as well.This has contributed to several major falls which might have been stopped if movement had been heard.

[ltcconsultant]

I've never of heard of this before. It seems that requiring bedroom doors to be shut at all times could potentially be a violation of resident rights. I'm curious as to how your facility has done on its last life safety code inspection?