This is a bad idea in my book. First off, they want the PCTs/Nurse Extern/Unit Clerks/Phlebs/Paramedics do hourly roundings.
First off, the unit clerks should not be doing the hourly roundings unless they bring back the 2nd clerk in which case that clerk could do the hourly rounding easily. It is way too often that they try to get me to do something like draw blood when I am a unit clerk and the night doctor starts flipping out because they can't find me and they need to admit/call a doctor/whatever. 2nd, the nurses rarely answer the phones and instead will let it ring. 3rd, the nurses do not enter orders into the computers at the moment. After they switch to electronic charting, it'll be easier as the doctors enter their own orders and I can see having unit clerks round then.
PCTs are run ragged. They have to do EKGs, stock, transport patients, and clean rooms. On night shift, we really should have a 2nd pct/nurse extern/phlebotomist but we don't. RNs will not do EKGs most of the time. I can tell them "hey, so and so is upstairs with a patient, can you get your EKG" and they will wait for the PCT to come back.
Paramedics - Usually they are triage. They flip out when no one covers triage, but then they also want them to do stuff in the back. I went on lunch once and came back to find out they left 3 patients sitting out there the entire time I was on lunch. Seriously, we can't win. They tell us to stay in triage and then flip out we're not helping in the back. When we help in the back, someone falls/becomes violently ill/something bad happens and we get yelled at for not being up there.
Phlebotomists start the IVs for nurses, do ekgs, and run patients up to the floor. They are also run ragged.
The next biggest issue I have is we're minimum staff. If we were at the previous staffing levels before people quit/were injured/became very sick out of all the positions, we would be better off. However, we're not. Hourly rounding could be passed onto the nurse extern/pct or the 2nd clerk. However, they eliminated the PCT and the nurse externs only work weekends and we're down to one that works every third.
The next issue is that how long will an hourly round take? When we have 20 rooms full and you have 1 person doing the rounds, it can take more than the hour to get around. We have usually between 2-30 rooms/hall carts full. It seriously makes no sense. Not to mention it is supposed to help update people but the pct/phleb/unit clerk will not know exactly what that person is waiting for whether it is test results (usually), radiology, doctor needs to get time to do a pelvic, medication, whatever. Oh and it's also to check the level of pain.
Not to mention any of the patient that do decide to use the bathroom we then have to track down the RN to figure out whether the patient needs a bedpan/commode/allowed to walk down to the bathroom/sample/whatever.
I guess I really don't like the idea of hourly rounding being given to one person. It wouldn't be so bad if it was on even hours, an ancillary member does the odd number rooms and the RNs do even and switch it that way. Some facilities do it that way on the floors and it seems to work. I think it would work out a lot better that way if they divide up the hourly rounding because the RNs are not going to do the rounding at my facility (less than 5 will take up their patient when the pct is on a transport instead of waiting for the pct to take the patient up and instead will sit and talk).
I guess I am ragging on the RNs right now, but there are some things that is ridiculous. The entire dept right now has low morale because we're short staffed. The RNs just found out that they are going to every other weekend and will probably be furious for the next few months as about 1/3 of our staff is retiring, quitting, or leaving for the new hospital.
In itself it is not bad and should be done, but how they are presenting it to be run will be bad and lead to more problems.
We also do hourly rounds (RN's even hours, PCT's odd hours) at our hospital, and it does help out with patients calling out/needing things, plus we know how they are doing at all times :). I only see this as a positive idea.
Are you on the floor or in the ER?
Also, with my hospital there is no mention of rotating it between RNs and ancillary staff, just "one person will do it each hour." Most of the other hospitals do rotate it between RNs and PCTs and that works well. However, knowing my department at the moment, they will not rotate it between RNs and ancillary staff/PCTs, at least at first. Not to mention they are implementing it when we are lacking quite a bit of staff on both RNs and ancillary staff.
To be honest, the RNs are kind of spoiled in my hospital. I can tell the ones that have worked elsewhere because they will make sure that their patients go up even if they take them up or will clean their rooms instead of waiting for the pcts to get back from doing the run. They will go do their IVs instead of waiting for the phleb to go do it. They don't just wait for the pct.
I would feel a lot better if they did rotate it between ancillary and RNs. I really would. That's the way all the other hospitals do it. Plus they require charting too. On my peds rotation, we had to chart something every hour and I did. However, they aren't requiring the mandatory charting at the moment and instead doing a clipboard method.
Honestly, I would feel a lot better if we weren't cutting/not replacing/losing staff. I know they want to improve scores, but scheduling more people would help a lot! Having 2 experienced nurses for quickcare would make quickcare fly by. Having 2 nurses and a HUC is even better! That way charts aren't run to the other station to try and find the HUC who is probably going to be rounding. Also, switching it up with the RNs and PCTs would help a lot and that seems to be standard, but there is zero mention of that in our proposed plan.
I work in a hospital on an Acute Rehab unit. It works well for us. I work 12 hour shifts, nights. The RN's & PCT's I work with are awesome! I'm super lucky!!!
green34
444 Posts
Are you on the floor or in the ER?
Also, with my hospital there is no mention of rotating it between RNs and ancillary staff, just "one person will do it each hour." Most of the other hospitals do rotate it between RNs and PCTs and that works well. However, knowing my department at the moment, they will not rotate it between RNs and ancillary staff/PCTs, at least at first. Not to mention they are implementing it when we are lacking quite a bit of staff on both RNs and ancillary staff.
To be honest, the RNs are kind of spoiled in my hospital. I can tell the ones that have worked elsewhere because they will make sure that their patients go up even if they take them up or will clean their rooms instead of waiting for the pcts to get back from doing the run. They will go do their IVs instead of waiting for the phleb to go do it. They don't just wait for the pct.
I would feel a lot better if they did rotate it between ancillary and RNs. I really would. That's the way all the other hospitals do it. Plus they require charting too. On my peds rotation, we had to chart something every hour and I did. However, they aren't requiring the mandatory charting at the moment and instead doing a clipboard method.
Honestly, I would feel a lot better if we weren't cutting/not replacing/losing staff. I know they want to improve scores, but scheduling more people would help a lot! Having 2 experienced nurses for quickcare would make quickcare fly by. Having 2 nurses and a HUC is even better! That way charts aren't run to the other station to try and find the HUC who is probably going to be rounding. Also, switching it up with the RNs and PCTs would help a lot and that seems to be standard, but there is zero mention of that in our proposed plan.