Nurse Leader Rounding: How We Connect With Patients

1. Nurse Leader Rounding:How We Connect With Patients

2. Why An Early Tactic? • Allows for leaders to connect with patients • High impact on results • Verifies and reinforces the behaviors you want to see from staff • Uncovers process improvement opportunities • Provides information needed to deal with low performers

3. Who Is Involved? • Nurse Managers • Charge Nurses • Nursing Directors • Team Leaders • AVPs

4. Our Approach • Teach concepts in the classroom • Perform assessment of each leader in a simulation environment • Provide feedback and “check-off” each nurse leader who will be rounding • On-going validation

5. Numbers Impacted • June: Acute Care Units • 154 attended class • 109 went through the check-off process • 12 trainers “performed” • July: ICUs and Peri-Op • 90 attended class • 68 went through the check-off process • 15 trainers “performed”

6. Rounding Standards • Acute Care: 100% of patients everyday • Emergency Department: 10% of patients • ICUs: all admissions and 25% of families everyday • Rehabilitation: On admission, after team conference, and before discharge • Outpatient: 20% of those scheduled for the day • Peri-Op: Families during surgery. 30-40% of same-day patients discharged • L&D/MBU: 100% before transition of care (after delivery) and then again before discharge

7. Rounding Script • “Hello, my name is __________ and I am one of the Nurse Leaders on this unit. Our goal is to provide you with the very best patient care. Is this a good time for me to round on you – it will only take about 5 minutes” • General questions to validate expectations • Specific questions based on unit and patient population

8. Beyond the Script • Scan the room for safety concerns • Bed in low position • Rails up • Ensure patient’s “Whiteboard” is updated • Reflect on what was learned • Determine how to use the information gathered • Coaching • Reward and Recognition

9. Results: April-June

10. Top Box %Results:Jan-Mar vs April-June

11. What do You Enjoy the Most about Rounding? • Taking care of the problem before it escalates (service recovery)  • Gives me an opportunity to quickly recognize and reward those staff who are doing a great job • Helps to connect back to the purpose of why we went into healthcare-  • Knowing what is going on and having an opportunity to get the patient experience right • Allows me to make a personal connection. • Makes me more involved clinically than I have been before, answering their questions or doing that one thing that is a 'nice touch' • The connection with the patients/families. It gives me the time to assess how well we are doing and ensuring that we are meeting and exceeding their needs/expectations.

12. What do You Enjoy the Most about Rounding…cont? • Interacting with the patients and families…it allows me to quickly address issues in real time versus days or weeks later. • You learn the key players in families and what's most important to them about caring for their love one. • Patients and families are expecting you daily so now part of their anxiety has diminished.  The patient and family know any issues that arise will be handled immediately, and now they know we care.  • I enjoy engaging the family because sometimes when the patient is hesitant to answer a question truthfully the family will usually jump in and provide useful information. • Rounding has reconnected me as the manager back to the bedside in a more meaningful way, and I am able to direct care and to help others navigate the system better. 

13. What Have You Learnedby Rounding? • That it takes very little sometimes to really make someone's day….maybe it is getting the patients family member a cup of coffee…talking to a patient who has no family to visit. • It makes me remember what a true privilege it is to get to be able to provide patient care. • Identifying themes with ancillary services, identifying those that need to be recognized for exemplary work • Finding certain patterns that need addressed • What my staff is and isn't doing consistently. • You must adjust each day depending on family dynamics or depending on which family member is present.  • The family and patient usually have a story they want to tell…when someone else enters the room just to concentrate on them and take time with them, then the patient usually will provide meaningful information.

14. What Have You Learnedby Rounding…cont? • Families can help the healing process. Some family members want to support a love one and others don't. When no family is available that is when I see Nursing go beyond just providing care - they also care. • It is amazing all the little things you learn about your staff and what they do for the pt. that would otherwise never be noticed if I had not asked that particular question. • It is best to always talk to the nurse before entering the room for patient/family rounding.  This empowers you to have problems solved or to have a plan before you go into the room. • I also like rounding on patients who are assigned to the same nurse in a back to back manner.  This helps me to see inconsistencies in nursing performance (ex. consistently untidy rooms, or white boards that are not updated.)

15. What Has Worked Well? • Getting rounding done in the morning • I view rounding as the most important task that I have to get completed everyday and use what I learn as a “coaching moment” for staff • Combining Leader Rounds and Discharge Timeouts so the patient is seen at time of dc for final medication rec. and explanation of any dc instructions • I make this an initial task in the morning, this allows me the opportunity to interact with the patients without too many interruptions.

16. What Has Worked Well…cont? • Our open (ICU) visitation has allowed me better access to the families • I am able to provide staff with kudos while patient / family is on the unit • I handle issues immediately and make the rest of patient’s stay positive • Not setting a specific time for rounding. I may round early one day and late the next day. I don't get worked up about the time of day that I round.

17. What Makes This a Challenge? • Time: seems that everything is a priority   • Busy unit, lots of patient turnover • Completing 100% of the patients everyday….it requires persistence and focus. • Figuring out what time of the day is the best to do this….working it in around meetings • Determining how to be consistent in incorporating the employee rounds with the patient rounds • The biggest challenge is being full--34 patients, 10 discharges and 9 admissions is difficult to see.  So we are seeing as many as we can before discharge, the first day after admission and the ones we do not see in the hallways walking.  • In Rehab, we have to avoid the time when patients are in therapy. So, we tend to round later and the patients are very talkative at the end of their day.

18. Other feedback • Persistence- persistence- persistence  • Patients and families love the one-on-one attention. • I have always rounded on my patients, but I now have a more prescribed means of doing it.   It is more focused than random rounding. • I did not think I would enjoy it but I do. After I round I give feedback to the staff and the staff can respond immediately to any patient issues • I like complimenting the staff immediately after rounds. Now they always ask me "What did my patient have to say about me today?" • I really wish that we would consider adopting a "house wide" rounding schedule with no meetings scheduled during these times.  This would help us all to be focused and to really shift the culture. • If we discover problems/issues that have occurred in another area, I think that we should have an agreement that the responsible department should come and address the patient/family.

19. Next Steps • Continually refine skills • Monitor results • Modify questions as priorities change • Reinforce with Director and Senior Leader Rounding