Hourly Rounding--pushing back

Posted
by CharmantUn CharmantUn Member

Specializes in CVICU. Has 1 years experience.

Has anyone successfully pushed back against hourly rounding against management?

I've been through mandatory "sim labs" on hourly rounding that take 20 minutes per nurse to hit management's entire script, managers checking that our whiteboards are updated and the patients are happy during every shift, and frequent reminders about hourly rounding during daily safety huddles. It's too much.

Management seems to believe this is the magic fix for our poor HCAHPS scores--I believe the numbers never going to improve so long as we are understaffed, only have semi-private rooms, and really inflexible food service.

How have you pushed back?

mindlor

mindlor

1,341 Posts

I just yeah yeah yeah and nod my head to these fools. Then I go back to doing things my way, which is very very successful. I have told many a boss that when they get tired of the way I do things......they can fire me. I have not been fired yet because my survey scores are through the roof.........I sure have quit a lot of jobs though.....I refuse to work for kool aid drinking fools.

xoemmylouox, ASN, RN

Has 13 years experience. 3,150 Posts

Has anyone successfully pushed back against hourly rounding against management?

I've been through mandatory "sim labs" on hourly rounding that take 20 minutes per nurse to hit management's entire script, managers checking that our whiteboards are updated and the patients are happy during every shift, and frequent reminders about hourly rounding during daily safety huddles. It's too much.

Management seems to believe this is the magic fix for our poor HCAHPS scores--I believe the numbers never going to improve so long as we are understaffed, only have semi-private rooms, and really inflexible food service.

How have you pushed back?

Of course it makes more sense to have hourly rounding than to staff appropriately. That way they can seem as if they are making changes to improve scores, without having to actually fix the problem. That my dear is called too much common sense for the big wigs. My god you might cut into their bonuses if things were staffed correctly - we certainly can't have that.

HouTx, BSN, MSN, EdD

Specializes in Critical Care, Education. Has 35 years experience. 9,051 Posts

I am also a skeptic in 'flavor of the month' solutions, particularly when it's thrown out before anyone actually knows what is causing the problem in the first place. There is a ton of research on patient satisfaction.... essentially boiling down to the fact that it is pretty much nurse-driven. A patient's interaction with nursing staff is the predominant influence in HCAHPS scores - especially "communication with nursing staff".

That being said, it is also an evidence-based FACT that happy staff produce happy patients. So, forcing grumpy, overworked nurses to paste smiles on their faces and scurry around filling out checklists will not produce happy patients. OTOH, contented nurses who have the time for meaningful interactions with their patients will have a much more positive impact on patient satisfaction.

I have seen hourly rounding work out very well if it involves the whole care team... CNAs alternating with nurses to 'round'. One of the best run units I have seen had hourly (multi-disciplinary) rounding as well as Bedside Shift Report. It was all hard-wired for success. For instance, on their last 'round' of the shift, the CNAs made sure that the patient and room were "ready" for Bedside Shift Report so that nurses could focus on it rather than responding to bathroom requests, fetching beverages, pillows and such.

My own personal opinion - Top-down initiatives don't work. Bottom-up initiatives that incorporate staff ideas and empower them to solve bedside obstacles.... Do Work.

CBlover, BSN, RN

Specializes in ORTHO, PCU, ED. Has 8 years experience. 419 Posts

Wow!! I'm reading this going, "Do we work together?!" We have hourly rounding also that just started recently. And no, as big a fit as we all pitched, it's only gotten worse. And we do those stupid safety huddles too!! I feel like I'm in elementary school and signing my homework pad. We have the whole whiteboard thing also. They sure do believe it'll fix HCAHPS don't they? I can't understand sometimes why they say, "We want to go as paperless as possible." Oh really? Well then why are you adding all this to our homework?!

CBlover, BSN, RN

Specializes in ORTHO, PCU, ED. Has 8 years experience. 419 Posts

That being said, it is also an evidence-based FACT that happy staff produce happy patients. So, forcing grumpy, overworked nurses to paste smiles on their faces and scurry around filling out checklists will not produce happy patients.

This is so awesome!!! Got a good laugh out of that! I love some of the humor on here.

Nurse Leigh

Nurse Leigh

Specializes in Telemetry. 1,149 Posts

I don't recall who it was, but when the topics of hourly rounding and scripting came up several months ago, a nurse told us that as she was required to spout off nonsensical scripts, she complied -in the strictest sense. Instead of memorizing said stupid script she would pull out a card with the whole thing written down and, holding it very close to her face, read it word for word in a monotone.

Most patients caught on and seemed to agree with the silliness of scripting, but ar least if mgmt asked if their nurse had gone through the spiel, they could honestly say yes.

I was so proud of that nurse.

dudette10

dudette10, MSN, RN

Specializes in Med/Surg, Academics. Has 11 years experience. 1 Article; 3,530 Posts

I round as frequently as my workload and patient condition dictates. I do not fill out the rounding sheets--I refuse to. The whiteboard gets updated with the date (for orientation reasons), my name and phone number (for safety reasons), diet if the patient is restricted in some way (so family knows), and next pain med due if pain is an issue. All the rest does not get filled out unless patient need dictates. I verbally communicate all tests and procedures scheduled for the patient to keep them informed. I round on patients with the off-going nurse for pt safety, but we don't do a full bedside report.

Everything I do is based on patient need, not management buzz words. No one has ever told me that I need to change it.

BrandonLPN, LPN

Has 5 years experience. 3,358 Posts

So much of the documentation in nursing these days pretty much just flat out demands staff lie.

Sometimes in meetings where we go over some new charting policy, I just want to interrupt the DON and say "Just cut to the chase and tell us which lie you want us to use!"

macfar28

macfar28

Has 20 years experience. 138 Posts

I CANNOT like this enough!!!!:yes:

My apologies..I thought I hit quote but failed to. This was in response to xoemmylouox's brilliant response.

Edited by macfar28
Tired brain

andrew.youv

andrew.youv

Specializes in Crit Care, Vent, Step-Down, Tele, Float. Has 5 years experience. 23 Posts

I'm all for hourly rounding, but with that being said, it seems the definition of hourly rounding differs per organization. In some of the Magnet facilities I have toured, hourly rounding was a collaborative effort which included nursing, nursing assistants, respiratory therapists, physical therapy, and (GASP) even physicians and management. A nursing manager would make a morning round after report and see all patients on the floor in some hospitals, effectively taking care of one of the hourly rounds. Overall it lead to reduction in falls, less call lights, and did make the team flow smoother. Everyone has to buy in, though. One person slacking off makes it harder for the rest of the team.

It does, however, seem that some facilities aren't really reading up on the evidence and assume that hourly rounding means that nurses need to be in the room every hour.

Push back with correct current evidence, include evidence on staffing, and always include estimates on costs and cost-savings; doing so will make an impact on the decision making. If you focus on items such as fall prevention, medication error reduction, and tie a cost to this, it can help. It's also good if you are able to pull direct costs that your organization has faced due to the aforementioned. Suggest your unit be a "pilot" to see if it is effective.

Good luck!

Andrew

Nurse Leigh

Nurse Leigh

Specializes in Telemetry. 1,149 Posts

^^^^ They initially tried telling us this is how it would be-that the chaplains, PTs, OTs, RTs etcetera would be responsible for rounding on the patient if they were in thr room, take care of any needs they could, and document properly.

It would NOT be solely up to the nurses and techs, no siree! Teamwork! Really, it will be easy and won't add any more to your workload-it will help!

Anyone wanna bet how long it worked that way? Actually I don't think I saw anyone other than a nurse or tech round. Shocking, I know. And just as suprising, it *did* add work to already overworked nurses and techs......:rolleyes: