Frequent Nursing Rounds Decrease Call-Light Use

JenNJFLCA · Sep 3, 2006

mchrisrn, are those pts suffering from ICU syndrome? lol! :chuckle Sometimes out pts from the unit that come to us on the tele floor feel neglected after get that more individualized care in the ICU. I don't think they always realize they are now one of 4-5 pts as opposed to 1:1 or 1:2. :)

PANurseRN1 · Sep 3, 2006

I'm assuming "The Big Man" also allows for adequate staffing so that pts. aren't "failed"

PeachPie · Sep 3, 2006

Looks like your facility is turning into a Hilton.

The new Big Man at our hospital says that if a patient has to use the call light that we as staff have failed them. On our 10p-6a shift either the RN or the Tech is supposed to enter the room every hour.

SmilingBluEyes · Sep 3, 2006

I agree with this statement. I know when I check frequently, patients are much more calm and relaxed, and yes, less likely to ring call bells for little things. I also think in a perfect world, this would be the standard everywhere. Unfortunately, we don't live there, yet.

I can't always round that frequently on patients, and at night, some resent it if we do----they want to sleep, especially if their babies are sleeping. I do tend to check in if I hear babies crying in a given room for any period of time, to see if all is ok.

One thing I have learned to do is, upon initial assessments and rounds, I do make sure they are medicated, clean, hydrated and have had the chance to tell me about how their day went----as well as reassure them I will bring them their meds/water promptly when called. Another thing I learned is to medicate people ON SCHEDULE, unless they request otherwise. If Percoset is due q4hours, they get it q4hours, period. It's saved me a lot of time and patients a lot of pain. And less pain is not a bad thing!

NurseyBaby'05, BSN, RN · Sep 3, 2006

Worked most of the time... except for that "all about me" patient with infected hangnail

Karen-

You should have had her do your nasty wound dressing change. Without gloves, of course!:roll :roll

On second thought, that may have been too cruel to the patient with the wound.

nursepearl · Sep 3, 2006

As a person with a family member who is frequently hospitalized and I would stay in the hospital with him.....even every four hours was almost too much to bear on night shift. Of course it was needed to take vitals....but man was it hard for us to get back to sleep afterward.

As an onocology nurse with pts that stay with us anywhere from a few weeks to a few months....I try to disturb them as little as possible on night shift...sleep is very important...especially for our long term pts.

knobby1 · May 29, 2009

I just had the worst night ever at my new job because two of my patients were constantly hitting the call light. Not to mislead, they had genuine concerns but I see a pattern in my own practice that I'd like to learn how to manage better. I have been a nurse for almost three years and I have a what I consider to be an efficient routine. I think what I need now is some tips on how to start off on the right foot with my patients. I want them to trust me and allow me to manage their care instead of them "managing" me with frequent call light use and poor timing if time consuming requests. By that I mean is they seem to bring up major issues/needs right before shift change. I have been getting alot of complaints from my fellow nurses that I seem unprepared for shift change. I have a routine but it is "routinely" interrupted by patients which leads to rushed reports and disgruntled co-workers. Any tips?

Virgo_RN, BSN, RN · May 29, 2009

I just had the worst night ever at my new job because two of my patients were constantly hitting the call light. Not to mislead, they had genuine concerns but I see a pattern in my own practice that I'd like to learn how to manage better. I have been a nurse for almost three years and I have a what I consider to be an efficient routine. I think what I need now is some tips on how to start off on the right foot with my patients. I want them to trust me and allow me to manage their care instead of them "managing" me with frequent call light use and poor timing if time consuming requests. By that I mean is they seem to bring up major issues/needs right before shift change. I have been getting alot of complaints from my fellow nurses that I seem unprepared for shift change. I have a routine but it is "routinely" interrupted by patients which leads to rushed reports and disgruntled co-workers. Any tips?

So many patients/families are unfamiliar with the routines of the hospital, and need a little refresher course. I make an attempt to fill my patients/families in at the start of my shift when I introduce myself. Naturally, I tell them my name and that I am their nurse, but I also include until what time I will be their nurse. During last rounds, I let them know I will be going off soon and they will have a new nurse, and is there anything they need from me before I am gone?

Basically, it goes something like "Hi, I'm Virgo_RN and I'll be your nurse until 11:00 tonight. Susie_CNA will be working with me tonight to assist you with anything you need. The two of us will be popping our heads in to check on you frequently, but if you need anything that can't wait, please press the big red button."

Throughout the shift, I give them little status updates each time I enter their room for vitals or meds or treatments. It might go something like "I need to take your vitals and give you your evening medications now. Unless you need anything else, I won't be back until after your blood sugar has been checked, and I might have some insulin for you." Or "Unless you need anything, I won't be back to disturb you, so is there anything I can get for you right now? No? Okay, then I'll poke my head in a bit later and make sure you're doing okay."

During last rounds, I might say something like "I'll be off duty soon, so I just wanted to check and make sure you have everything you need until your new nurse comes in to check on you."

This works really well for me, but I wish my CNAs would get on board and be more proactive instead of just waiting for patients to press the call lights before checking on them. Some patients never do, and will save up all their requests for when someone (namely me, the nurse) comes in for some other reason. When I am focused and task oriented, which is a neccessary survival tool at times, this can derail my attempts at getting caught up and getting out on time. Sometimes the only time a patient sees their CNA is at the start of the shift, maybe when the meal tray is brought, and at the end of the shift. All of the time inbetween, it's the nurse doing everything. I'm hoping that hourly rounding will help in building a more proactive and team oriented skill set among our CNAs.

Elvish, BSN, DNP, RN, NP · May 29, 2009

Unless I just happen to draw the short straw and get assigned all the callbell queens or have people with genuine, acute status changes, I don't have a lot of people calling out for stuff.

At the start of my shift (1900), I go into everybody's room and say, "Hi, I'm Elvish, and I'll be your nurse for the next 12 hours", and proceed to kind of lay out the schedule for the night. I tell them I'll be in to check on them at least every 1.5-2 hrs unless they specifically want me to be in there a bit more or a bit less (and if it's less, I document as such). I tell them I won't knock unless they want me to, so as not to wake them up if they're sleeping. Alternately, I tell them that they can call me whenever they get up to pee or get up with the baby(I'm on mother/baby/antepartum), just so I can lay eyes on them and meet any needs at that time. When I'm in there, I try to do a quick once-over to see if they need things like water, diapers, pads, and I ask them if they need any pain meds, or if they need any baby help. Sometimes they want to chitchat, and if I have time, I do. If not, and if all their needs are met, I leave. And really, like I said, my patients by and large do not call out.

I disagree that stable patients need q1hr rounding at night. That's not a) reasonable, nor b) conducive to people getting the sleep they so desperately need.