How do you get the nursing care done with hourly rounding & computer documentation?

[medsurgrnco]

I work on a high-acuity med/surg unit and typically have 6 patients. We are now expected to do walking rounds, hourly rounding on patients documented on a form at the patient room (alternating with CNA's who often don't do it), document extensively in Meditech, do 24-hour chart checks, and respond promptly to patient phone calls and bed alarms. Anyone have any advice on how to get everything done timely? Also, does anyone have suggestions on how to document quickly in Meditech? I've used the system long enough to know the basic key functions and we can use the F5 key, but those F9 lookup tables are long and cumbersome. And doing patient orders is difficult as I often have to make many guesses to find an item.

[Chaya, ASN, RN]

If I've stuck my head in the door for any reason during the hour-consider rounding done on said patient.

For sure, if a nursing action isn't documented it isn't done. However, this degree of documenting shifts the focus of our practice to being task oriented which acc to Benner's theory is the level at which novice nurses practice before they are able to put it all together, or incorporate diverse observations and information into an integrated and comprehensive concept.

When I am scurrying around like a nursing student checking off little boxes I am not getting the big picture. I don't consider having a little extra time to chat with my patients just "nice"; I consider it essential to achieve the next level of caring for them-as the experienced and proficient nurse I have become from my years of experience. Kind of a waste of limited personnel time, and it's the patient who suffers on a wholistic basis even if all the little boxes get filled in.

[nelcoy4]

I do hourly rounds, but I check the box on the paper hourly rounds sheet at the end of the shift or if I remember, or shh.....if something happens. Some nurses don't do it at all bc it's not part of the official chart. On the computer their is a box that we check that says comfort rounds completed.

[bigredrn57]

I wish something like that would work here where I am, but all that would happen is that the nurse would be fired for being too slow. We're also not allowed to say things that make the hospital look bad, especially in the chart, as that could open the hospital up to a lawsuit.

This is an at-will state, meaning anyone can be fired for any reason. We also have no unions here. So we're really between a rock and a hard place. We just do the best we can and hope that nobody's out to get us, because we all fall short.

Thanks Angie O. This is why nursing as a profession is screwed up. MO is also a right to work state. But what do I expect from the,"Show me state." But then again who else would elect a dead guy to be governor?:imbar

[capnnikkiRN]

I work at a facility that does hourly rounding and many of the nurses expressed the same concerns that you have. I work as an educator on that unit and did some research to rework the process. Here was my suggestion, we follow the 4 P's (pain, potty, position, placement) and the nursing staff assess these needs at least once during the hour for their patients. The goal is that rounding isn't a special event, but the concepts of rounding are carried out on a routine basis. The nurses on my unit have a better outlook about rounding and our patient satisfaction scores are going up.

Good luck with rounding, I think it gets better when we focus on the patient needs and not a piece of paper and from the sound of it so do you.

[MB37]

I spent a semester in school on a floor that trialed rounding, and it was as capnnikkiRN described. Either a nurse or a tech had to stick their head in the door, ask a pt the 4 Ps, and either check the boxes or write "sleeping." You could do the "1300" time slot anytime between 1300 and 1359, and I know some people would check 1200 and 1300 right at 1300 (or at 1259 and 1301). That seemed to work a little better than taking a specified block of time out of your day to "round" on your pts.

[litbitblack, ASN, RN]

Gosh I have been out of the hospital for 3 months and it is so niceeeeeeeeeee!!!!I actually get to sit with my residents and visit, although it is an alzeimers facility so they probably don't remember it but to actually spend TIME with my residents has been so awesome......Although sometimes i feel i am wasteing my knowledge.....when I was in the hospital WHat i would do is on the ones I had meds on for different hours those would count as my rounds. The others I just peeked in on to see if they needed anything. The bad thing about those papers is that when family or management come in and you have been so busy running around that you have not checked the papers even though you have been in there, the perception is that you haven't been in there. There needs to be some other way to keep up with it. Sorry but the cna's i work with now keep track of i/o, meals and elimination and that is there responsibiltiy. Of course when I have nothing to do I am out there helping but the change in scenery has brought me back to the reason I went into nursing: to take care of my patients

[sparketteinok]

Just got my a** chewed out today for not getting my rounding papers up (which were the night shift's responsibility to get up), and of course, for not signing them...

oh- I'M SORRY- I was TAKING CARE of patients-

The hourly rounding is a good idea in concept- I agree, and when we have days that we can actually do it- say, with 4 patients....

it works great....it really does- cuts down on call lights, etc...

But- on 6 or more patient days, enough is enough- HOW is it possible to get even basic care done and sign the stupid forms??!!

I am new, and I work hard. I really do. I am not one of these that sits at the desk, sucking up to the doctors, or talking about what my kid did this weekend, or looking up crap on the internet. There is a nurse that I work with that does all this, and she still gets all her charting done, meets on all the committees, and gets her rounding signed. Guess how? She never takes a stethoscope to a patient, washes her hands, thoroughly checks charts (I've had her patients the next day and there are major errors). And guess who all the management loves??

All I can say is I'm trying. I'm trying the best I can, and it's not good enough.

[inshallamiami]

Let's hear from some management types -- I KNOW you're out there. What advice can you offer and HOW can you defend these unrealistic expectations?

[medsurgrnco, BSN, RN]

Just got my a** chewed out today for not getting my rounding papers up (which were the night shift's responsibility to get up), and of course, for not signing them...

oh- I'M SORRY- I was TAKING CARE of patients-

I am not one of these that sits at the desk, sucking up to the doctors, or talking about what my kid did this weekend, or looking up crap on the internet. There is a nurse that I work with that does all this, and she still gets all her charting done, meets on all the committees, and gets her rounding signed. Guess how? She never takes a stethoscope to a patient, washes her hands, thoroughly checks charts (I've had her patients the next day and there are major errors). And guess who all the management loves??

From the OP: Yes, this has turned into a real problem. Management thinks it can be done because some nurses will appear to do it all. I had a manager who wanted me to shadow another nurse for half a shift to help improve my efficiency, as he thought that was my problem. I pointed out the awkwardness that could result if the nurse I followed cut corners, etc. in order to get out on time daily, and asked that I shadow the manager. Obviously he didn't like that idea! So when is management gonna look beyond the surface and see how some nurses supposedly can do it all while others can't?? And see the resulting negative impact on PATIENT CARE - HELLO, WE DO WORK IN HEALTH CARE. :banghead: :banghead:

I solved this one by finding a job without those expectations. :):):):):)

[medsurgrnco, BSN, RN]

Let's hear from some management types -- I KNOW you're out there. What advice can you offer and HOW can you defend these unrealistic expectations?

OP again: GREAT IDEA! Please, managers, help us out. We do want to do a good job and take care of our patients, and are really struggling with this one.

[sparketteinok]

hey guys, had 4 patients today, not only did I do patient care, but my sheets were up AND signed (imagine that), and charting was done by 1400!!

It did make me feel good that I was actually able to provide care and please management. But it's the days that everything goes south by 7:30, you have doctors and families in constant battle, and you have either A: I want my pain meds every hour, or B: a really sick person that needs help....what about those days....when it's all you can do to make sure no one dies.....

am I really inadequate, or do other nurses struggle with this???

[correctlywrong]

I've decided that my answer is to give the best care possible to the patients and the paperwork be danged.

I am less protected if there is an adverse event because my charting sucks.

I am less likely to have a patient experience an adverse event if I spend my day at my bedsides instead of at a computer.

However, statistics will eventually catch up with me and there will eventually be an event despite my diligence. I can either choose to speed up that date by changing my focus to documentation over patient care, or I can avoid it all together by leaving bedside nursing all together.

I've accepted a new position.