I Have The Time and Other Lies

[Preeps]

I will admit that have been remiss on keeping up on what nurses at AllNurses have to say on the hourly rounding mandate. But my hospital seems to be going over the top and literally forcing nurses to script their interaction with patients.

We have hourly rounding quarterly validations and over 75 percent of the RNS failed recently (though we have been doing it for 2 plus years).

The nurses failed to use the works: "hourly visit" but may have phrased it as hourly rounding

Also not stating: "What is the most important thing I can do for you today?"

But the icing on the cake is that they are requiring us to state, "I have the time."

The funniest part is that the patients are continually commenting on how ridiculously busy all the RNS are and the phone rings 5 times the minute we enter a room.

One patient's husband stated to me: "I have never witnessed one of you nurses walking casually or slowly, you are always hurriedly going somewhere with intention."

We obviously do not have the time! We have no time.

One patient recently refused to have a foley placed because the RN kept receiving phone calls. Mind you that she did not answer the phone but the patient became upset and said he thought he deserved at least 5 minutes of uninterrupted time with his caregiver.

Is this common in other facilities or is my place of employment just unique?

[Preeps]

Yes! Exactly! We have papers we have to sign hourly in each room also. I am a very honest person and I resent hugely that we are forced to lie!!

I use to fill them out honestly. . .but my nurse manager noticed that the 2pm hour was not signed on many days. . .that is the time I try to get my 15 minute lunch in. . . so I may not get into all of my rooms from 2-3pm. .this is not acceptable and my manager told me I had to sign that I was in each hour. So now I fill in all the hours. Now I ma usually in each room 3-4 times an hour or maybe a few rooms multiple times in an hour and another room in an hour and a half. Whatever is safe and reasonable and necessary. I have NOT changed my practice since this ridiculous hourly rounding has come about. I was always a present pro active RN and this has not changed me one bit. I will now play the game and say the script when I am being "tested." But then I go back to the way I have always practiced not like some scripted monkey.

[cardiacfreak, ADN]

We have "secret shoppers" and if you are caught not doing "effective" hourly rounding you can be terminated. Every hourly round we are expected to start by saying, "I am here to complete your hourly rounding. How is your pain being managed? Do you need to use the bathroom? Do you need repositioned? Is there anything else I can do for you, I have the time." We are also expected to "arrange" their possessions. After we complete the "effective" rounding we must mark it on a form in their room and note their pain level and if we repositioned. If they have gone to the BR we must mark the time on a white board. If we administer pain meds we must mark that on the white board as well as what time the next dose is available.

After we perform all of these duties we have to chart it all again in the chart, because we all know if it isn't charted it wasn't done.

[Graduatenurse14]

We have those sheets too. The RN and the CNA are to rotate. We mark: Where is the Patient? bed or chair. Are their TEDs/SCDs off or on? Is their call bell in reach? Is this Hourly Rounding? Then we initial it at the bottom.

I try, I swear I do but many times it is the last thing on my mind as I hustle out of their room to another patient's room!

[Preeps]

This sounds very (sadly) familiar. We too have to use the white board to put what time we gave the pain meds, and what time it is due next. We also have to write what is the most important thing we can do for them on the board (in addition to verbalizing it). We also have to sign and check each hour that we went into the room. And then like you said go out to the computer and chart it all again. We also have to address the 5 P's and also asked them if their room is up to their standards in cleanliness.

I must say that I have lost ALL respect for management, upper and lower, in the facility I work out. They are so out of touch and have no clue.

[danceyrun]

We have "secret shoppers" and if you are caught not doing "effective" hourly rounding you can be terminated. Every hourly round we are expected to start by saying, "I am here to complete your hourly rounding. How is your pain being managed? Do you need to use the bathroom? Do you need repositioned? Is there anything else I can do for you, I have the time." We are also expected to "arrange" their possessions. After we complete the "effective" rounding we must mark it on a form in their room and note their pain level and if we repositioned. If they have gone to the BR we must mark the time on a white board. If we administer pain meds we must mark that on the white board as well as what time the next dose is available.

After we perform all of these duties we have to chart it all again in the chart, because we all know if it isn't charted it wasn't done.

Arrange their possessions?? If I was a pt and my nurse was moving my belongings around I'd be perturbed!

[icuRNmaggie, BSN, RN]

We have all met the post op pt who sets his cell phone to wake him up when the next dose is due.

It is absurd and even dangerous to expect nurses to enable patients to abuse prescribed narcotic analgesics by writing it all out on a white board.

The reality is that these are the people who refuse their IS, refuse to get OOB because they are too narcotized to move and end up with an ileus and abuse the narcotics even more. These patients must be educated:

"Use the splint to cough and deep breathe. Use your IS every hour. Day 2 mobilize - up in the chair. ( I do write that on the white board).

We can not take all of the discomfort away. Yes it will hurt when you move and that is to be expected, it will hurt more if you don't and get an ileus."

[lindarn]

Everyone is missing the point. The hospital WANTS to have revolving door of nurses. If nurses stay too long at one place, the have figured out and filtered through all of the BS.

They can now take action, like unionizing, because they all know each other and can act in unison.

As long as they keep a mobile work force, no one stays long enough to be able to effect change in the work place. This has been going on since time immemorial in nursing, and, as I said, no one stays in one place long enough to be able to make any change.

JMHO and my NY $0.02

Lindarn, RN, BSN, CCRN, (ret)

Somewhere in the PACNW

[nurseprnRN, BSN, RN]

Forcing nurses to say "I have the time" when they clearly don't is demeaning, dishonest, and deceptive.

And is therefore in violation of the nurse practice act, which mandates that the nurse be honest in all communication. This isn't optional or nice-to-have. Have them put that in their pipes and smoke it.

[westieluv]

I was just thinking...if I was hospitalized and my nurse came in and quoted that script to me, ending in, "I have the time", I would either know immediately that it was scripted by some upper management stooge who had never provided bedside care in their life or I would think that the nurse was being sarcastic.

Guess I've been in this business too long, because my cynicism is showing.

[FLAlleycat]

I was recently hospitalized for four days. Although I felt fine (no pain), I just couldn't kick a 2-month cough that was keeping me up 24/7 and interfering with my life! I heard the script, "I have the time", from almost every RN. Of course a pt is going to figure out it's scripted. Most of the RNs first day/night came in every hour to check on me. I finally realized this, too, was scripted. I told them I was a NP, felt fine, know how busy floor nurses are, and did not need to be checked every hour. If I needed something (never did), I would call for it but please don't waste time doing hourly checks . . . just mark it off at the end of the shift. If some administrator visited me and asked, I'd cover. One RN still checked all night . . . it really interrupted what little sleep I actually could get. Administration is so out of the loop . . . they assume pts will like something and we don't!

[TNurse4u]

we also are subjected to the hourly rounding, initialing, and some scripted bologna- i will sign the slips but forget the scripted garbage - i will not do it!i ensure my patients needs are met!

[ScrappytheCoco]

I can't even speak of this in the ER. We have 10 ambulances lined up at the door, an active STEMI in the lobby and we're pushing tPA in CT, but "I have the time" for your 8th Sprite. NO!