Walking Rounds

solneeshka, BSN, RN · Nov 2, 2009

It's a pain, I'm sorry. Managers like them because they read about it in a book somewhere or heard about it at a conference and they think it will give the patient a warm fuzzy, raise patient satisfaction. It doesn't. All it does is make report take twice as long, for every single reason you cite. Plus you have to learn to write while standing up and walking, and you have to learn to speak in code because patients very naturally are uncomfortable when they are spoken about in terminology that they don't understand (or would be insulted by if you were being as straight-up as you can be when report is done away from the patient). Like a thousand other things in nursing, the theory is fantastic and the practice is just one more thing that slows us down and makes the job harder. I wish I could have given you better news!

mesa1979, BSN, RN · Nov 2, 2009

We do walking rounds, and I really like it.....It gives me some since of what's going on in the rooms (as I peak in) and on the floor before I actually take over. It also allows me to see if all work have been completed, like CNA activities, before I take over....

What I do is get a blank nurses note, write each room number on it eg., 303a-303b, with the patients last name beside it and I write the info from report on each line; this helps me stay organized......

if the patient needs something an we are doing rounds, I either grab on of the aids if it's something they can do or I tell the patient to give me about 15 min, if they are not in any distress.....Hope this help, take care!

Oh get a 1.00 clip board from wal-Mart to put your notes on, very handy...

TheCommuter, BSN, RN · Nov 2, 2009

While I have done walking rounds in the past, I do not particularly enjoy conducting a change of shift report in this manner. I'd rather report on the patients in a private area, because some patients might have a negative reaction to the things we're saying about them.

Report tends to progress much more rapidly in a private area. When there are no walking rounds, no one is being stopped in the middle of report for non-emergent issues such as taking a patient to the toilet or answering a repetitive question such as, "When am I going home?"

mesa1979, BSN, RN · Nov 2, 2009

While I have done walking rounds in the past, I do not particularly enjoy conducting a change of shift report in this manner. I'd rather report on the patients in a private area, because some patients might have a negative reaction to the things we're saying about them.
Report tends to progress much more rapidly in a private area. When there are no walking rounds, no one is being stopped in the middle of report for non-emergent issues such as taking a patient to the toilet or answering a repetitive question such as, "When am I going home?"

I see your point, but patients should want to hear what the nurses are saying, gives them a chance to jump in and be apart of their own care. We just say things, such as pt A-B ok no problems reported, pt C started vanco on 11-1, pt d positive for c-diff....I don't know why the pt would be upset, I don't know some people (patients/family) are just anal sometimes....

rntg · Nov 2, 2009

I see your point, but patients should want to hear what the nurses are saying, gives them a chance to jump in and be apart of their own care. We just say things, such as pt A-B ok no problems reported, pt C started vanco on 11-1, pt d positive for c-diff....I don't know why the pt would be upset, I don't know some people (patients/family) are just anal sometimes....

If all you say in front of the patient is what you describe above, then where do you get the rest of the report. If you have never had "patient A & B" then you know nothing about them and "ok" just doesn't cut it.

locolorenzo22, BSN, RN · Nov 2, 2009

we are to start this soon as well...the opinions/tips are appreciated. we are going to have a form that gets transferred from nurse to nurse, with hx, drs, etc on it and the abnormals checked or written, updates will be done on a section as they occur...I could see it would become a problem with handwriting or space....any tips from those who do it?

mesa1979, BSN, RN · Nov 2, 2009

If all you say in front of the patient is what you describe above, then where do you get the rest of the report. If you have never had "patient A & B" then you know nothing about them and "ok" just doesn't cut it.

These were just a few examples....I don't have the time nor the energy to type all the things we could possibly say in report...... I should be sleep, I have to work tonight, but I'm wide awake! lol

mamamerlee, LPN · Nov 2, 2009

Many years ago we gave an oral report, AND did walking rounds in the ICU. The 'walking' part was to eyeball the pt and confirm IV drips and monitors, so thee was no confusion. It went pretty well; we weren't exchanging information in a public sphere that would be inappropriate for strangers to hear. I.e., 400 cc's left in the main IV, 800 of TPN. VS WNL for this pt.

Maggie09 · Nov 2, 2009

I'm a relatively new nurse, and my unit has been doing walking rounds for over a year. I much, much prefer walking rounds to taped report because I like being able to pause the conversation and ask questions instead of having to hunt down the nurse or give them a call if they've already left. Anyway, to answer your questions:

1. How do I go about it- I work day/eve rotation, but I always try to get to work around 30 minutes ahead of time. We utilize kardexes that have patient information (hx, dx, meds, nursing interventions, lab results, and nursing updates from every previous shift). So...I look through the 3-4 pt kardexes, highlight important information and meds due my shift. As soon as I'm done, I find the night shift nurses who had my pts overnight and proceed to get report. We go right outside the pt's room where there are shelves that we keep the medical charts. I get the majority report right outside the room where the pt's can't overhear every little thing. We look through the chart, I have a minute to ask questions, then we go in the room, and I introduce myself, and we discuss any last minute issues (that was one long run-on sentence but I'm tired, ha ha).

2. What if a pt needs something- Since we aren't directly in the room while giving the majority of report, this usually isn't an issue. Should the pt need something when we go in the room, we either call the PCA or tell them it will be addressed in about 15 minutes (as long as it isn't something urgent).

3. How do charge nurses handle it- The night shift and day shift nurses do verbal report at the nurse's station.

4. Do patient's like it- I think so...I think they like meeting the oncoming nurse and get a sense of "continuity."

5. If a nurse is running late- The night shift tapes if the person is going to be more than 15 minutes late.

6. More day shift than night shift nurses- Most of us on day shift get are "crud" together a little early and get a head start so that the night shift doesn't have to wait around. It usually isn't an issue.

solneeshka, BSN, RN · Nov 2, 2009

Many years ago we gave an oral report, AND did walking rounds in the ICU. The 'walking' part was to eyeball the pt and confirm IV drips and monitors, so thee was no confusion. It went pretty well; we weren't exchanging information in a public sphere that would be inappropriate for strangers to hear. I.e., 400 cc's left in the main IV, 800 of TPN. VS WNL for this pt.

This is how is actually turns out most of the time on our unit. We give regular report in private and then together go see the patient, peek in, make sure they're breathing! I think this is an appropriate compromise between the two styles, although it does of course add to report time, it doesn't add as much as full on walking report does and it doesn't get the pt all confused.

solneeshka, BSN, RN · Nov 2, 2009

I'm a relatively new nurse, and my unit has been doing walking rounds for over a year. I much, much prefer walking rounds to taped report because I like being able to pause the conversation and ask questions instead of having to hunt down the nurse or give them a call if they've already left. Anyway, to answer your questions:
1. How do I go about it- I work day/eve rotation, but I always try to get to work around 30 minutes ahead of time. We utilize kardexes that have patient information (hx, dx, meds, nursing interventions, lab results, and nursing updates from every previous shift). So...I look through the 3-4 pt kardexes, highlight important information and meds due my shift. As soon as I'm done, I find the night shift nurses who had my pts overnight and proceed to get report. We go right outside the pt's room where there are shelves that we keep the medical charts. I get the majority report right outside the room where the pt's can't overhear every little thing. We look through the chart, I have a minute to ask questions, then we go in the room, and I introduce myself, and we discuss any last minute issues (that was one long run-on sentence but I'm tired, ha ha).
2. What if a pt needs something- Since we aren't directly in the room while giving the majority of report, this usually isn't an issue. Should the pt need something when we go in the room, we either call the PCA or tell them it will be addressed in about 15 minutes (as long as it isn't something urgent).
3. How do charge nurses handle it- The night shift and day shift nurses do verbal report at the nurse's station.
4. Do patient's like it- I think so...I think they like meeting the oncoming nurse and get a sense of "continuity."
5. If a nurse is running late- The night shift tapes if the person is going to be more than 15 minutes late.
6. More day shift than night shift nurses- Most of us on day shift get are "crud" together a little early and get a head start so that the night shift doesn't have to wait around. It usually isn't an issue.

If the OP's manager calls this walking report, then I'm all for it! On our unit, we get our knuckles slapped if we don't do full report in the patient's room.