Problems with q15 rounds

[AustinPower]

I am one of two RN's on a 20 bed psych unit at night. We either have one or two mental health associates who are supposed to do q15 minute rounds with an RN also rounding hourly on the patients. The problem is that our MHA's often don't round at all and the few that do round only do so hourly. The MHA's at our facility have no respect for the nursing staff and get angry and vengeful if we ask them to do their job. My immediate supervisor has been made aware but they too seem not to care. If I go to my director, I end up with angry MHAs and an angry supervisor. I don't want anything to happen to my patients nor do I want to get in trouble. All of the staff is aware that all of the halls are being videotaped 24/7 but even that is not motivating my MHA or my immediate supervisor

How do they do q15 minute rounds at your facility? Do MHAs do all or most? How do you handle MHAs who don't do their jobs? Should I leave this facility since they don't back nursing staff?

[VivaLasViejas, ASN, RN]

Hello, and welcome to Allnurses!

My only experience with psych units is from the patient's side, but where I was, the nurses made the Q 15 min rounds because they rarely had CNAs or techs. Fortunately the ratios were really low, 4-5 patients per nurse, and they took turns rounding so no one got stuck with all the checks.

It sounds like your unit needs some attitude adjustments, however. Just keep plugging away and do YOUR job, and keep your supervisors in the loop when your aides aren't doing theirs.

[A&Ox6, MSN, RN]

My unit has 15 beds and supposed to have two nurses and at least one PCP at all times. We have had more than one patient on 1:1 at a time and not gotten any PCP. The next morning, we were admonished because the supervisor had seen that we were not doing the q15s on the 15.

[nurse lala, BSN, RN]

I have never experienced this specific level of insubordination which sounds like mutiny to me. Our unit staff are diligent and do the best they can to comply with q15" rounds. If it isn't completed that is an exception because of patient care interfering with routine safety measures. But it wasn't always that way. Having worked a multidude of locked units and private to federal institutions. I have had to deal with complacency and multiple cultural biases. I have worked with some incredibly inappropriate people who had no skills sets to meet the role they played, other than being a warm body who showed up everyday. In some cases, the staff had quit growing in their careers long ago, and were just waiting for retirement. Others came to MH as the end of the road because they were ineffective elsewhere. I think this is the nature of the beast and as the RN, we are essential in bringing about change. I have seen it work and trust that you too can help nurture change in your workplace. Or you can run away. You may find an effective team elsewhere or not. What you need to know is you have the skill sets as a MH nurse to fix this.

So what can you do? You told the boss who is just glad the dummies showed up and perhaps hasn't had a suicide on his/her watch. Big dummy. So make a point to send an email referring to your discussion of concern and reporting no changes. Explain why it is a concern by referencing policy and mention the high risk clients currently in house. Request feedback on the next step and thank the supervisor for assistance. THIS WILL NEED TO BE REPEATED AS IT IS PROOF OF YOUR DILIGENCE SHOULD SOMETHING GO HORRIBLY WRONG.

As the charge RN on your shift, it falls upon you to address the safety concerns not being addressed adequately. So the rounds must be done. Then you need to address the staff assigned to the duty that you or the other RN are completing You develope relationships, establish expectations and tHen coax the staff into compliance. Let them know that you have concerns and talk to them about them. Share that as the individual responsible for the safety of the unit you will need to document that which is not being done. Meet regularly and document your education and expectations.

Perhaps the boss will get miffed because all the work isn't getting done. Request assistance problem solving.

It takes time. Sometimes staff come around. They will learn to respect and trust you. Your can do this.

[Isitpossible, LPN, LVN]

Gosh couldnt agree with lala more!! God firbid there is a murder, (yes it happened at my facikity), suicide, rape or any other event..Heads are going to roll including yours#! Please dont let this go.email top administrator s about your very valid concerns.. If there is no change you may need to seek a safer environment... Dont worry about negative MHTs either.. Everyone has to do their job to keep patients safe..

[nurse lala, BSN, RN]

Perhaps the boss will get miffed because all the work isn't getting done. Request assistance problem solving.

It takes time. Sometimes staff come around. They will learn to respect and trust you. Your can do this.

To expand a little: THE SUPERVISOR AND THE STAFF are complacent. By practicing due diligence, by meeting with the MHAs and recording your efforts (and their response) and by regular updates to your supervisor, you are without fault and are doing what is in your power to address. Either the MHAs will come around or your boss will. Things usually get worse before they get better. But these acts on your part can help bring about change. It isn't easy being right in a culture where safety is an option, not the rule. Good luck to you.

[AustinPower]

Thank you all for the advice. It is very helpful. I'm going to do my best to keep my patients safe :)

[Helluvanurse]

Yes leave. It's an abusive environment. Also the fact that people get vengeful tell me they aren't stable enough to act professional which means they aren't a good fit for this field. The focus should be on the safety of the patient via rounding on time not focusing on backbiting and being immature.

[Psychcns]

At least there are two RNs to set a professional tone.

[elkpark]

I've been in somewhat similar situations in the past, and have been successful in eventually shaming the techs into doing the 15" rounds by doing them myself. If I were you, I would try that -- bottom line is, the rounds have to be done and the RNs are ultimately accountable for that. Meanwhile, I would be looking for another job in case "plan A" (shaming the techs into doing their jobs) doesn't pan out. Eventually, something is going to go seriously pear-shaped there, and it is the RNs who will be blamed and take the fall, not the techs. If it were me, I would not want to be sticking around for that to happen.

[shamrokks, ADN, ASN, RN]

I'd leave. My techs always do their rounds as scheduled and it's never an issue. If I remind anyone they aren't vengeful and admin backs this up wholeheartedly. Patient and staff safety are a priority.

[marshmallowstar, BSN, RN]

We assign q15 rounds in 1 hour blocks at the beginning of the shift, nurses are in the rotation just the same as MHWs. On the RARE occasion that Q15s didn't get done (it's only happened once for me and it was when two behavioral codes were happening simultaneously) we have to do an incident report that gets sent directly to QI. Check your policy it may dictate what reporting needs to happen if standard procedure isn't followed. I would hope QI/Admin would want to know/fix things. Is there a staff meeting you could bring this up at? How do other nurses handle it? Ultimately patients' safety is at risk and this needs to be addressed.