Do you round on your patients every one hour? - page 4

I work on a tele floor where it is not uncommon at all to have nine patients. Seven or eight is usually the number I have. We also usually have only two techs on nights, so one tech to fourteen... Read More

  1. Visit  abundantjoy07 profile page
    0
    Unfortunately I cannot always round every single hour. I have to chart, respond to phone calls (from lab, doctors, family, etc), prepare for new admits, give meds, draw labs, and deal with all those "issues" that always seem to arise (new orders, late orders from the previous shift, restarting IVs, checking on the patient that is confused and irritable, appeasing irritated family members, quieting beeping pumps, dealing with pain issues, dealing with the one patient that really isn't doing so well...).

    I just can't fathom asking people what they need every hour because someone is always going to need something and some of those things are not serious issues.

    I check on them as I make my way around and when I have things that need to be done with/for them. But to time it...it takes at least 15 minutes with each patient that means as soon as I finished with my 6 it's time to go around again!

    I use my nursing judgement when it comes to rounding and waking people up.
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  3. Visit  Elvish profile page
    0
    I don't round every hour unless I'm worried about a particular patient, or it's a fresh admit. I round every 2 hours, and each time I make sure my pt's needs are taken care of, and that their callbell is in reach so they can call if they need something between rounds. I work nights in mother/baby. Sleep is precious to these new moms, and they appreciate my not being in there every 60 min waking them up. I warn them that I'll be in there every couple hours to check on them but that I won't knock, so if they're sleeping they won't be awakened, but if they want me to knock, I will. They usually say no.
  4. Visit  nursemike profile page
    2
    Quote from eriksoln
    I dont get it.
    I was tired and a little grumpy, so I was being sarcastic. Our facility says we are "patient-centered," and to be honest, I think we usually do a decent job of that, although I've never actually understood how we could not be.
    At times, it seems more like we are supposed to be "bean-counter centered," or "PR centered," or "an unusual hotel where sometimes the service is a bit too personal." I actually have a fair amount of respect for our management, but it seems to me a reflection of their lack of understanding of what nursing is really about that they feel "patient-centered," needs to be made a policy. Gee, and I thought people wanted us to wash their cars!

    Q1H rounding is one of our expectations, and I always have tried to "peek in" on people about that often, depending on their situation. But I also try to tailor my care to the patient's needs. Some you need to check every ten minutes to make sure they haven't wiggled out of their restraints. Some really need a decent night's sleep. A few are really put out about being awakened for Q4H vitals and neuro checks. If it seems appropriate, I'll discuss with the physician whether they might be made Q8, or "Q4 while awake," but a lot of times I just explain that while their comfort is a high priority, keeping them alive is a higher one and we need to watch them pretty closely for a bit, even at night.

    I have to admit, there do seem to be a few nurses who need to be reminded that it's about the patient, but they seem to be a very small minority. Since I don't have an MBA, it seems more logical to me to get rid of them than to burden the very good nurses with a lot of crap aimed at the lowest-common-denominator. A lot of us feel we end up having to fight to give better care than the system demands/allows, because the system is too "one size fits all," because the people running the system don't spend a lot of time at the bedside.

    And, really, I have to admit that the patients who think they're there to have their nails done are also a small minority. Most of mine seem to realize I'm trying to help them get better, even when that entails a certain amount of discomfort. Very, very often, a hospital stay entails doctors, nurses, patients, and even family members, working together effectively toward an optimal outcome, and when that's happening, I just don't see the value of trying to squeeze that into some universal template.

    But I'm just a nurse. What do I know?
    Ruby Vee and Altra like this.
  5. Visit  ®Nurse profile page
    1
    I've worked at a facility in the past that required regular rounding. On the shifts in which I worked night, I always asked my patients "Do you want me to wake you up every two hours to find out if you need anything?" USUALLY....the patient responded in a firm tone that they indeed, did NOT want to be awakened for something like that. I made sure that their call light was within reach and DOCUMENTED in the nurses progress notes that the patient refused hourly rounding and has call light withing reach.

    No one ever approached me and told me that I couldn't do this, but I had a defense prepared just in case someone would have - The patient has the right to refuse, and I have the responsibility to use my nursing judgement.

    'nuff said.
    nursemike likes this.
  6. Visit  Ruby Vee profile page
    3
    Quote from nursemike
    i have to admit, there do seem to be a few nurses who need to be reminded that it's about the patient, but they seem to be a very small minority. since i don't have an mba, it seems more logical to me to get rid of them than to burden the very good nurses with a lot of crap aimed at the lowest-common-denominator. a lot of us feel we end up having to fight to give better care than the system demands/allows, because the system is too "one size fits all," because the people running the system don't spend a lot of time at the bedside.

    but i'm just a nurse. what do i know?
    [font="comic sans ms"]i snipped out some of your very good post so as not to subject everyone to incessant scrolling.

    i have an mba, and it seems more logical to me to get rid of those nurses who don't understand it's about the patient than to burden the other nurses with a lot of crap aimed at the lowest common denominator. and i still find the idea of mandated hourly rounding with a sign-in sheet (and a do-nut, for heaven's sake!) highly insulting. but then, despite my advanced education, i'm just a bedside nurse.
    canoehead, Altra, and nursemike like this.
  7. Visit  nursemike profile page
    1
    Quote from ruby vee
    i snipped out some of your very good post so as not to subject everyone to incessant scrolling.

    i have an mba, and it seems more logical to me to get rid of those nurses who don't understand it's about the patient than to burden the other nurses with a lot of crap aimed at the lowest common denominator. and i still find the idea of mandated hourly rounding with a sign-in sheet (and a do-nut, for heaven's sake!) highly insulting. but then, despite my advanced education, i'm just a bedside nurse.
    thank you for this fine example that a surplus of education does not have to be an insurmountable handicap.

    you know, i truly do believe that everyone from my nm to my ceo wants to do the right thing, and many times they do. but i also believe that a lot of the humble, or icky, or heart-rending, or inspirational tasks we do on a daily (or nightly) basis have a lot to do with keeping us grounded in reality.
    Altra likes this.
  8. Visit  oncnursemsn profile page
    0
    (((I'm sorry)) I skipped a few pages. I instruct my students- to round every hour. They have 1. That's one patient. They should look at IV. Bathroom. Pain. Food. Tissues and other needs. Clear tray and ask what the pt needs.

    In my own practice-I have 3-5 patients. I ask the same. I am obsessive about removing old trays and garbage. Empty the hat of urine/stool.
    I go around every hour and make sure the IV will not go off and they have what they need. Compulsive? yes. BUT I think that is what makes a good nurse.


    Just MHO. If you were in the hospital and had to save everything. Had your IV beeping every few hours- when trying to rest. Would you not be disturbed?
    And now you have to call to have your hat emptyied with urine? NOT on my watch. Off of soap box now.
    :typing
  9. Visit  LilyBlue profile page
    1
    Quote from oncnursemsn
    (((I'm sorry)) I skipped a few pages. I instruct my students- to round every hour. They have 1. That's one patient. They should look at IV. Bathroom. Pain. Food. Tissues and other needs. Clear tray and ask what the pt needs.

    In my own practice-I have 3-5 patients. I ask the same. I am obsessive about removing old trays and garbage. Empty the hat of urine/stool.
    I go around every hour and make sure the IV will not go off and they have what they need. Compulsive? yes. BUT I think that is what makes a good nurse.


    Just MHO. If you were in the hospital and had to save everything. Had your IV beeping every few hours- when trying to rest. Would you not be disturbed?
    And now you have to call to have your hat emptyied with urine? NOT on my watch. Off of soap box now.
    :typing

    With three to five patients, these grand ideas are extremely possible. With nine, not so much.
    oncnursemsn likes this.
  10. Visit  jam2007 profile page
    0
    I work on a busy tele floor with 4-5 high acuity patients. It comes down to Press Ganey and pt satisfaction. It is an unrealistic expectation and I would love to see management (when was the last time they were on the floor anyway) implement this in reality vs. in theory. It's just one more thing for us to do. i tell my pt's that I will do my best to check on them and inquire about (fill in the blank), but that if I don't, please use the call light. Most are ok w/that.
  11. Visit  AnnaN5 profile page
    0
    I work on a floor where we get 6-7 patients at night. We are required to do hourly rounding but I do not wake up patients if they are sleeping. I step into the room to make sure they are still breathing, IV is still going, etc and move onto the next patient. I usually split the rounds with the PCA, I'll do odd hours and they do even or vice versa.


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