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?

[Paul Hubbard]

as nurses, we should practice following the best practices evidenced by research. it's a little difficult to argue with success. nurses involved in an hourly rounding protocol find that their shifts are less stressful, their time more productive, and patient safety and satisfaction scores hitting all-time highs. the new strategy for rounding comes in the wake of research results from 27 nursing units in 14 hospitals across the country that show how consistently checking on patient needs reduces monthly call-light use by 38%, patient falls by 50%, and skin breakdowns by 14%, while satisfaction scores move upward.

[regularRN]

This is interesting, because when hourly rounding was implemented where I work, an expensive consultancy was hired to "train" us with a speaker and a slide show. From what I can remember, the studies were based on "pseudo scientific" methodology... implying (in my mind) that the research to back hourly rounding was not exactly "scientific". During the three times I have attended college and university, I have never heard the term "pseudo science"... all research had to follow the "scientific method" and be subject to strict statistical analysis.

Does anyone know what "pseudo science" is?

[rn/writer, RN]

as nurses, we should practice following the best practices evidenced by research. it's a little difficult to argue with success. nurses involved in an hourly rounding protocol find that their shifts are less stressful, their time more productive, and patient safety and satisfaction scores hitting all-time highs. the new strategy for rounding comes in the wake of research results from 27 nursing units in 14 hospitals across the country that show how consistently checking on patient needs reduces monthly call-light use by 38%, patient falls by 50%, and skin breakdowns by 14%, while satisfaction scores move upward.

i'll bet patient satisfaction scores would jump through the roof if they had 1:1 nursing care, but try doing that with a full patient load.

i'd be interested in what the research shows about the nurses' side of the equation. could you give us a link to the study you referred to? or any other pertinent research.

a couple of questions come to mind. were the nurses making contact themselves on an hourly basis, or was this a shared responsibility with cnas or other ancillary staff? did they just make an inquiry, or did they have to do some kind of initialing or other form of charting.

i'd also like to know what kinds of units, staffing ratios, and other details went into this study.

who sponsored this research and who conducted it? were nurses in any way involved in the planning or evaluation.

i guess i'm just plain skeptical. administrative types are exceedingly well known for coming up with one gimmick after another that tries to raise satisfaction scores at the expense of front line staff. that, and i know that many patients are less than enthused about being disturbed every hour. at times when i have been hospitalized, i did not want someone checking up on me that frequently and would have been incensed to the point of asking to be left alone for 2-3 hours at a time.

some folks do warrant that kind of attention, and complex patients may have someone in the room far more often than once an hour. others, especially those who have attentive, reasonable family members, may not need this kind of hovering. it gripes me that this is just one more "decision" that we are judged incapable of making on our own. go after the bad apples that do not exercise good discretion in this area, and let the rest of us do our jobs in peace.

[Paul Hubbard]

Your right, if it didn't work at your institution then it doesn't work at all and it should be considered "pseudo science". Is that your approach to any new initiative or practice change? There is solid research in place that supports a decrease in falls, a decrease in the use of call lights and an increase in patient satisfaction resulting from hourly rounding.

[eriksoln, BSN, RN]

as nurses, we should practice following the best practices evidenced by research. it's a little difficult to argue with success. nurses involved in an hourly rounding protocol find that their shifts are less stressful, their time more productive, and patient safety and satisfaction scores hitting all-time highs. the new strategy for rounding comes in the wake of research results from 27 nursing units in 14 hospitals across the country that show how consistently checking on patient needs reduces monthly call-light use by 38%, patient falls by 50%, and skin breakdowns by 14%, while satisfaction scores move upward.

i'd love to see these research results. are they published in any way? where did you find out about them if not?

the one unit i was at where it was actually enforced, the physicians.........not the nurses, insisted it be ditched. falls did not decrease because.......ok, we get the sprite for pt. 1 while pt. 2 falls when we otherwise would have been focused on pt. 2.

top that off with, yes, ok, pg scores went up slightly, but lenght of stay went through the roof. the hospital lost money. in reality, thats why the ditched it, not because of the physicians.