How often have you found yourself in your patient’s room, garbed in full personal protective equipment only to realize that you forgot something? Or maybe something just doesn’t seem right with your patient but you can’t put your finger on it? We’ve all been there. Now you ponder these questions:
Do I take the time to de-garb and go get the supplies I need?
Do I check the hallway and hope that someone will be around to run for supplies or to offer a second opinion on my patient’s condition?
Do I interrupt another nurses’ workflow to come to my aid?
Do I call the charge nurse, who undoubtedly is helping someone else with an equally pressing matter?
What if there was another option? What if you knew someone was coming to check on you in a matter of minutes? Research indicates that proactive and purposeful rounding by the bedside nurse reduces significant safety events, patient call bell use, and interruptions to nursing workflow, while also improving patient satisfaction.1 So, why wouldn’t we employ that same logic for ourselves and our coworkers? Well, that is the idea of proactive charge nurse rounding.
Proactive Purposeful Rounding
Forde-Johnston2 stated that purposeful rounding involves proactively checking in with patients and families to ensure that all of their basic needs are being met. Current literature on proactive hourly rounding offers various suggestions as to what needs should be addressed hourly. The universal theme is that the hourly face-to-face experience fosters trust and establishes realistic expectations between the nurse and the patient.3 The proactive nature of these rounds allows the bedside nurse to anticipate and mitigate needs, instead of only reacting after problems have developed.4 Additionally, proactive charge nurse rounding allows charge nurses to establish standardized and realistic expectations, while improving teamwork and workflow with bedside nurses.5
The logistics of charge nurse rounding cannot be universally dictated, but rather a process must be developed on each patient care unit that meets the needs of nurses and the patient population. Complex patient care times vary from one patient care setting to another but are undoubtedly the times when bedside nurses may be in need of the support of charge nurses. In order to provide that support, when and where it is needed most, charge nurses must be attuned to what is happening on the unit. Cornell5 explained that situational awareness is a vital component of effective charge nurse leadership. Charge nurses support staff in patient care decisions, de-escalate interpersonal conflicts, manage decompensating patients, facilitate safe staffing, and complete leadership tasks6. Successfully completing these charge nurse responsibilities requires awareness of the most acute needs on the unit. That awareness comes from a presence on the unit facilitated by proactive rounding.
Patient Safety
Changes occur in the inpatient setting at a rapid pace, Experts agree that interdisciplinary communication is a tool that can prevent sentinel events and improve patient outcomes, yet communication needs improvement in many medical facilties6. Proactive charge nurse rounding opens the lines of communication with bedside nurses at regular intervals and allows the nursing staff to seek a second opinion on a patient’s condition, to ask for help with new and unfamiliar tasks, and to discuss best practice and institutional policy guidelines. When charge nurses conduct proactive rounding they not only lay eyes on each patient but also offer support to the nursing staff and maintain a consistent awareness of patient flow and acuity.
Interdisciplinary teamwork is a key component of the safe and effective care of patients1, which is the priority for both bedside nurses and charge nurses. Additionally, proactive charge nurse rounding leads to increased patient safety, improved interdisciplinary collaboration, practice accountability, and professional empowerment7. Charge nurses are able to facilitate contact with, and support bedside nurses by contacting, the higher levels of the interdisciplinary team when patient conditions deteriorate. Supporting bedside nurses in their professional growth, skills, and confidence promotes nurse satisfaction and retention but also reduces patient safety events.
SEE ALSO: Nurse Leadership and Staff Satisfaction
Nursing Satisfaction
Bedside nurse retention is reliant on many factors but none more important than job satisfaction. Facilitating nursing satisfaction at the frontlines is a role most often assigned to unit charge nurses8. Whether it’s fostering growth in novice nurses or offering a second opinion to seasoned nurses, proactive charge nurse rounding allows charge nurses to engage with each bedside nurse and provide timely and crucial support. Carlin and Duffy9 noted that novice nurses felt most supported by charge nurses who were visible, present, and readily accessible on the unit, stating that “it’s always good to have that kind of back up from the charge nurse and not feel alone”(p. 27). While the support and satisfaction of the bedside nurse is enhanced by charge nurse rounding4, the satisfaction and retention of qualified and skilled charge nurses is also improved.
Just as proactive hourly bedside rounding optimizes the workflow of bedside nurses and sets realistic expectations for the patient, proactive charge nurse rounding cultivates a greater sense of understanding between bedside nurses and charge nurses. Mitchell10 found that bedside nurses often do not fully understand the workflow and additional responsibilities held by the charge nurse and thus do not perceive their continual calls or minor requests to be as big a burden as they often are. Proactive charge nurse rounding allows charge nurses to create a timeline within their own workflow to support and oblige the needs of the nursing staff in an organized manner. For bedside nurses, there is an improved sense of teamwork knowing that charge nurses can be depended on and will be coming to come to their aid at a specific time.
Now, with the implementation of proactive charge nurse rounding, nurses who find themselves in a patient room in need of supplies, a second opinion, an escalation of care, interpersonal mediation or need a helping hand, there will be comfort in knowing that help is already on the way.
Kaela Appleman works at Penn State Hershey Children’s Hospital.
References
1. McLeod, J., & Tetzlaff, S. (2015). The value of purposeful rounding. Am Nurse Today. 2015; 6-7.
Retrieved from http://americannursetoday.com
2. Forde-Johnston C. Intentional rounding: A review of the literature. Nurs Stand. 2014; 28(32): 37-42. doi:10.7748/ns2014.04.28.32.37.e8564.
3. Lyons, S., Brunero, S., & Lamont, S. (2015). A return to nursing rounds – person centered or a task too far? Aust Nurs Midwifery J. 2015; 22(9): 30-33. Retrieved from http://www.anf.org.au/
4. Harrington A, Bradley S, Jeffers L, Linedal E, Kelman S, & Killington G. The implementation of intentional rounding using participatory action research. Int J Nurs Pract. 2013; 19(5): 523-529. doi:10.1111/ijn.12101.
5. Woolley J, Perkins R, Laird P, et al. Relationship-based care: Implementing a caring, healing environment. MEDSURG Nurs. 2012; 21(3): 179-184. Retrieved from http://www.ajj.com
6. Cornell P, Vardaman J, Townsend-Gervis M, Yates L. Improving situation awareness and patient outcomes through interdisciplinary rounding and structured communication. JONA. 2014; 44(3): 164-169. doi: 10.1097/NNA.0000000000000045.
7. Goldenhar L, Brady P, Sutcliffe K, Muething S. Huddling for high reliability and situation awareness. BMJ Qual Saf. 2013; 22: 899-906. doi: 10.1136/bmjqs-2012-001467.
8. Normand L, Black D, Baldwin K, Crenshaw J. Redefining “charge nurse” within the front line. Nurs Manage. 2014; 45(9): 48-53. doi: 10.1097/01.NUMA.0000453274.96005.35.
9. Carlin A, & Duffy, K. Newly qualified staff’s perceptions of senior charge nurse roles. Nurs Manage (Lond). 2013; 20(7): 24-30. doi:10.7748/nm2013.11.20.7.24.e1142.
10. Mitchell M, Lavenberg J, Trotta R, Umscheid C. Hourly rounding to improve nursing responsiveness: A systematic review. JONA. 2014; 44(9): 462. doi: 10.1097/NNA.0000000000000101
