How do you round?

[Mommy TeleRN, RN]

Just curious about other nurses routines. Especially the first few hours of the shift when it's so hectic.

I am a new nurse still on orientation. I share a load with my preceptor but she allows me at this point to work fairly independantly. She is close by if I am unsure of something, and she does her own assessment of the pt too, sometimes doing part of my rounds with me.

So I work nights and we do verbal face to face report with offgoing nurse. Usually we are done right around 7p. Right now I take 4 patients. I will eventually take 6. We do two assessments during our shift and 3 sets of VS (we do our own since it's cardiac floor, CNAs do temps/sats but I do those too because well for one my preceptor wants me to and 2 I really like to know my pat sat right then, not later when I can look it up in the computer..seems like a time waster..faster just to take the sat myself! lol)

So... I'm trying to decide what is more time efficient/safe for pt: taking VS, introduction (write name on board) and then coming back and doing assessment, or just doing it all at once.

Right now I'm doing it all at once because it seems like a waste of time to go back again and then go back AGAIN for 9pm med pass. But the problem is I might not see some pt until after 8pm.

I have a "brain" I created myself I keep notes on for charting because I still forget things I have assessed if I don't write them down..plus it reminds me to check things (did that foley bag have a date? If the pt was wearing SCD compression devices were they actually ON? What kind of bed was the pt on? etc)

On this I keep a running to do list so that I can remember what to bring back to room (pt needs hat for toilet, or a new urinal, or some pillow cases, or a fall alert arm band, etc) so that I can grab everything at once while I'm up at the nurses station/supply room.

My preceptor teases me about my "fall precaution" rounds. I go through and put slippers on everyone and put fall bracelets on them. Everyone forgets to do that stuff and I'm so nervous about a pt falling! I'm like the bed alarm queen lol.

Anyway - I think I've got some pretty good stuff down..trying to simplify it though so I don't stay so consumed with taking TOO much time to organize lol..it's a fine balance!

Mainly curious about how to actually organize the time itself to fit it all in and see my patients in a timely manner. The only bad thing about doing it all as I go is if the pt asks for something say ice, and I still have 3 patients to see, well it might be 90 min before I am done with seeing all my other patients and gettng pain meds etc and I hate that it took so long to get something minor, but you have to prioritize the most important things.

Thankfully a lot of nights we have nurse interns you could ask to do small things like that (the CNAs seem so busy I hate to ask them to do a lot of little tasks) However it seems some nurses get a little ticked when I delegate because "you only are taking 4 patients and you need to learn to manage your time" but isn't delegating part of managing MY time? lol

I dunno..I'm sure I'll figure it all out eventually lol.

[agent66]

I only do nights and we are usually good for a few or more night admissions/transfers in cardiology so I always try to get done when the time is available. After getting report down I do a rapid round to say hi, check Iv's, chest tubes , pain control. Most still have visitors as well till 9 or so so start with either the ones with no visitors or the heaviest to get them settled. We still do written charting so I bring my nursing notes, med sheets all in with the med cart , talk and chart at the same time as well, saves doing it later. I tell all the new girls this as it saves a lot of time plus you never know when its going to break loose and you really need to have your charting up to date. We have 6-8 patients on nights, I usually give each patient 15-45 minutes each,initially, depending on their stability and teaching needs. Giving backrubs is also old school but it relaxes people for bed and makes them comfortable with you as well. Cuts down on the bell ringing too! Try to do your assessments, vs and pills all at once if able to. I give 8pm, 9pm and 10pms at same time, with the hour allowance for meds saves going back for 1 pill later. There are exceptions with the meds of course but generally i try to put them all together. Hope this helps, it takes a while to get yourself in a good routine and believe me there are still girls out there who can't get done before midnight no matter what their assignment. Organization and time management are big items to getting through nursing, hope you find something that works for you!:lol2:

[classicdame, MSN, EdD]

Unless someone is a new admit needing assessment I usually make rounds to check for bracelets, introduce myself, evaluate pain control and safety issues, check the IV site ---- then come back later for the full assessment. There is no rule, I assume, that you have to do the assessments all at once, so you might do some with the meds and others with a scheduled procedure, like dressing changes. Combining trips will save your energy and give you a little more time for charting.

[MrsMommaRN]

i am new too and in orientation. i am taking 5-6 patients. this is what has been working for me:

• introduce myself write name on board
  
• wash hands
  
• do vitals and assessment. check op site and neuro check
  
• check iv status
  
• assess need for pain meds
  
• before i leave the room ask if they need anything else and let them know i will be back shortly with their morning meds and something for pain if needed.
  
• grab the meds and back into the room with mar in hand pass meds and off to the next.

hope this gives you a little help. i work on a busy ortho floor that is all total joint replacements and some spine. i didn't mean to sound so simplistic with the routine but i thought it might help.

[Mommy TeleRN, RN]

mom2bears - you pass meds as you go too? wow. How long does it take you to get through all 6 patients?

[ptadvocate81]

I work in ICU, and only have 2 pts, but do assess and reassess more than it sounds like you do, so I hope that this somehow helps. We do face to face report as well. After getting report, I am off to the sickest pt first, where I introduce myself, verify name and allergy bands, and do an initial assessment. During the assessment, I jot down anything that stood out as abnormal or that would be important in my charting. Then it's off to the next pt where I do the same things. Once finished, I chart in and start my first med pass. Just remember, if you are too busy to sit and chart, keep a small notebook in your pocket and write down important things to remember about each pt. Pt care ALWAYS comes first- then charting. Just keep track of what you need to chart. Hope that this helps- you will get into your own routine in your own time. Hang in there and welcome to the best profession (most days) ever! Best wishes.... :welcome:

[queenjean]

I work nights. Our assessments are scheduled at 8pm, Meds at 2100, VS and I/Os at 2200.

I always work on a TPC, meaning I don't have an aide. I usually start out with three pts, and pick up one admit during the noc.

I get out of report at somewhere between 7:15-7:30. I do my assessments right then, have them completed by 2000. I chart them right away. That way within the first hour I've introduced myself, checked to see if they need anything, and if any pain needs to be controlled. If they have visitors, I'll just do a quick intro, check their fluids and pain, and then do the assessment the next round.

in the 2000 hour I try to get all my VS, meds passed, and I/Os. Even though it's a bit early for the VS, many of the meds require a BP or HR, so I might as well just do the whole shebang. Plus alot of times our pts are tired and ready for bed. I let them know that I round once an hour during the noc, and discuss the plan of care, and make sure everything is kosher with them.

If I can't get my VS, meds, and I/Os done in one hour, at about 15 til 9, I'll make a quick round on the pt's that I haven't seen in the 2000 hour yet, just making sure they are okay, and letting them know I'll be in shortly with meds. Usually, though, I can get the VS, meds, and I/Os done in the eight o'clock hour.

Then I round during the noc at least once an hour, reposition, give prns, change attends, take them to the commode, etc. At 0100 I'll do VS if they need it, as condition warrents. At 0400 I do VS, I/Os, and wts, and then I write my notes and tie up any loose ends between 0500 and 0700.

I try to get things done ahead of time, because you never know when you are going to get an admit, someone will code, or the computers will go down--or all three--and then you might be a couple hours past 0700 charting.

[MidnightTang]

I'm a new nurse as well. I have only one more precepted shift left. What I have always done, as an RN and as a CNA, is to start my day off with a "breathing check". I introduce myself, assess the need for PRNs and just make sure they're not in distress. This way, you know if something needs to be attended to immediately. I usually pass meds next and then do a full assessment a little later. I work on a neuro floor and there are a lot of meds that have to be given on a consistent time schedule, particularly seizure and Parkinson's meds, so I have to make my med pass on time. The full assessment can usually wait a bit.