Rounds

I am in a moderate sized (40 bed) Level IIIc NICU at a teaching hospital. All our rounding services expect RN input. We have had to beg, borrow, steal, plead and threaten to get them to this point. But now it's gone the other way with our neo service. If we are busy with our other patient(s), we are almost chastised for not being at the rounding baby's bedside.

Surgery rounds are at 0600 with the fellow, residents, interns and PA's. In our unit only the fellow is called for anything with any of our surgery kids. Residents and interns do not make any decisions for them. The fellow on that day leads rounds and at the end after the review of systems asks for RN input. And they listen! Wow! That was the hardest group to get on board with listening to us. It took the former program chair to retire until that happened.

Residents and interns are split into teams and babies are assigned to each team. Neonatology rounds are staggered based on what team was on call the night before (they get to round first) and done with the attending, fellows, NNP's, PA, resident and intern(s). The fellow leads rounds and the intern usually presents their own baby, then the attending asks questions of the intern, then the fellow and the team. They tend to be more fluid about asking for RN input during system review rather than waiting until at the end.

We also recently instituted a plan of the day sheet that gets filled out (or is supposed to) daily during rounds with what that day's plan is (vent wean, feeding increases, cultures, etc.). It is also a place where we can write questions or parents can ask questions to be addressed during rounds.

Hope that helps.

I work at a teaching hospital and our nursery is a level 3. It is preferred that the bedside nurse be in rounds, some attendings round by nurse, you get a call 5 minutes before it is your turn. We have NNPs and residents, they are who present during rounds. If there is an issue with a baby, or a parent has a question, I catch the resident/NNP when they are doing their morning assessment so they can address it on rounds.

I don't speak up in rounds unless the attending has a question for me or the resident is not presenting the scenario correctly. I'm not rude about it, I usually say something like, oh that was last night, since I have been here today I have noticed such and such. The attendings know when the resident is a little off base and they will usually look at the bedside nurse for validation. If the resident wants to do something stupid I also speak up.

Our unit is a level 4 (or whatever) 58 (but usually more like 70) bed teaching unit. Babies are divided into teams, one of residents and one of NNPs. The fellow leads rounds and the resident or NP presents. We're still working on having more nursing input. We are technically expected to be present if our baby is a fresh post-op cardiac. I try to be there in general, because I like to learn from the process. I will butt in if the resident/NNP says something incorrect, or I'll speak at the end if I have a question or concern. Some of the attendings are better than others about asking for input, and it also depends on whether they know and trust you. They ask much more of the 30-yr vets than of a new grad, obviously. One of the attendings told me he really likes nursing input when he's with the resident team because "I need grown-up help." Hee.

One of my best days ever happened during surgery rounds - I'm pretty friendly with one of the fellows, and she came to my bedside with her team of doclings, and she and I started discussing what happened with the baby overnight. The intern just started presenting while I was in the middle of a sentence. The fellow turns, dead cold, and says "Excuse me. I was talking to elizabells." I finish what I was saying, and she says to the intern "All right. Now you may speak." I heart her.

I work at a level 3 unit that usually has a census in the 40's, but has had a census in the low 20's for months (sigh...) Anyway -

Rounds happen first thing in the morning. Nurses are (almost always) present as we are somewhere in the room at all times. Usually we're trying to vital / feed a kid and the docs start asking all the questions with our stethoscopes in our ears! Attendings will usually mostly run rounds, with the 3rd years and fellows taking over as they feel more comfortable during their rotations.

The babies on the main service get split up in to groups and are "assigned" to a 1st year resident. That resident will present that particular baby during rounds is responsible for all the prerounding stuff and what not on their babies...

We also have a second "west-coast" service. Babies on this are some easy feeder growers who are close to going home, and our chronics. On this service, there is just one attending (no residents!). This way the chronics will get more specialized care. Our discharge coordinator will also round on these babies with the attending. She helps make sure all the discharge (or planning for discharge one day things for the chronics) things get done. It's nice to just have to deal with that one attending when you have some pressing needs for the attending.

We also have long-term care meetings once a month. It involves social work, our discharge coordinator (who is also a nurse), pt/ot, speech, the attending on for that month, and then the primary nurses for those particular chronics (if they can make it). During this meeting, we discuss the plan for each chronic that month, and what the short (and long) term goals should be. This way, when a different attending is on during the weekend, they can figure out easily what is going on and don't mess things up!

Overall, our docs really do a good job of actually listening to the nurses on my unit. We have a great relationship with all of the attendings. They trust us in our decision making, as well as our "nursing intuition". Like when we tell them that our primary "just isn't acting right" - they listen. It takes a while for a lot of the new residents / fellows to trust us, as we do things differently than the other NICUs they rotate through, but they eventually warm up to us!