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?

[rngolfer53]

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!

Good idea. I was in a nursing home last night for about 2 hours. For the first hour and a half, three CNAs were sitting at a table, and never moved. Ooops, I take that back. One of them was eating ice cream, so she must have moved to get to the fridge.

This isn't at all unusual.

[Virgo_RN, BSN, RN]

Thanks for the positive feedback, golfer. For it to work, accountability has to be built into the system, and nurses must be backed up by management if we have to discipline a CNA. Both of those elements are lacking, and have been, for some time. Other CNAs who float to our unit are floored by what ours get away with. It's brutal.

[mamason]

Certainly, hourly rounding takes time, as does filling out the log sheet.

The payoff is supposed to be less use of the call light, since the Pt will not be in pain, have to pee, or need position change.

So, do you guys find less use of the call light, fewer falls, etc?

I have no horse in this race, since I don't work in a hospital, just curious about how the experience now fits with that which was studied for the article that spurred hourly rounding.

I can only tell you about my experience. I am in and out of those rooms as much as my NA. It doesn't matter. If you have a little nervous nelly on your hands, no paper work is going to stop her from using that call light every 3 minutes to have her pillows adjusted. You just deal with the best you can. If I have someone confused and is at high risk for falling, pulling IV's and foley out, then they come and sit at the nurse's station to be watched. Basically because the hospital won't provide a sitter. I've heard of this study, but, apparently it wasn't done at my hospital or the one I worked at before. Which brings me back to the educated pencil pusher who has no clue as to what nurses really do or have to put up with in a shift. And we wonder why there's a nursing shortage. Humph.....

[mamason]

Just an after thought. If a hospital is truly serious about reducing falls and increasing pt satisfaction, then, they will staff accordingly. If a nurse has too many high acuity pts, then this in itself increases the risk of falls, errors, and dissatified "customers." Administration knows this. It's not rocket science. The all mighty dollar plays a huge role in this decision making. Until they realize that they are going to have to spend the money on proper staffing ,nothing is going to change except that a bunch of burned out nurses are going to throw the towel in and move on.

[rn/writer, RN]

I work nights on a postpartum unit. I check frequently on new sections and anyone else with complications. There are times that I am in a room throughout the night to look at a mom with pain issues or a cold baby doing skin-to-skin or a kiddo doing triple photo-therapy or some other condition that warrants frequent assessment/intervention.

The rest of my patients? I do peek in periodically, but if I were to disturb their few minutes of badly-needed sleep, I think they would start throwing things at me. Their significant others would no doubt help.

Granted, most of my patients are not truly ill. But even on a med-surg floor, it seems like there ought to be some discretion for the time of day (is there an adjustment for noc shift or post-hs time?) and acuity of the patient.

The walkie-talkies shouldn't need hourly evaluation as they can make their needs known and would most likely not want to be disturbed, even during daytime hours.

Total care patients and those with many needs and interventions will likely have someone in the room more often than once an hour, so a formal system with extra paperwork is not only superfluous, it may actually distract or take time away from patient care.

It's those in-betweeners who are not always able to fend for themselves where the concept is probably most useful. But the added paperwork still seems like a drag. And really, it punishes those who do get the concept in order to rein in those who don't or who just don't give a hoot.

I would like to see facilities promote the idea and explain and encourage the positives (as in Tweety's post) without turning it into yet another mandatory hoop to jump through. It would be nice to see administration have a little faith in the front line staff. Those of us who care about our patients are always looking for ways to improve their care and our efficiency. Those who don't--well--adding more fussy paperwork isn't likely to improve lousy attitudes.

I would like to require that form-happy administrative types come to the floors to discuss implementation of any future "great ideas," along with at least weekly follow-up visits to evaluate the results in both patient AND employee satisfaction.

What's that? Too much work to do a weekly assessment of your latest mandate? That's just a tiny taste of what you're asking from many of us.

[eriksoln, BSN, RN]

I work nights on a postpartum unit. I check frequently on new sections and anyone else with complications. There are times that I am in a room throughout the night to look at a mom with pain issues or a cold baby doing skin-to-skin or a kiddo doing triple photo-therapy or some other condition that warrants frequent assessment/intervention.

The rest of my patients? I do peek in periodically, but if I were to disturb their few minutes of badly-needed sleep, I think they would start throwing things at me. Their significant others would no doubt help.

Granted, most of my patients are not truly ill. But even on a med-surg floor, it seems like there ought to be some discretion for the time of day (is there an adjustment for noc shift or post-hs time?) and acuity of the patient.

The walkie-talkies shouldn't need hourly evaluation as they can make their needs known and would most likely not want to be disturbed, even during daytime hours.

Total care patients and those with many needs and interventions will likely have someone in the room more often than once an hour, so a formal system with extra paperwork is not only superfluous, it may actually distract or take time away from patient care.

It's those in-betweeners who are not always able to fend for themselves where the concept is probably most useful. But the added paperwork still seems like a drag. And really, it punishes those who do get the concept in order to rein in those who don't or who just don't give a hoot.

I would like to see facilities promote the idea and explain and encourage the positives (as in Tweety's post) without turning it into yet another mandatory hoop to jump through. It would be nice to see administration have a little faith in the front line staff. Those of us who care about our patients are always looking for ways to improve their care and our efficiency. Those who don't--well--adding more fussy paperwork isn't likely to improve lousy attitudes.

I would like to require that form-happy administrative types come to the floors to discuss implementation of any future "great ideas," along with at least weekly follow-up visits to evaluate the results in both patient AND employee satisfaction.

What's that? Too much work to do a weekly assessment of your latest mandate? That's just a tiny taste of what you're asking from many of us.

I like how you see things. Except one point, which is my primary point in all this:

The one's who dont give a hoot dont get reined in with this. If they dont care to come off the computer long enough to answer a call light or see why the lady in bed 12 is yelling about, why would they bother getting up for an hourly rounds form?

I think hourly rounds put the pressure on the ones who..........dont need to be told to round hourly.

[iriska_meller]

I like the way we do rounds on night shift on our unit. Between the hours of 12 am and 6 am when at least some patients fall asleep and most of medications are administered, we assign each half-hourly round (for the whole unit) to one of the RNs and PCTs. Everyone ends up doind around 2 rounds, so you don't have to interrupt your care to run to do your rounds every hour. I personally just peek in the rooms with a flashlight, making sure not to wake up people, check if any Iv fluid bags need to be changed, making sure patients are in bed and in some cases I actually stop and make sure they are breathing. If there is no emergency or unexpected finding (like a fall:madface:) my rounds usually take less then 5 minutes.

[Batman24]

We don't have an hourly rounding sheet. Thank God. I don't need any more paperwork. I'm in my patient's room or the CNA is every hour to check in and see how the patient is doing. Now if the patient is sleeping we don't wake them up to ask if they have to pee. That's absurd. If a patient is enjoying some family time and we know they have support we will try and spend extra time with a patient that doesn't have someone in to visit as often. Some patients need more care and we make sure they get it. Management wanting to treat them like cookie cutter patients is ridiculous.

[rn/writer, RN]

I like how you see things. Except one point, which is my primary point in all this:

The one's who dont give a hoot dont get reined in with this. If they dont care to come off the computer long enough to answer a call light or see why the lady in bed 12 is yelling about, why would they bother getting up for an hourly rounds form?

I think hourly rounds put the pressure on the ones who..........dont need to be told to round hourly.

We're in agreement.

Little short of a dynamite suppository will motivate those who really don't care. My point is that I think management believes this exercise in busy work will help to rein the bad apples in when all it does is penalize those who don't need it in the first place.

Good teaching with evidence-based resources could help inspire folks who really do care about their patients' best interests, and tedious forms should not be needed. With those who couldn't care less, no amount of fussy paperwork will spin selfishness and insensitivity into patient-care gold.

[BeachyRNn08]

Certainly, hourly rounding takes time, as does filling out the log sheet.

The payoff is supposed to be less use of the call light, since the Pt will not be in pain, have to pee, or need position change.

So, do you guys find less use of the call light, fewer falls, etc?

I have no horse in this race, since I don't work in a hospital, just curious about how the experience now fits with that which was studied for the article that spurred hourly rounding.

I don't find that it decreases call lights, imo. I dunno how it is everywhere, but some of my pts, you can check on them, give them pain medicine, reposition, get some water, whatever, and specifically ask if they need anything else, then they're on the call light literally 5 minutes later with another request... You really can't win with some folks...

[Roy Fokker, BSN, RN]

I like the way we do rounds on night shift on our unit. Between the hours of 12 am and 6 am when at least some patients fall asleep and most of medications are administered, we assign each half-hourly round (for the whole unit) to one of the RNs and PCTs.

That was giong to be my suggestion as well.

Another idea:

In my ER, the CNA's wear little 'locator' badges that can be tracked through the overhead paging system (e.g." As soon as a CNA walks into Room 11, a green light outside the room lights up and the paging board shows her as in 'A11'). It shouldn't be too much more of a hassle to build in a time stamp into the system so that each time anyone walks into a room, it can be recorded.

Of course, this presupposes that management is actually willing to - you know - put their money where their mouth is.... :icon_roll

cheers,

[LilyBlue]

I don't find that it decreases call lights, imo. I dunno how it is everywhere, but some of my pts, you can check on them, give them pain medicine, reposition, get some water, whatever, and specifically ask if they need anything else, then they're on the call light literally 5 minutes later with another request... You really can't win with some folks...

I was thinking that this having to go in the room every one hour and ask if the patient is having pain is a drug seeker's dream. It's like a kid in the candy store.