Nursing Rounds

cardiacRN2006, ADN, RN · Sep 14, 2007

In the ICU, a lot of my report is given at bedside. I will point out my assessment findings and issues that I encountered during my shift. I don't see a problem with this.

But I can see how this would be harder in tele or med-surg....

nyapa, RN · Sep 14, 2007

I have been involved in this. It is difficult, because there are some things that you can't say like "this pt can be aggressive" or "they are investigating for..." (when doctors have suspicions about say cancer but don't want to give incorrect infomation to the pt until they have more information.

AngBthatsme · Sep 14, 2007

We do walking rounds on the cardiac floor that I work on. I like it. Of course when we started it there was resistance to the change, there always will be when change happens. Doing walking rounds is good for a number of reasons. If my patient has gone down for a cardiac cath, we are going to look at the groin site, so I will know later if there has been a change. Im looking at the IV and checking the date while Im in there. Im immediately finding out if that patient is in any distress. Of course there needs to be good communication and you need to remember hippa. Basically we do alot of the report before we walk into the room and then we walk in, introductions are done and if the patient or family members start to ask alot of questions, we simply and politely tell them that after report the oncoming nurse will come back and address their questions. I find that it makes the outgoing nurse more accountable. If you know that the nurse is going to be looking at the date of the IV and its outdated or if the person is in pain and you "got busy" or any other number of things I just feel it makes the outgoing staff more accountable. Patients seem to like it to. Give it a chance...its not so bad :)

KR · Sep 14, 2007

I have done this when working in the ICU, but only to an extent. If there is assessemnt stuff I want to show the oncoming RN I will go over that limited information at the bedside. The rest is not done in the room though. I don't see how it would be right to do the entire report in the bedroom, especially if family is in there. That would be a total HIPPA violation. Not to mention, it would be pretty awkward for the oncoming nurse. I am just picturing how one would take written report notes while standing???? I would be verbalizing all of these concerns to management. I hope this helps. Just my two cents worth:)

meandragonbrett · Sep 14, 2007

I work in ICU and this is the way we have always done it. We perform walking rounds at the bedside and get report. Then we go to the desk and review any new orders, travel plans, what the team's current plan is, and we review each item on the MAR. Report takes a good 45 minutes for us. We come in at 630 and leave at 715

RNperdiem, RN · Sep 14, 2007

There is always a trade off when you change things. I do know what you mean about things you can't say in front of patients and their families- "the patient's wife and girlfriend got into a fight today and were escorted out by security, so be aware of this problem" type of things.

In my ICU they want this too. I have been doing report at the nursing station then doing a "show and tell" at the bedside to check PCA's and tricky drainage systems.

GrnHonu99, RN · Sep 14, 2007

Our hospital has starting a new program called Nursing Rounds, basically instead of giving report to the next nurse in another room, the previous shift RN and new shift RN walk into each room together. The previous RN introduces the new RN and then goes over the pt's history, problem, current issues, IVs, diet, etc in front of the patient and family! I'm not sure how I feel about this, I understand some of the pro's and con's such as noticing if the off-going RN didn't unclamp an antibiotic, etc or any questions such as "was the pt like this before" etc. But what about confidentiality of the pt and other's in the room and the nurses will be very limited in the questions they can ask without offended the pt and family. I wanted to know what other nurses thought of this new policy. . .

We don't give report at bedside. We give report outside pts room. We then do a bedside handoff which is much like what you explained although we dont go over history and all that, just our assessments to make sure they match. I did give report at the bedside yesterday as I had to take my pt to OR..so the day nurse and I did report at the bedside since he of course went at shift change. It felt weird as the pt was intact...

scattycarrot, BSN, RN · Sep 14, 2007

I tried to get bedside report iniated at my last place of work but they were resistant to change and didn't want to upset the way things were. It was a shame as in my experience, nursing rounds are an excellent way to give handover. Firstly, you can immediately eyeball your pateints and begin the priortisation for your shift. Not that I don't trust my fellow nurses,of course, but we all have different expereince and a number of times I have been recieved report on a patient who was supposed to be fine but wasnt. This way you get to see for yourself how the patients are looking and plan accordingly. I also take in details better with imagery, so just hearing a patients name dosen't enable me to put the patient and their needs together but actually seeing the patient with their iVs hanging and pumps going helps my recall. I also think that it improves the care of those less conscientious nurses who are often happy to leave jobs for the next shift that they could have got done. Its also better for the patients as it enables them to meet thier nurse and start a relationship immediately. Now, I am sure everyone reading this introduces themselves to their patients but not everyone does and this way, you have too. It enables patients and family mambers to ask questions, makes them feel invovled in decision-making and invovled in thier own care. With regards to the lack of privacy during handover, we would give the basics at bedside or just outside the room and any info which was sensitive in any way, was given afterwards away from the room. I find with normal nursing handover that alot of nurses (including me sometimes!) ramble on and on about stuff which is irrelevant and this stops that, allowing you and the nurse handing over to focus on the important information. If you give it a chance, I think you will grow to like it. Like anything new, it will take some getting used too.

PatricksRNMommy · Sep 14, 2007

On the floor I work on, we do walking rounds first, where we focus on IV sites, fluids, foleys, wounds, etc. We introduce the oncoming nurse and discuss the plan of care for the night (or day, whichever the case may be). We make sure the patient is stable, pain is controlled, etc then tell them we will be back to see them shortly. Then we go to the desk and give the history and the rest of report. It has actually worked really well. It has reduced the interruptions during report of patients calling to use the bathroom, get pain meds, and most importantly of falls during shift change. It's also nice to not have so many surprises when you go in for initial assessment (patient pulled out IV, IV infiltrated or out of date, pt on floor, messy wound dressing, etc). It was met with ALOT of resistance at first, but ultimately has been working really well.

AnnaRobuccio · Apr 30, 2011

As a patient, who was very sick last year, I think rounds are great. They make me feel confident in my nurses. I feel like the nurse is being so polite to come in and introduce herself, and then by going over stuff in front of me, I feel like I can trust what they say and they aren't keeping secrets. I also like it because I can make sure that we all are on the same page with my treatments. Rounds rock! :) Thanks