Nurse Rounding

Brita01 · Dec 27, 2006

I don't understand. You're SUPPOSED to round on patients at least every 2 hours. It's like the law or something. Are you saying you were rounding more often and now they want you to round less often at every 2 hours? Because otherwise, I don't get it.

VegRN · Apr 23, 2007

I am shocked and appalled to read this. 2 hour rounds? Are you saying the minimum to check on a patient on a med surg unit is every 2 hours? How about every 30 minutes? That is our unit standard. How many patients do you have? We have 4 to 5 on days. I would feel like my licence was hanging out the window if I didn't check in on a patient less frequently than every 30 minutes.

Checking on each pt every 30 minutes with 4-5 pts? Are you kidding? I have worked at a high acutity m/s floor and the changes in pt conditions that I need to attend to would absolutely not allow me to check on each and every one "every 30 minutes". The higher acuity pts are going to get more of my attention and that may mean that the stable pts are going to be checked on closer to Q2 hours at times.

Here's a clip from one of my days on a m/s floor and it is pretty average. pt #1 is vomiting, gave anti-emetic, pt vomits again 30 minutes later, call doc and request another antiemetic, wait for antiemetic to kick in before giving pills. At the same time pt #2 admitted for N/V. H/H dropping, start 2nd IV, get type and cross, discuss with md. meds and plan of care. answer family questions. pt #3 trading off with NA in getting total care pt with frequent incontinence up to commode and back. pt #4, it was a good thing he was stable.

And that is plus med passes, checking orders, calling pharmacy for missing meds, charting, teaching and whatever the nurse tech decides they won't do (don't get me started on it, management ignores it).

With all the things that happen during a typical M/S day how can you possible say that we can check on each and every one of our pts every 30 minutes?

queenjean · Apr 23, 2007

We check on our patients q 1 hour, day or night, minimum.

It's a medical floor, 45 bed, census between 22-35 on average.

As an LPN, I don't have a team with an aide, only as total patient care, so I always check on them myself. I don't know what the RNs who work with an aide do; I think it is that someone needs to check on them a minimum of every one hour, aide or nurse.

I, too, am surprised at the thought that patients go longer than one hour in an acute setting without anyone checking on them at all.

kellyskitties · May 15, 2007

OK, our hospital requires q2hour rounds in med surg. I work nights. Often my rounds on a STABLE, self care pt is just walking through the room or a quick focus on what they are there for (or for an expected possible complication of what they are there for).

Rounding q30mins? WTH, I've had as many as 13 pts this last winter. My most acute, helpless pts get more attention then and my walking talking pts (who I might add pass me in the halls as they go down to smoke) might get less than q2hrs if my time is too short.

I set a goal of q2hrs minimum, but reality isn't always going to allow that. Reality is my most acute, helpless pts get me more. My walkie talkies may get a little less - but if at all possible, everyone gets a minimum q2hrs visit from me.

Our floor has intituted the 3 P's. Love them, hate them. Dread asking drug seeker about pain - I know the answer. Dread asking ms. whoozit about position knowing I'll be there 30 mins rearranging pillow cases and moving her feet over 1/4 inch to the left again. And dread asking Mrs. Whatzit about Potty when it will take her a minimum 10 mins to shuffle those little feet the 2 feet to the BSC. Q30 min rounds? Only if they are in distress or a severe fall risk.

jmgrn65, RN · May 15, 2007

we do hourly rounds the aids odd hours and the nurses even hours, or it could be the other way around I can never remember. On days you are in and out of the rooms so much, between meals, baths and medpass. you are there every hour or less.

chuck1234 · May 15, 2007

Q 2hr is reasonable!!!

meownsmile, BSN, RN · May 16, 2007

Rounding is a shared responsiblity as far as my facility goes. LPN, CNA and RNs. Very few times there might be a patient that hasnt had any contact with a member of staff at 2 hrs. And that depends on what is going on throughout the unit. Most instances patients are checked on at a min of hourly.

Our ratios dont allow 30 min rounds, that would be totally impossible. The only time we do have less than 7-8 patients is when our census drops, then it will only be for part of a shift until they can readjust staffing. There have been days when i had 10 patients on days,, so that would mean i would have 3 minutes with each patient.

It takes longer than 30 min. to get a new surgical, take report, do a post op check and paperwork at my facility.

veronica butterfly, ADN, RN · May 18, 2007

Both the hospital I recently left and my new hospital require q2h checks on patients and documentation. The new hospital however, does something I really like. After change of shift report - when we're coming on, we accompany the Nurse going off into each of our patients rooms. She tells the pt. she's leaving and introduces the new Nurse coming on, gives us a chance to not only check on our pt's condition, but also look at the condition of the room, IV tubing dates, etc.
I'm not sure if many hospitals do this, but think it's a great policy - that way, you don't get any surprises once the other shift has left. There's nothing like getting report - told everythings great, then finding out your pt's IV tubing should have been changed 2 days before, fluids ran out, pt's in pain or laying in a wet bed, bedside commode hasn't been emptied, etc. This way, by going in the room together, if you find something hasn't been done - the other Nurse takes care of it before she leaves, instead of leaving you with problems (saves a lot of time).

Wow, I love that. We often end up taking patients from several previous nurses (nancy had 201, becca had 203, etc..). How do you manage how much time this takes at the end of a shift? Sounds like a wonderful idea though!!! How great for the patient and the staff, nice continuity. We sometimes will do this on occasion when something crazy is going on with one particular patient, but not a standard for all patients.

veronica butterfly, ADN, RN · May 18, 2007

Checking on each pt every 30 minutes with 4-5 pts? Are you kidding? I have worked at a high acutity m/s floor and the changes in pt conditions that I need to attend to would absolutely not allow me to check on each and every one "every 30 minutes". The higher acuity pts are going to get more of my attention and that may mean that the stable pts are going to be checked on closer to Q2 hours at times.
Here's a clip from one of my days on a m/s floor and it is pretty average. pt #1 is vomiting, gave anti-emetic, pt vomits again 30 minutes later, call doc and request another antiemetic, wait for antiemetic to kick in before giving pills. At the same time pt #2 admitted for N/V. H/H dropping, start 2nd IV, get type and cross, discuss with md. meds and plan of care. answer family questions. pt #3 trading off with NA in getting total care pt with frequent incontinence up to commode and back. pt #4, it was a good thing he was stable.
And that is plus med passes, checking orders, calling pharmacy for missing meds, charting, teaching and whatever the nurse tech decides they won't do (don't get me started on it, management ignores it).
With all the things that happen during a typical M/S day how can you possible say that we can check on each and every one of our pts every 30 minutes?

I had that same patient load last time I worked... Did I get your patients???

confused101 · Jun 11, 2007

I have to do every hour before 11pm then every 2 hours. The Rn and techs are supposed to rotate every other hour or time. I thought it was only on my floor. Now I floated to another after our floor does it and they are doing it. People have gotten written up or talked to for not scripting. I think it is something for press ganey.