Do you round on your patients every one hour?

Nurses General Nursing

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suni, BSN, RN

477 Posts

Specializes in med surg.

We just started a pilot of hourly rounding and to be honest I am not sure how it is going, I know there is little scuttle from the nurses about it and most of the rooms I was in the papers were not signed.

I round a minimum of every 2 hours but as you all know we are generally in the room more like every hour. Post ops we are in every 15-30 minutes for the first several hours.

morte, LPN, LVN

7,015 Posts

:lol2::lol2::lol2::lol2::lol2::lol2::lol2: Are you serious!?! That is the dumbest thing I have ever heard of. Really, who wants to look up to a doughnut?

LETS ALL IMITATE THE DOUGHNUT AND DO OUR HOURLY ROUNDS!

LOL

oh and I am supposed to do hourly rounds but I rather not seeing as I work night shift and I fear that someone might throw a bedpan at me for not letting them sleep. I check the windows that let you see into the patient rooms often just to make sure they are in bed. But from that to going in there and asking stuff; not gonna happen.

i have warned persons, when having this convo face to face, that if they wake me up to ask me any of that crap, that had best be ready for a right cross to the chin.....

nursemike, ASN, RN

1 Article; 2,362 Posts

Specializes in Rodeo Nursing (Neuro).

The problem, here, is that some of you people are foolishly clinging to the outmoded notion that a nursing education and however many years of working experience qualify you to make nursing judgements, when clearly you ought to have gone to business or law school.

Many nurses, and I'm sorry to say, more than a few doctors, are far too oriented to helping people get better, rather than appropriately documenting their decline.

ETA: I dunno. Maybe it's time to change my sig line.

Ruby Vee, BSN

17 Articles; 14,030 Posts

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

i work in the icu, so i'm with my patients most of the time. i do my "hourly rounds" by stepping out of the room to check and see if co-workers need help. but i remember when i worked on the floor and had anywhere from 5-15 patients. yes, i did hourly "sheet checks", even at night. you'd step into the room just long enough to make sure the sheet was moving (the patient was breathing), the iv pumps were functioning and there were no obvious signs of impending disaster, and then quietly disappear and step into the next room.

i've always believed that hourly rounding was just what you did to ensure safety of your patients. the other stuff -- asking them if they need tissues, cokes, the room temperature or lights adjusted and signing off on a donut -- is just crap dreamed up b y some manager somewhere to make our lives difficult.

SoundofMusic

1,016 Posts

We do it, and honestly, I really do it, because when I haven't, I've had one patient who happened to have de-satted down to nothing and was almost dead when we found him. Had I only rounded q 1, I would have been in there sooner.

Anyway, I don't wake them at night - just check to make sure they're breathing, not out of the bed, no falls, etc. Some patients I agree not to bother them at all, if they're not critical, not on a monitor, etc. But the monitors are nice as they will at least let you know if their heart is ok.

Yep -- they're big on rounding on our unit. I'm not sure it increases pt satisfaction as we still struggle w/ scores -- but for some they really seem to need it with all their "needs," both real and imagined.

eriksoln, BSN, RN

2,636 Posts

Specializes in M/S, Travel Nursing, Pulmonary.
The problem, here, is that some of you people are foolishly clinging to the outmoded notion that a nursing education and however many years of working experience qualify you to make nursing judgements, when clearly you ought to have gone to business or law school.

Many nurses, and I'm sorry to say, more than a few doctors, are far too oriented to helping people get better, rather than appropriately documenting their decline.

ETA: I dunno. Maybe it's time to change my sig line.

I dont get it.

Specializes in Peds Hem, Onc, Med/Surg.
i have warned persons, when having this convo face to face, that if they wake me up to ask me any of that crap, that had best be ready for a right cross to the chin.....
See that is exactly my point. I rather not get hurt if I can avoid it.
Specializes in Psych, Med/Surg, LTC.

Where I last worked, 9 was a normal # of patients to have. It usually took me 2 hours to assess and medicate everyone with the full assessments, routine meds, and prn's. If I went back after an hour to see the first pt, I would not have yet even seen some patients initially.

A program like this was piloted on my unit late last year. We are a telemetry floor/cardiac stepdown with 64 beds. On nights, we have 16-18 RNs and 2-4 techs.

We were supposed to inquire about:

pain

environmental comfort (temp, lights, etc)

hunger/thirst

toileting

and any other desires that the pt had.

We objected STRONGLY to the instruction that we wake pts to ask these questions, and this was altered prior to implementation.

The results were presented [internally] last week.

Generally speaking, the results were:

Staff thought it was annoying and generally ineffective.

Pts knew they were being checked on frequently, but it had no appreciable effect on pt satisfaction.

Call light use did not change.

Fall frequency did not change.

There has been no movement to make this a lasting policy, though several of us do make an effort to check on people at least once per hour. Often, that's just me tiptoeing in with my little flashlight, listening for breathing, checking the IV fluids and IV site, checking urinals and foleys, squirting some hand scrub and sneaking back out.

See, this sounds like professional competence. A "policy" that requires q1 rounds impairs professional competence; it's what an ancient teacher of mine called "monkey medicine" where you just do what the paper (hospital policy) tells you to do, and try to remove the capacity for a professional to make individualized judgments.

Exactly. This is one of the reasons why I will never work the floors again.

The problem, here, is that some of you people are foolishly clinging to the outmoded notion that a nursing education and however many years of working experience qualify you to make nursing judgements, when clearly you ought to have gone to business or law school.

Many nurses, and I'm sorry to say, more than a few doctors, are far too oriented to helping people get better, rather than appropriately documenting their decline.

ETA: I dunno. Maybe it's time to change my sig line.

:up::yeahthat:

Kylea

149 Posts

Specializes in Med/Surg, LTC, Rehab, Hospice, Endocrine.

I work in what is humorously called a nursing home. In reality, we are a go-between in the middle of the medical acute floor and the nursing home. A sub-acute unit most would say. Except for the fact that we accept direct admits from ED and home for rehab and hospice. What I am trying to say is we are very busy. Nurses float from other SNF units at our facility and vow never to come back because they think we are an acute floor. We have on average a census of 25-30 with two RN's and three aides on PM's and one or two RNs and one or two aides on NOCs. During each shift we have to chart Q30 min rounds on each patient. We also transitioned from taped report (which I thought I hated) to walking rounds (which I really hate). All of this to improve patient satisfaction scores and decrease falls. I hate the idea of forced rounding like this. It takes away from my care to my patients because I am always worried about getting that charting done. We all know that you cannot round effectively on 8-10 patients in 30 minutes. We work with an elderly population. What am I supposed to do? Ignore the fact that three of my patients need incontinence care just to make sure I round on the other six before my half hour is up? I really wish we could trade places for a day or two with upper management and let them try it out for a little while. Some of the people making the policies were good nurses at one point...they have just been away from it for so long they have forgotten what it is really like in the trenches. All they see is the bottom line. That is sad.

Specializes in Geriatrics, Transplant, Education.

I try to round frequently on all my patients, but certainly NOT hourly. I work 3p-11p on a sub-acute unit and have up to 8 patients, depending on if my side is full. Even though they are sub-acute, many of them are quite ill, and others may be just about ready to be d/c'd home, so they are more independent. Some need me more than others.

On a typical day, I see all my patients during the 1600 med pass, 1800 med pass, 2000 med pass & 2200 med pass (if they have 2200 meds..if not I stick my head in and make sure they are ok.) There have been some days when I've had admissions that I feel like such an awful nurse because I don't get to see people as frequently as I'd like. However, in my setting, most are a&ox3 & know how to use the call light if they need something. The CNAs on my floor are awesome, and are very quick to get me if a pt has a request they can't take care of, or if someone/something doesn't look right.

It would be impossible for me to round hourly, and annoying for the patients. I try to cluster my care so that they can relax after a long day of therapy & get some rest.

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