our hospital recently implemented hourly rounding. but before that we have to go through a one on one teaching session with our manager so we can go through a script on how we will address our patient every time we make rounds (a script...sounds like a play!)
"is there anything else i can do for you? i have time."- this should be the exact words we are required to use before we leave patients room.
(i could bring a recorder with me and play it everytime i check on my patient...hehe! ) of course, our patient are expected to be informed of this hourly rounding. and if we don't show up in their rooms or missed the due time for rounding..patient and family can write us up and complain.
take note , we are to document this rounding in a piece of paper. if not our attention will be called for not documenting it. so my guess would be unrealistic documentation. why? most of the time you can be stuck in one patient for 45 mins to an hour esp when you have a needy patient. and they rarely provide us with nurse aide or techs.
(can i just clone myself..! maybe clone a secretary so somebody can enter doctor's order while i do my hourly rounding).
well the reason for this because they want a high score on patient satisfaction..oh yes to be recognize!
how about nurses satisfaction? nah..they don't care!
Okay this is going back a few years ago, when I worked on a knee & laminectomy floor. My CNA & I would be assigned a "Mod" of patients. Each Mod had the capacity of 10 patients. At the beginning of our shift, we would do the initial assessment of each patient, together..We would tell each of our patients that one of us would be there each hour to see if they needed anything. We co-ordinated our times, for my med pass, & dressing changes, breaks, etc. & each hour, one of us would ,check on our pt's to see if they needed anything.At 9:00 PM our pt.s would be asked if they would like their sleeping pill? (The Dr's had everything available in writing as far as Pain, Nausea, Sleep etc. in their orders)If they didn't have a sleeping pill & it was time for a pain pill, I would ask them if they thought they might need a pain pill to help them rest? Our pt's never got on their lights, because they knew one of us would be there every hr. My CNA & I choose to work together,so we didn't have to work so hard, our pt.s were happy too..We didn't have lights & pt. buzzers going off, like the other nurses & their CNA's did...
Our hospital recently implemented Hourly Rounding. But before that we have to go through a one on one teaching session with our manager so we can go through a script on how we will address our patient every time we make rounds (a script...sounds like a play!)
"Is there anything else I can do for you? I have time." this should be the exact words we are required to use before we leave patients room.
The funny thing....patients do know when they are being lied, courtesy of the micromanagement gadgets.
Just say:
I may have a patient admitted with an unusual disease. That requires a lot of teaching, done in a calm gentle manner, regarding medications that are high maintenance - think high level immunosuppressives, with all the physical and PSYCHOLOGICAL effects. The MD changes the regimen adding a wellknown chemotherapy drug, WITHOUT EXPLAINING this to the patient. And I as the nurse have to go in explain this change to the patient, do the chemo teaching, without scaring the living crap out of the patient.
Just say the word "chemotherapy" around any patient and watch the panic...and these days with the internet, they will realize what they are getting chemo.
I enter the room to do this instruction, along with all the helpful products to prevent complications. I sit down to talk to the patient and spouse.
During the conversation, I receive 7 phone calls (MDs wanting to give nonemergent verbal orders, family members making one of the 20 daily phone calls to the nurse of their loved one, CT wanted to know if a patient REALLY, REALLY needs a CT scan today, and could I call the MD RIGHT NOW to ascertain the answer, etc. - nothing emergent). I then turn the phone off, only to have the secretary come to the room several times (courtesy of the lovely nursing low jack we are required to wear) to ask why my phone is not working, calls regarding such concerns as Mr X wants to know how his wife slept, but he doesn't want to worry her by asking her himself.
At the same time, my beeper goes off over and over AND OVER. Such beeps as "1812 needs PCA for fresh water. You see some MORON in adm, decided that your beeper rebeeps every 60 seconds, so you don't "Forget". And if it beeps the PCA more than twice, the beep does the same thing to the RN. And even the PCA/RN answers a call, the beeper continues to go off, until you clear the thing.
I spent maybe 25 minutes with my patient, and left the room to find my beeper full, NO lights on pending to be answered. And my patient had to be oriented to a distressful issue, with phones ringing, and my pocket buzzing like an industrial beehive (even on vibrate, those things make noise).
"Do you need anything - I have the time" rings quite hollow, when you can't ask your nurse a question, for the phones, the secretary, and the nurse's buzzing pants pocket.
Just found this thread after starting one of my own. They've just started this where we are and have taken it one step further into the depths of "are you kidding me?"
We are supposed to ask our patients about their satisfaction scale: I don't know if we get a cute little chart with smilie or frownie faces or not. If the best is 5 and the worst is 1, what can I do for you that will make your satisfaction a 5? Okay, can we even begin to count the number of ways this can and will go wrong? SOmeone mentioned being asked to play cards; well, I can imagine, with some of the visitors our OB patients get, that sexual harrassment might be a result. For crying out loud.
I have signed the paper, but I don't script. I have for 32 years done all of that anyway, and won't become a robot, as much as they are trying to make that happen. I see my patients much more often than q 2 anyway and should since we don't have CNA's most of the time.
Another brilliant idea to keep some people employed while making others' job more completely miserable. IMHO, of course.
About the hourly rounding.....that concept was rolled out at our hospital a few months ago, we had to initial a paper in the pt room. Pt began complaining that we came in and just signed the paper. That was it, no inservice, no reasons etc, just sign the paper. It was dropped.
Now, we have a committee to roll out the "Rounding with a purpose". We made videos of the right and wrong way for a pt encounter. The Studer video was a joke, we decided to best way get this thing going is first to over come resistance by making our own educational devices, not prescribing an hourly plan but timely and involving every department that comes in contact with the pt -- housekeeping,dietary,admissions et. Yes, Studer Group strikes again! I have written, emailed, and tried to phone all involved to find out the pt/nurse ratio and skill mix(Nurse aides,unit clerks, Pt care specialists) to see just how they did the study. No answers. Posed the same question to my CNO, CO and Studer Rep, the answer is "I don't know". I also questioned the need for the hourly rounding, do we have an assessment? Have we identified a problem? Hellllooo, nursing process! No.
We have an advertising campaign about to roll out and we have to be ready to say,"....I have time." I will keep pressing on about the need for good customer service and the Administration to read that darn book and make THEIR rounds as prescribed!
Finally, someone is putting nursing based evidence to work! With all those questions you asked, if NBE had been used, you should have EASILY received a response! No response = no (or minimal, at best!) research OR evidence to me!
Finally, someone is putting nursing based evidence to work! With all those questions you asked, if NBE had been used, you should have EASILY received a response! No response = no (or minimal, at best!) research OR evidence to me!
We were given a very long and very wordy report on how this is supposed to be the cat's meow and solve all our problems. So there's at least one study out there. I don't have it here at home, but I did skim through it. I DID NOT "have the time" to read each and every word!!!!!!! (I'm convinced they get paid by the word.)
In their controlled environments, I can see how it might work, and I believe they mentioned 1-2% improvement in how many call lights went off. They thought that to be significant, I call it nothing.
Good grief...........I am SO glad I left acute carel!!! I'd get fired in a New York minute if I were working in a facility that treated professionals like Wal-Mart greeters. I can just see myself telling administration, "Right---I went through four years of college and $20K in debt so I could learn how to act like a #@*! parrot!!!"
I can't believe this trend toward "scripts"........as if nurses are too stupid even to know how to talk to people. And that silly phrase "I have the time"---what happens when you DON'T have the time, do they just take you out to the town square and execute you?
I'm not usually one to agitate for a revolt, but I really think it's time for nurses to rise up and REFUSE to put up with this. There are a lot of jobs out there that don't require one to surrender all dignity or be treated like a first-grader. We should vote with our feet and refuse to work anywhere that nurses are regarded as glorified waitresses. I mean, can you imagine anyone making a physician or a physical therapist do hourly rounds and act like a Stepford wife?? Sheesh!
BRAVO!!! I totally concur with your take on this. :yeah:
Just a thought...Scripting would most likely improve pg scores. Instead of explaining side effects to the patient in a meaningful way, we could instead say " I want to be sure you understand the side effects of your medications." Then rattle off a list the way the drug companies do in their commercials.
We all know that more frequent rounding does in fact decrease the number of times a patient uses the call light. Some patients need the extra reassurance that we are in fact paying attention. Most do not. In the past, I would round in an unobtrusive way. (Except for the patients who need the extra reassurance.) Now I often make a point of telling the patients that I'm "doing my rounds, making sure the IV is O.K. and that you are not in any discomfort." Sometimes this is more helpful than I expect. The patient sometimes can be involved in a conversation about how I know everything is O.K. and I can explain the rapid assessment that I do on entering a room and even validate that assessment with a more formal assessment. It's an interesting way to get patients involved in their own health care. But to be honest, pg does not reflect patient satisfaction and mostly leads to good scores verses good patient care. The same can be said for scripting and timed rounding.
It is funny because I read this thread yesterday. Anyways, I was at work this afternoon and my manager approached me. YEP we're doing the every hour rounds now!
I said, "You must be reading Studer's book, eh?" She was amazed and said, "why yes! Have you read it too?"
It was pretty funny, because I look all smart now. Thanks allnurses.com!
I just bought a Studer book on amazon.com, used. If I'm going to be "managed," I think I'd like to know the plan. I suggest all of us who are being made to script and round do this. We might find out something interesting :chuckle
aknurs
60 Posts
Okay this is going back a few years ago, when I worked on a knee & laminectomy floor. My CNA & I would be assigned a "Mod" of patients. Each Mod had the capacity of 10 patients. At the beginning of our shift, we would do the initial assessment of each patient, together..We would tell each of our patients that one of us would be there each hour to see if they needed anything. We co-ordinated our times, for my med pass, & dressing changes, breaks, etc. & each hour, one of us would ,check on our pt's to see if they needed anything.At 9:00 PM our pt.s would be asked if they would like their sleeping pill? (The Dr's had everything available in writing as far as Pain, Nausea, Sleep etc. in their orders)If they didn't have a sleeping pill & it was time for a pain pill, I would ask them if they thought they might need a pain pill to help them rest? Our pt's never got on their lights, because they knew one of us would be there every hr. My CNA & I choose to work together,so we didn't have to work so hard, our pt.s were happy too..We didn't have lights & pt. buzzers going off, like the other nurses & their CNA's did...