mandatory hourly rounding

  1. Ok so the latest mandate at my job: Hourly rounding. To be checked by the nurse manager. She will be making rounds, on all shifts, to patients rooms to find out when the last time they saw their nurse. She said PCT's can also help but come on, our pcts sometimes take over an hour to get the vitals. And they are not responsible, we--the nurses--are if something goes un done.
    Its like kindergarten.
    We have gone from 4 to 5 couplets, and in that mix can also be gyn surgeries on top of c-sect and vag births and antepartums with issues.
    We are mandated to increase our satisfaction scores.
    So now we have more patients, and must see them all on a very frequent basis. I will have about 10 minutes/hour with each couplet. Meaning that anything I do, will have to be quick because I will have to see them all within an hour, and then start again. As it is, assessments and vitals on mother/baby couplets take 15 minutes if I rush it, so I am already late.
    Getting someone out of bed for the first time post-surgery can take up to half an hour.
    When c-sects come, they need vitals q30min X3, and hourly respirs etc. How am I realistically supposed to round hourly when I have to do this??
    I am feeling so pressured. The last few nights with five mother/baby couplets have been brutal. I round on my patients frequently but not each patient every hour. They sometimes get bothered if you go in too much. We were told in school to check on your patients but minimize interruptions if at all possible. Moms and dads and babies need uninterrupted periods to bond and my personal belief is that after the first 24 hours, they NEED to begin to figure things out on their own, in the hospital and in the environment where we can help if they need it. If I am constantly coming in, they will be asking me to change the diapers, help the latch etc...which I am fine doing, but not if I am going to get written up for not seeing all my patients every hour.
    I might just be tired but this an overwhelming thing to do to our already over-stressed and under-staffed floor. We can't hire more nurses d/t budget, we are not allowed overtime--must leave all undone tasks for next nurse(who ripped me a new one when I tried that once), and now its more patients and see them even more frequently. Oh my god. I am SO WORRIED that its unsafe. I am so worried that in my haste to do what I am told to do I will miss something, hurry thru an assessment or something and miss something. What about the time to fill out charting and stuff????
    I am sorry. I feel like I am going to lose my mind at work these days.
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    About MIA-RN1

    Joined: May '05; Posts: 1,356; Likes: 40
    Nursing isn't a job--its a calling!

    12 Comments

  3. by   angel's RN
    NOW! I have heard it ALL!!!!!!!!!!!!!:smackingf (Not you, your "facility"). All I can say is, be real careful, cross all your t's and dot all your i's (sometime in the middle of lunch?), so that if anyone comes back and says they didn't see you but 10 time in your shift instead of twelve, you'll be covered!!
    Best of luck, REALLY, my thoughts are with you!!
    :angel2:'s RN
  4. by   Lilorfnannie
    It reminds me of when I used to work in the restaurant industry. I worked at a number of places. I found that each one had their "thing", and thought they were more efficient, better than the rest, etc. because of their "thing". One place insisted that people wear latex gloves for every single task. Another insisted that we have chain gloves whenever we touched the meat slicer. Another insisted that we wash our hands and wipe down our station every hour, on the hour. Another had special bleach-water buckets under the counter at every station, with bartowels in them, and insisted the water be changed every hour.

    I found most of that to be substitutes for skill and good technique. Vinyl/latex gloves are unnecessary in restaurant work if the people actually wash their hands frequently!!

    Anyway it was annoying- but the Pointy-Haired Boss exists in every profession. They always have their "things" that they think are SO important and SO vital, and make their company better than the rest. Puh-leeze.

    I always complied as much as I could, certainly when the PHB and other toadies were looking, and sometimes followed my own fashion of actual SKILL the rest of the time. Although, I am one for following the rules of a place, even if they are stupid rules (and don't harm anything), because I believe it is the moral thing to do.
    Last edit by Lilorfnannie on Apr 18, '07
  5. by   Lilorfnannie
    All I can say about your situation though, is that if you think it's unsafe, you need to take it up the chain of command. Make noise about it- but follow the rules until then. I'm sorry it's stressing for you
  6. by   bsunurse
    Welcome to my world of hourly rounding. I recently graduated, but where I worked as a student nurse we had hourly rounding where we had to sign a sheet that was inside the patient room stating that we did round to that room during the hour. Not only did we have to round, we had to say "is there anything else that I can do for you, I have the time". This is because they did a survey somewhere in the world and "found" that patients did not ask for what they really needed or wanted because they thought us nurses were too busy.

    *** It was funny though bc the nurse managers (who was also in charge of implementing the hourly rounding for the whole hospital and also went to the national conference on it) daughter was a patient at one time and we made sure that we went into that room hourly and asked her if there was anything else that she needed because we had the time. She finally admitted that it was too much and that we were constantly bothering her and her daughter throughout the night. It was too late though because it was already a hospital policy!!!!

    Where I currently work, all floors except the ICUs have hourly rounding, but they have a CNA whose only job to do for the shift is to round. Usually the aid is assigned to 2 floors to do hourly rounding on. Hopefully, your employer will realize that nurses are too busy for this and will come up with a better idea!
    Last edit by bsunurse on Apr 18, '07
  7. by   RNperdiem
    I hear you. This is the nursing equilavent of managentment fads that seem to run epidemic through corporate workplaces.
    Humans have been working just fine long before there were vision statements, mission statements, right sizing and all the other fads that come and go(or overstay).
  8. by   Mulan
    the problem with this hourly rounding

    we all must be just sitting at the nurse's station right? and we have to get up out of our chairs every hour and go into the patient rooms

    Yeah, get real, on medsurg, I am so busy trying to get the meds passed, the work done, etc. that I am constantly doing something for or with some patient, I don't have TIME to do hourly rounding. Whether they are all seen every hour or not I really don't know. All I know is that I am going non stop.

    As far as the checkoff paper, I'm sure it's like anything else, it probably gets checked off for every hour whether it's accurate or not.
  9. by   ICRN2008
    At my peds hosptial we are required to round on our patients every hour and chart their activities, assess the IV site and chart numbers (pulse ox, iv totals, etc.) if applicable. We have four patients most nights, so it can get a bit crazy when we get a new admit (which can take up to an hour) or when it takes twenty-five minutes to get a 3 year old to take an oral med.
  10. by   NurseCherlove
    Oh please don't get me started!!!!!!!!!

    We have been doing this stupid crap for over a month now and I work on a med/surg floor....it's totally laughable!!! Also, like CoopergirlRN, our manager rounds and checks to see if the rounding papers in the patient rooms are current (not with blank hour slots, so we don't go back and back chart) and we too will be written up if they are not.

    This fad is based on a study that supposedly cuts down on call lights which is written by some entrepreneur guy - Studer, is the last name. I have read some of the literature, and while it sounds so great, with his slanted statistics and all, we all know it's not realistic and that this idiot just wanted to get some press for his extraordinary idea on improving healthcare. Gimme a break! He even goes on to say something to the effect of several nurses actually thinking that implementing this silliness ended up saving them time because they weren't answering call lights all the time.

    Personally, I have found this to be a nuisance and just another piece to add to the mountain of already existing required documentation.

    I'm hoping this fad will die out really soon!
  11. by   MIA-RN1
    thanks to all for the support. I am so worried about getting everything done now. I have been very organized, have a great assignment sheet to work from, but I am just not sure I am capable of all of this. With five couplets (10 patients) that equals out to just over five minutes per patient, per hour. Totally not enough time. I can see hourly rounding on three or four patients, total. But five couplets?
    I think its the Disney mentality. Maybe that guy Studer wrote that book too. There has been rumors circulating that we will have to write something about it after we've all finished our assigned reading of it....
    *sigh*
  12. by   crissrn27
    The hospitals that are doing this "hourly round" crap are in for a lot of trouble, IMO. One of the first things a med-mal attorney worth his salt does is get the policy for the floor that the pt had a problem on. If your policy says to do hourly rounds, and the pt dies or whatever after 65 min. of not being "rounded" on, then the family has a case. It can be said you aren't even following your own policies and that never looks good. What do these places think their trying to do?? Craziness! I think I would point this out to the idiot who decided this. The standard of practice in mother/baby is not hourly rounds, in most cases. Your policy should stick close to what is the standard so it can't be said you aren't following your policy, even if you are following the standard of care, KWIM? nut cases making policies! OK-I'm off the soap box now....... well, maybe.

    BTW, copper, 10 pts is alot on any floor, and one with as much teaching involved as mother/baby it is too much! No wonder your stressing! I work in well newborn and we can only take 5 babies, and we don't even have mom! We also go to deliveries, so thats why it is a little lower, but I know when I have 5 I run my behind off.
  13. by   Roy Fokker
    They tried to implement it where I work.

    We simply ignored it. If they want, they can fire us en masse.

    I don't have time to put up with stupid "feel good" measures when I have 7 patients/nurse and 1 tech/34 patients! :stone

    cheers,
  14. by   rn undisclosed name
    I agree that this hourly rounding is a huge PIA. Some patients just don't want someone in the room all the time. There are several people in and out of the room on a daily basis from the nurses, aides, dietary, housekeeping, doctors, etc. that it is just disruptive to the patients.

    I haven't seen a reduction in call light usage either. You have some patients that are always on the light and no matter how often you go in their room they will still use the call light to excess. And why is it that the younger patients who are the most independent can be the neediest?

    But anyways we alternate hourly rounding. The nurse rounds on the patients on the even hours and the aides on the odd hours. Oh, and I don't mutter that stupid phrase about how I have time and can get them whatever they need. I ask them how they are doing and if they need something but I'm not about to tell them I have the time for whatever they need cause I'm not going to lie to them.

    Some patients are just tired and ill and trying to sleep. I'm not about to wake them up unless I have to. How about we interview some patients and publish our own study that patients think this hourly rounding is ridiculous. Besides we are in the room often enough that the rounding is overkill.

    Kelly

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