Arguments Disfavoring Hourly Rounding

diane227, LPN, RN · Feb 10, 2009

No one has time to do this on my floor. We are a 34 bed medical ortho floor. Right now today we have 19 patients, 12 of whom are total care. We are in these rooms all the time. Having to document this is just stupid. All they need to do is look at the nursing record.

mamason · Feb 10, 2009

I'd love to be able to round hourly on my pt's if it's doable. Most of the time it isn't. The acuity of our pt's are just getting higher, and we are working with less staff. Ohhhh....and let's not forget the extra paperwork that's loaded onto to everytime you turn around related to the person upstairs with a master's degree who doesn't have a clue what it's like to step in our shoes for just a half of a shift. Apparently they believe that we sit around and eat bon bons all day and have all this extra time on our hands. Cracks me up everytime I think about it. :smokin:

BeachyRNn08 · Feb 10, 2009

I think those hourly rounding sheets are such a joke... I think I've completed one since they became mandatory on my intermediate care unit. Our floor already requires activity charting every 2 hours on each of our pts, that, combined with all of the other standard charting (meds, assessments, md notified, vs, education, i&o, wound documentation if applicable, tele strips, the list goes on and on) to do should be enough. I'm over all this double charting.. But I'm sure I'll be written up for not doing it, it's only a matter of time!! But it's definitely not a priority to me..

sxybuttrfly · Feb 10, 2009

I said it b4- I'll say it again...the people in the ivory tower or management know the least about what it actually takes to provide adequate and safe patient care- but yet, they make all the decisions that directly affect patient and staff safety/morale/satisifaction!

meadow85 · Feb 10, 2009

I'd love to be able to round hourly on my pt's if it's doable. Most of the time it isn't. The acuity of our pt's are just getting higher, and we are working with less staff. Ohhhh....and let's not forget the extra paperwork that's loaded onto to everytime you turn around related to the person upstairs with a master's degree who doesn't have a clue what it's like to step in our shoes for just a half of a shift. Apparently they believe that we sit around and eat bon bons all day and have all this extra time on our hands. Cracks me up everytime I think about it.

I know, right! The other day we were short-staffed and I had 5 patients during the day ... the educator comes and asks if I am available to learn how to use the PCA pumps?! Why does it have to be on my time?? I was off for 2-3 weeks (due to cuts) and they refused to train me then ... when I had all the time in the world!

RN2be_07 · Feb 10, 2009

I found them to be a huge time waster and just another piece of paper to fill out. Many times we would sign ahead for upcoming hours or behind ourselves at the end of the shift. They want to increase patient satisfaction, but how is spending your time trying to get hourly rounds in conducive to effective patient care which creates patient satisfaction.

Similar time wasters we had that was supposed to increase patient satisfaction included what they called "intensities" where we were supposed to log how much approxmiate time we spent doing different nursing skills for each patient and determing each patients acuity level and plugging all this into the computer at the end of every shift (this took about 5-15 minutes where I could be in a patients room spending time with the patient!) and the 2nd thing was that they made the unit call EVERY patient after discharge 24-28 hours to survey them on how they felt about their stay and if they were doing ok and had any questions. I am not against making sure our patients have good outcomes after discharge, but why make the nurses do it? BTW all 3 of these things were implemented within 3 months of each other while I was orientating as a new grad - lets just say it was not a good way to be introduced to hospital nursing.

rngolfer53 · Feb 10, 2009

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.

FireStarterRN, BSN, RN · Feb 10, 2009

I think it's the filling out of the sheets that is pointless. It's good to check on patients frequently. Most of us just fill out the sheets all at once, it's too much bother to do it every time your enter the room.

madwife2002, BSN, RN · Feb 10, 2009

I found them to be a huge time waster and just another piece of paper to fill out. Many times we would sign ahead for upcoming hours or behind ourselves at the end of the shift. They want to increase patient satisfaction, but how is spending your time trying to get hourly rounds in conducive to effective patient care which creates patient satisfaction.

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

Tweety, BSN, RN · Feb 10, 2009

I'm curious as to those who do hourly rounding is that the nurse doing the rounding, and is it med surg? A nurse doing anything q1h hour in med surg is next to impossible, especially rounds. Heck sometimes I'm in a room for an hour on one patient if they are total, trached, etc.

We do hourly rounding but the tech does the even hours and the nurse does it the odd hours. For those going through the motion, walking in the room and signing the sheet, or signing the sheet at the end of the shift, it's a waste of time. But those that actually round, stop in and see if there's anything the patient needs, tell them someone will be back to see them in one hour, the payoff is indeed more control, less call light use, and a happier patient.

I'm not a fan of the sheets, but I'm a big fan of rounding and taking care of the three p's because it keeps me in a little better control. Some patients if they know a tech or nurse will be coming consistently (and you have to set the standard and show them it's true) will wait.

I love the nurses who say "when I round the patients are going to want something......". Um........yeah.

eriksoln, BSN, RN · Feb 10, 2009

A friend of mine in school (he went to Pitt, I went to communit college for the nursing program) was in business. He told me a story once that comes to mind when hourly rounding comes up. It was a topic that had been debated in his classes.

There was a chain convenience store/pharmacy in PA that had to spend millions to retool its policies and cashier drawers/computers.

In the begining, they had used a system (the one that reminds me of hourly rounding in hospitals) that had many many checks done. To scan an item for sale took three actions as opposed to the single action most cashier systems use. The entire store was run this way too. Every breathe the workers took had a form to fill out and be signed by management. If you bought a soda on break, it took two forms to be completed and a manager signature. Then, going on break took a badge swipe at the time machine, one form, and another manager's signature. Coming back from break took completeing the "going onto break" form, another swipe, and another manager signature.

The administration held their heads high. They had created a system of policies that would gaurantee no employee theft, lunch break abuse and would make item sales errors a thing of the past.

This is where the system really got them:

Managers, so bussy signing things for people going on and off breaks or buying a soda on break, were unable to completely pay attention to what they were signing. There would be a "needs management sig." box near their office and they would grab the 6 inch pile of forms that had built up over two hours and just start signing. No awareness whatsoever of what the forms said. All of a sudden, delivery forms from truck deliveries that had MAJOR flaws in them were getting passed through. On more than one occasion, forms for "charity" had been signed.........mother of a boy who plays for local baseball team would drop off a form for the store to help fund new uniforms, worker places for in "to be signed" bin, manager doesnt read it, it gets signed, store has no committed to giving funds to the team (a real life example that had occured multiple times, nasty signs about not fund raising on the premesis were put up.....those signs cost money).

Also, managers were so bussy with the paperwork, customer service took a huge drop. They would often be short with customers needing help (cant find an item, need help reaching that high up item) and took very long to answer the phone when customers called in with questions. If the question took any research time at all, they usually answered with a "You'll have to come in and investigate that for yourself, I dont know" answer.

The lines of the store swelled to five and six people deep DURING DOWN TIME. The lines were not bussy because the store was bussy and making sales. The were long because it took much too long to register one persons sales. Three people in the store at the same time caused chaos at the cashier line. It was noted through systems analysis that there was a problem with people turning around at the front door. If someone came in with the intention of buy a gallon of milk, they'd walk up to the door. If there was 3 or more people in the line, they turned around at the door, never entered the store. The convenience store had earned a reputation for being too slow at the cash register line and it was costing them business.

Error in scanning items increased instead of decreasing. Much like the manager who signed off on forms without reading them, the cashiers were clicking this and that confirmation key without regards to what they said. They just wanted to get the sale done. People, in a line five deep would begin to grumble, and the cashier would beging to rush the scane process. Complaints of not getting charged the right amt., not getting the sale price or being charged for the wrong number of items rose dramaticaly.

The employee theft also got worse instead of better. The manager, too bussy with signing forms saying "Yes, I did see Sally fold and stock exactly 10 blue, 5 red and 6 green towels. I recounted the towels and they are all accounted for", was not around to see expensive stereo equipment go out the back door or the two cases instead of one in the employee's cart whose friend is as the register.

Point is, all the forms/checks did not serve the function in which there were created for. The system created in a 4x4 cubical made sense only in the ideal setting of.........a classroom or 4x4 cubical. It had no value in a real work setting.

The hourly rounding forms/policy is the same thing.

They went this direction at the hospital I worked at for a few months. It got dropped at the request of.......hold your breath..........the PHYSICIANS. With nurses too bussy fetching sprite for the chronic back pain pt., the physicians suffered the most. They had no way to quickly update on the pt. status, no one was catching them before they left reminding them the blood consent form is not signed yet. The phone calls they received at home increased dramatically. Overall, administration went a different route than enforced hourly rounds because, after complaints from Case Management, they realized, lenght of stay was growing at an alarming rate also. Just as with the conveniene store, the policy was not well planned out and actually took the workers away from the primary purpose of them being there.