Do you have to attend "rounds'?

RN92 · Jul 25, 2004

Let me guess!! Someone sitting behind a desk all day thought this would be a good idea to expedite pt through time. It obviously isnt anyone who has ever worked as a nurse on the floor. All of this could be done by having a case manager who is responsible for contacting all of the different disciplines (doc, social worker, nurse, physical therapy, etc, etc...) :rolleyes:

We do have "Bed Huddle" at 10am. The charge nurses, and other representatives of each discipline meet every am and decide who can go home and how many beds we can clear out. Our hospital stays full and sometimes, even if a pt has been discharged - the floor nurses try to hide the empty room. Its soooo unprofessional and childish. Not to mention, its not fair to the patients waiting on beds in the ER. I work in the ER and we are forever holding pts because they claim there arent any empty beds. Bed huddle has cut down on this ALOT!

RN4NICU, LPN, LVN · Jul 26, 2004

in my hospital, we have oft's (i'm not sure what that stands for) that rn's need to attend daily. the nurse manager, cns, social worker, utilization review, pt/ot and dietary usually attends and sometimes other disciplines will be there too. we are to give a report on our pts, why they are there and what we can do to get them out the door. sometimes it turns into an inquisition and it can really put the rn on the spot. these are held each day at 9am and if it is a pt you never had seen before its hard to answer the questionsif yu haven't had time to read the whole chart. also it is held during our major 9:00 med pass. we've tried to get the timing changed but it doesn't work well for the other people who have to attend.
now to make matters worse, our manager gives us an assignment after rounds that needs to be done and verified by her before we leave for the day! most of these are call the md and find out why the patient is still here, or call and find out why he did not order labs, consult ect. our md's are not pleased with being questioned and take their frustrations out on us and if we do not come back with the answer nm wants, she makes us call again. does anyone else have systems like this and how are they handled? any advice is greatly appreciated!

i'd let my feet do the talking to that moron. yet another example of an nm who checked her brain at the door before accepting the position.

if she wants to second-guess the medical plan of care (especially if it is appropriate), well, she has a phone in her office doesn't she?

the only practical advice i can offer would be to inform the docs that are upset with the questions that it has been deemed part of your new job description and they can refer their complaints to __________, nm - they are customers that bring business into the hospital - let them complain to people who can change this ridiculous load of crap that has been foisted upon you...at my hospital, the bean counters would have a stroke over this. rn hours being wasted on nonsense??

second piece of advice - whip out those want-ads, baby, and spruce up the old resume. when your nm runs out of nurses, she just might learn.

EmeraldNYL, BSN, RN · Jul 26, 2004

I work in an ICU and we are required to attend rounds on our patients each morning-- pharmacy and respiratory therapy is sometimes there too. I think it's great in an ICU setting because it ensures that everyone is on the same page regarding what is going on with the patient. But I really don't see how it could work on the floor when you have 8 or more patients, and calling the docs up to harrass them about why the patient is still in the hospital is just ridiculous!!

USA987, MSN, RN, NP · Jul 26, 2004

When I worked at a different hospital we had to do OFT's as well. I see you are in Milwaukee...I worked down in Kenosha...possibly in the same hospital system...Always inconvienent...didn't care what you were in the middle of...you had to be there!

Good luck!!!!!!!!!!

Celia M, ASN, RN · Jul 26, 2004

I manage the ICU in a small rural hospital and we do not have official rounds here or on the floor. Each patient in the hospital has a nurse Case Manager assigned to them from the Quality/ Utilization Management Department and it is the Case Managers responsiblity to contact physcians re DC planning, liase with the family and patient and reduce "Avoidable days" It seems to me to be a waste of a valuble resource to have the RN do the calling, it should be the managers responsiblity. Also, sho is the primary caregiver in this setting, the nurse. Your rounds should be at a more convenient time for you and your manager should be facilitating this. Good luck and if things don't change and you have met with your manager about these thingd (and documented the meeting) move on up to the next level to voice your concerns.

Critical care rn · Jul 26, 2004

We have daily rounds on in my ICU. All disciplines come including the case managers. We identify pt problems and goals for the day. It helps in getting everyone "on the same page". It works well for us. At first everyone thought the 9am time would be difficult, but we made it work. Of course we only have 2 pts to talk about, so at most each nurse is there for 15-20 minutes. As for the demands of your NM, I would ask for a meeting with your nurses, the NM and her boss ( director, whatever). This is not professional, and it takes you away from patient care. Our Case managers help with physician communication and discharge planning. On our MS floors, these rounds are held every other day, and that works for them...Good Luck!!

missmercy · Jul 26, 2004

Our intradisciplinary discharge planning meetings are held FORMALLY once a week -- however, we have discharge planners/case managers who are working to get patients moving in the system through out the week and of course, we are all supposed ot be "watch dogs" for the organization -- finding ways to eliminate financial excesses where ever we can. --- HMMM! I thought I was here for the patients -- to help them get well and learn how to stay that way! NOPE! Gotta attend meetings, shuffle papers and talk to bean counters and send these folks out ASAP!

VA_CCRC · Jul 27, 2004

Every afternoon there is a formal 'discahrge planning' session that usually last 30-45mins. The charge nurse, social worker, home health nurse and sometimes PT/OT are present. I find this duty is more of a 'legal' obligation to satisfy documentation in the pts care plan.

On the other hand, am rounds by the docs usually happen anywhere between 5-8am. I think it is the primary nurses resposibility to be present and contribute to rounds. I think a lot of nurses feel that they don't have anything to say at these 'pow wow's' at the bedside.

How many times have you been cornered by pts and their family memebers with tons of questions that should be directed to the doctors? I make sure and tell my pts "the docs are rounding so if you have any questions now would be a good time".

By making yourself visible during rounds you ensure pts get their questions answered by the doctors AND you get to give your very VALUABLE input. I find that half the time the docs have NO clue what is going on with the pt and appreciate my input, whether it be about poor pain management, hey man they are getting a diet but not eating how about a nutrition consult or they are not going to be able to do this dressing change at home we need home health etc...

We are their eyes at the bedside!

blue280 · Jul 28, 2004

Today my homework from rounds was to find out from the MD why he did not order a psych consult on a ETOH withdrawal pt. MD was firm in his belief that the pt did not need a psych consult. My manager wanted me to report the conversation in writing (I guess she is following up on all the requests made in rounds) I suggested that she tells the docs that they should come to rounds. She said it wouldn't be convient for them! I told her that its not convienent for me to call them for things that could wait and I think it is irritating to them to get these kinds of calls. It definately is not fostering good MD/RN relations at this point. Now they are getting a new work group in to teach MD's how to write progress notes so they fit a pt's DRG. Guess who these docs are going to take their frustrations out on?