Hourly Rounding

Scripts are yet another way that hospitals are attemting to hide the lack of care they really have for the patients and the staff. They are more interested in appearance and less on actual delivery of care.

Your nurse manager is fully aware of what it takes to do your job. We let them of the hook by claiming they are out of the loop or clueless. They are aware and in my opinion, many should have their license revoked for patient safety violations. They could help solve the so called "nursing shortage" if they would just improve the working conditions and begin treating nurses and patients with some repect. I am tired of being patrionized and I believe so are our patients. What good does it do to ask if there is any thing I can do when I don't really have the time to do it. Please ask your manager that question.

We can only change this by standing together and demanding better staffing, that includes staffing ratios, trained ancillary help and managers that work for the patients and the nurses and not to enhance the bottom line. Support these issues in your voting, write your repreasentatives about safety violations and need for reform, get help from unions if necessary, band together on your floor and draft a petition that expresses your grievances. Lifeis to short and I want to love my work and not dread going in each day. Our profession is challenging and will always be hard but I must draw the line on unsafe and I would ask that you do as well. There are no gains without risk.

The thing is, even if you say, "I have time" (our hospital also wants us to say this...they must all go to the same management pep meetings) the patients see us running our butts off and know we do not have the time.

as I have said on another thread, as a patient scripts wouls pi$$ me off. If all my nurses said the same thing I would KNOW it was not genuine and that would upset me, I would worry were they only doing ANYTHING for me because they had to.

We're supposed to do this at my hospital too. I try to do hourly rounds, but if my pt is asleep, no way am I going to wake them up to say this. If they're awake, I'll say "how are you doing? Is there anythin I can do/get for you right now? Push your call light if you need anything while I'm gone, I'll be back to check on you soon" or something very similar. If they're asleep, but their family is there, I will ask the family if they and the pt is doing alright, basically the same thing. But there is no way I'm gonna say "I have the time". That implies that I have nothing to do right now, so start barking off commands and I'll jump and do it right away. I think the way I say it is more genuine and says to them that it is important to me that their needs are met, while not sounding like I'm a waitress who is just there to wait on them and kiss their rear end.

Our hospital was just purchased by the CHS group. Of course being under new ownership always brings new change and hourly rounding was one of the new techniques recommended to bring about increased patient satisfaction without getting a lower patient nurse ratio.

Managers told us we needed to do this and of course what happened is the nurses would go into the room and just sign the paper and sometimes not even talk to the patient!

This is what I have learned about the Studer Group. They are basically an infomercial. We have all seen them. Loose weight fast, make a million in a year, just pay $5000 and I'll show you how. Well this firm is the same except it's a firm devoted to teaching prescriptive tools and processes that company's can use. Really Studer is smart. Afterall a company makes more than an idividual so they can sell this deal for a whole lot more. And hospitals are buying it without doing the research. All the hospital CEO see are increased profit margins.

And this is another kicker, Studer owns the research lab that all the stats originate from. Any good research topic needs to be unbiased and have the numbers and study group available. Have any of the hospitals that you all work at done research prior to implementing this "fix" so you can even see if its working to fix whatever is wrong with the hospital. That's another problem. Dont fix something before knowning what is broke. How can you tell "on paper" if this "fix" is fixing anything at all. You have to do research first to tell that there is a problem, then place a fix, so you can see if the fix is working.

Something else, intially this program was to get the leaders to round on employees every hour. Studor states that this is the crutial first step without doing so sets the program up to fail. At our hospital the managers, CEO, nor the DON saw anyone.

OK off my soap box, Everyone have a blessed day.

We have been doing hourly rounds now for about 4-5 weeks and like everything else we have absorbed it into our working day with very little problems.
we have noticed however that the call lights have definatly reduced.
The most frustrating thing I have found is the documentation-not mine because I have always documented q2hourly anyway but when the PCT documents-this becomes a problem because as we all know we cannot always get to our charts and document because we may be dealing with something more important than scribing at the said time. So when I return to my charts somedays I am forever playing catch up and writing 'late entry'.
Overall the thought of doing this hourly round is worse than actually doing it.

I am medically retired now, but I can remember many nights that it was after 2:30 when I finished 1st rounds(10 patients or more) because of problems, picking up what 3-11 couldn't get finished, complications, midnight meds, IVPBs, you name it. thank god I had nurse techs who could keep an eye out and at least verify that everyone was still breathing!!!

so frustrating, expecting more and more out of already spent nurses. When and where is it all going to end?/ Only time will tell and it will not be good!!!!

So for you nurses out in the trenches, I am sorry for you having towork so hard and under so much pressure. Even today, after being home for 5 years, it takes the least little thing to get my "fight or flight" system going. It is such an overwhelming feeling and I lived it for so many years, my nervous system is shot!!!!

But I loved it so much, yes I would do it over again, but would make alot of changes and take care of me-toilet and feed and hydrate me!!!!!

About the hourly rounding.....that concept was rolled out at our hospital a few months ago, we had to initial a paper in the pt room. Pt began complaining that we came in and just signed the paper. That was it, no inservice, no reasons etc, just sign the paper. It was dropped.
Now, we have a committee to roll out the "Rounding with a purpose". We made videos of the right and wrong way for a pt encounter. The Studer video was a joke, we decided to best way get this thing going is first to over come resistance by making our own educational devices, not prescribing an hourly plan but timely and involving every department that comes in contact with the pt -- housekeeping,dietary,admissions et. Yes, Studer Group strikes again! I have written, emailed, and tried to phone all involved to find out the pt/nurse ratio and skill mix(Nurse aides,unit clerks, Pt care specialists) to see just how they did the study. No answers. Posed the same question to my CNO, CO and Studer Rep, the answer is "I don't know". I also questioned the need for the hourly rounding, do we have an assessment? Have we identified a problem? Hellllooo, nursing process! No.
We have an advertising campaign about to roll out and we have to be ready to say,"....I have time." I will keep pressing on about the need for good customer service and the Administration to read that darn book and make THEIR rounds as prescribed!

Okay this is going back a few years ago, when I worked on a knee & laminectomy floor. My CNA & I would be assigned a "Mod" of patients. Each Mod had the capacity of 10 patients. At the beginning of our shift, we would do the initial assessment of each patient, together..We would tell each of our patients that one of us would be there each hour to see if they needed anything. We co-ordinated our times, for my med pass, & dressing changes, breaks, etc. & each hour, one of us would ,check on our pt's to see if they needed anything.At 9:00 PM our pt.s would be asked if they would like their sleeping pill? (The Dr's had everything available in writing as far as Pain, Nausea, Sleep etc. in their orders)If they didn't have a sleeping pill & it was time for a pain pill, I would ask them if they thought they might need a pain pill to help them rest? Our pt's never got on their lights, because they knew one of us would be there every hr. My CNA & I choose to work together,so we didn't have to work so hard, our pt.s were happy too..We didn't have lights & pt. buzzers going off, like the other nurses & their CNA's did...

The funny thing....patients do know when they are being lied, courtesy of the micromanagement gadgets.

Just say:
I may have a patient admitted with an unusual disease. That requires a lot of teaching, done in a calm gentle manner, regarding medications that are high maintenance - think high level immunosuppressives, with all the physical and PSYCHOLOGICAL effects. The MD changes the regimen adding a wellknown chemotherapy drug, WITHOUT EXPLAINING this to the patient. And I as the nurse have to go in explain this change to the patient, do the chemo teaching, without scaring the living crap out of the patient.

Just say the word "chemotherapy" around any patient and watch the panic...and these days with the internet, they will realize what they are getting chemo.

I enter the room to do this instruction, along with all the helpful products to prevent complications. I sit down to talk to the patient and spouse.

During the conversation, I receive 7 phone calls (MDs wanting to give nonemergent verbal orders, family members making one of the 20 daily phone calls to the nurse of their loved one, CT wanted to know if a patient REALLY, REALLY needs a CT scan today, and could I call the MD RIGHT NOW to ascertain the answer, etc. - nothing emergent). I then turn the phone off, only to have the secretary come to the room several times (courtesy of the lovely nursing low jack we are required to wear) to ask why my phone is not working, calls regarding such concerns as Mr X wants to know how his wife slept, but he doesn't want to worry her by asking her himself.

At the same time, my beeper goes off over and over AND OVER. Such beeps as "1812 needs PCA for fresh water. You see some MORON in adm, decided that your beeper rebeeps every 60 seconds, so you don't "Forget". And if it beeps the PCA more than twice, the beep does the same thing to the RN. And even the PCA/RN answers a call, the beeper continues to go off, until you clear the thing.

I spent maybe 25 minutes with my patient, and left the room to find my beeper full, NO lights on pending to be answered. And my patient had to be oriented to a distressful issue, with phones ringing, and my pocket buzzing like an industrial beehive (even on vibrate, those things make noise).

"Do you need anything - I have the time" rings quite hollow, when you can't ask your nurse a question, for the phones, the secretary, and the nurse's buzzing pants pocket.