Arguments Disfavoring Hourly Rounding

[CaLLaCoDe]

These are the arguments I want to share with managers and fellow RNs in health care disfavoring hourly rounding. You might have others you want to share.

1. Need for staff nurses to at times dedicate more time with a patient due to acuity of patient's status, impending rapid response concerns versus a patient who is fairly stable and provides most care by self and who requires less attention in an acute setting.

2. Nurses have others rounding (support staff): CNAs, Respiratory therapists, Physical therapists etc. Why should we be required to round when there are others rounding besides us?

3. One more needless task, hourly rounding sign off sheets. I for one find myself not signing off on the sheet during my shift, for I have placed that duty as a low priority. What gripes me is that management assumes that I am not rounding regularly when I am without signing the sheets time and time again. Often I am lean on time spent charting due to job demands and that scares me from a legal standpoint. We are pressured to clock out on time lately every time by management.

Sometimes I find myself and others signing off when they or myself have been busy: what a useless task I often think to myself.

I am sure there are arguments pro and con, what are yours?

[NeosynephRN]

I couldnt agree more but be careful about signing early for care as somebody on our floor was fired for signing early-they said he was frauding his documentation, I would rather late entry now.

We have to do hourly rounding and write an entry afterwards to prove we asked about the 3 P's-Pain, Position and Potty !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! give me a break

If i were in the hospital sick...and someone came in my room every dang hour asking me the "3 P's" I would probably get out of bed and kick them. Same with that "I have the time" crap I am susposed to say at work.

[chicookie, BSN, RN]

I was actually speaking with a guy who is an intern at the department where they make these policies or rather enforce them. He didn't even know that we do discharge papers AND admitting papers. Then he stated No wonder you nurses are always cranky, so many papers sometimes you don't even get a chance to see the patient, oh now it makes sense. Well duh. I think the people who come up with these things have no clue what it is to be actually on the floor. Sure I could do it if I had 2, 3 patients, but I get 8 patients, 6 on a good day there is no way I could see every single one of them every hour. Especially on night shift, I would get a bed pan thrown at me for not letting them sleep.

[eriksoln, BSN, RN]

I was actually speaking with a guy who is an intern at the department where they make these policies or rather enforce them. He didn't even know that we do discharge papers AND admitting papers. Then he stated No wonder you nurses are always cranky, so many papers sometimes you don't even get a chance to see the patient, oh now it makes sense. Well duh. I think the people who come up with these things have no clue what it is to be actually on the floor. Sure I could do it if I had 2, 3 patients, but I get 8 patients, 6 on a good day there is no way I could see every single one of them every hour. Especially on night shift, I would get a bed pan thrown at me for not letting them sleep.

Exactly, the people making the policies are too far removed from the pt. care setting.

[FireStarterRN, BSN, RN]

I never sign them ahead of time, always after. What if someone came by and say you had filled in your sheet ahead of time, you'd be busted.

[FireStarterRN, BSN, RN]

Perfect example, Eriksoln. The managers are told to check up on the hourly rounding sheets, they write a few nastygrams at first, then the whole thing eventually goes by the wayside because the managers are so up to their ears in other paperwork, and the whole idea was impractical in the first place.

[caroladybelle, BSN, RN]

We have to do hourly rounding and write an entry afterwards to prove we asked about the 3 P's-Pain, Position and Potty !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! give me a break

We actually have a list of 7!!!!!! tasks to do on hourly rounding and sign off on, including pain positioning and potty.

I work Onco/Hemo. We were told that we would be losing our medical overflow beds and that they would be transitioned to surgical onco beds. And they said we would get training. Unfortunately, said training has not been forthcoming in the past year and a half or so. we are getting TAH-BSOs, bladder tackings, surgery for uterine prolase,etc......not a problem, if we would get some wound care guidelines or DC teaching. Again, not forth coming.

Not to mention that we still get some medical patients.

Then we started to get OB - 20 something weekers with severe emesis, PROMs, fetal demise still in utero (to be "completed"out) and ectopics. I have had MDs say that as we have had training in these, it should not be an issue. Problem is we HAVE NOT HAD ANY TRAINING in these.

Someone gave us a booklet for some of the surgical procedures, most of which we do not actually get any patients for. They say that they cannot afford the class time.

When we clock out even a minute or two late, we get "spoken to " about incidental OT. Because the bean counters say, "A few minutes add up"...to a big expense.

When you DC a patient, you are required to have it in the computer within 10 minutes. Because a few minutes late - per the PTB - add up to patient dissatisfaction and slower throughput. Yet no pounces on the MDs for neglecting to put in DC info, doing med recs, and all the things that contribute to much greater delays in "pt throughput".

They have added on paperwork, upon duties, upon tasks, upon shortstaffing. They have doubled the amount of paperwork involved in merely transporting patients. The nurses are told, "It will just take a few minutes".

BUT DO ANY OF THEM RECOGNIZE THAT CONTINUALLY ADDING "A FEW MINUTES" ONTO NURSES ALSO HAS A COST THAT ONLY THE NURSES ARE BEARING PERSONALLY AND PROFESSIONALLY??????????????

Nah, they would rather make us sign a glorified potty sheet, like we work as waiteresses at the Golden Corral.

[Virgo_RN, BSN, RN]

I'm looking forward to trialing hourly rounding on our unit this Spring. We're working to fix a CNA problem, and the hourly rounding trial would require CNAs to participate in rounds, alternating with the nurse. Since the nurses already round, we just don't do it as a formal process, making sure the CNAs are getting into those rooms instead of doing their homework or checking their email will help improve nurse morale. I can't wait!

[eriksoln, BSN, RN]

I'm looking forward to trialing hourly rounding on our unit this Spring. We're working to fix a CNA problem, and the hourly rounding trial would require CNAs to participate in rounds, alternating with the nurse. Since the nurses already round, we just don't do it as a formal process, making sure the CNAs are getting into those rooms instead of doing their homework or checking their email will help improve nurse morale. I can't wait!

Hmmm, well.........good luck with that.

If your CNAs are doing homework and playing on the computer...........hourly rounds wont fix it. The people who act this way at work will treat the hourly rounds the same way they do the rest of their work.........just get around it. They will, more than likely, just sign the form, do no rounds. Or, do the same thing the CNAs on the unit I was on that tried it..........and just completely ignore it.

No amt. of paperwork will convince CNAs/RN/LPNs/whoever to all of a sudden work hard. In the end, the forms wont get done and administration will be chomping on your tail about it, not the CNAs.

[FireStarterRN, BSN, RN]

Exactly Erik.

Management seems to take blanket measures like this to avoid the uncomfortable task of confronting individuals. It's a widespread problem in many industries.

[Virgo_RN, BSN, RN]

We'll see.

[kellykelly]

At first I was really offended by the idea that I, as a licensed professional, could not be entrusted to do my job and needed to sign a piece of paper to prove I was in the patient's room. I don't mind it so much now. I was already in there all the time anyway, now I just have to initial the paper. I do get busy and forget to sign it all the time and sometimes have to go back and do it later.

We alternate between CNAs and nurses, nurses get odd hours and CNAs even. At night, we are only required to sign every 2 hours, and you do not have to wake the patient up to ask them the 3Ps. I wouldn't anyway--that's just stupid. I peek and make sure they're breathing and appear comfortable and that the call light is within reach, and that the urinal or hat is emptied. I did all that before anyway. Sometimes I am in there every hour myself for other reasons. I do let the patients know ahead of time that I'll be sneaking in to peek at them and sign that sheet so if they see me in there in the middle of the night they'll know why. Doing it that way, I have not had any complaints from the patients. We all agree it's stupid but what can you do...like others have noted, it's that Ivory Tower thing.

[MiaLyse, APRN]

>

Same here. I check on my patients as frequently as possible. The paperwork does get forgotten at times, especially with isolation pts. I'm too busy gowning, gloving up, meeting the pt's needs, ungowning, washing up and moving on the next pt. The paperwork I do find as a waste of precious time.