Finding a Balance between Lowering Stress Levels of Staff and Increasing the Quality of Patient Care

Hourly rounding also known as intentional rounding or comfort rounding is an initiative that hospitals nationwide are beginning to implement. Hourly rounding should be purposeful. “Hourly rounding is a systematic proactive nurse-driven evidence based intervention to anticipate and address needs in hospitalized patients” (Deitrick, Baker, Paxton, Flores, & Swavely, 2012, p.13). “Purposeful nurse rounds encompass a practice where nurses attend to and document scheduled patient reviews at pre-determined and regular intervals (hourly or second hourly)” (Lyons, Biunero, & Lamont, 2015, p.31).

Hourly rounding is something that has been around for a while. One of the first things we learned in nursing school was that you should check on your patient every hour or every 2 hours (depending on nursing aid assistance). I started my research by looking at what hourly rounding entails. From there I found the majority of articles that think hourly rounding really does affect patient care and only a few opinion articles that think the opposite.

Hourly rounding can be defined as proactive nursing intervention, at regular intervals in order to ensure patients needs have been met. Nurses attending to patients’ comfort, safety and

Rounding allows nurses to gather information in a structured way. It’s proactive, not reactive like call light responses. It’s a great way to get a handle on patient problems before they occur. It’s all about providing the best patient-driven health care… The great thing about hourly rounding is that it doesn’t benefit only the patients. (¶ 4).

Within the recent years, hospitals and medical facilities have been experiencing nursing shortages that necessitate more nurses to be present to compensate for the care needed to be given. This requires nurses to be dealt with imperative extended work hours along with their normal shifts with no denial or excuse accepted. Working extra hours are accompanied with negative effects that have an impact on the nurse, coworkers, and patients. A major concern that occurs with overtime is that nurses become fatigued or burnout. Fatigue that is experienced is a result of sleep deprivation from working overtime that is associated with arduousness neurobehavioral functioning

Hourly rounding is a continuing challenge for hospitals across the United States. What’s effective about this method is that it has brought some positive changes to some Health care facilities. There are three factors that have been constantly tested to improve patient care. These factors are: 1) fall rates 2) call light usage and 3) overall patient satisfaction.

Patients in a hospital and/or healthcare facilities have to be cared for all day and all night, everyday of the week by nurses. The usual way to fulfill this need is to divide up the day into three 8-hour shifts. Different shifts have been put into place to help improve nurse satisfaction, decrease the nursing shortage and save the hospital money. The 24-hour day is made up of two 12-hour shifts; 12 hours in the day and 12 hours at night. There has been quite an ongoing debate over the years regarding this issue of nurses working over 8 hours in a single day. Many people, such as hospital nursing administrators, have reason to believe that working long hour shifts causes more errors in

Nurse staffing have an effect on a variety of areas within nursing. Quality of care is usually affected. Hospitals with low staffing tend to have higher incidence of poor patient outcomes. Martin, (2015) wrote an article on how insufficient nursing staff increases workload and job dissatisfaction, which in effect decreases total patient care over all. When nurse staffing is inadequate, the ability to practice ethically becomes questionable. Time worked, overtime, and total hours per week have significant effect on errors. When nurses works long hours, the more likely errors will be made. He also argued that inadequate staffing not only affects their patients but also their loved ones, future and current nursing staff, and the hospitals in which they are employed. An unrealistic workload may result in chronic fatigue, poor sleep patterns, and absenteeism thus affecting the patients they take care of.

Nurse rounding is important to hospital-based practice because it directly impacts patient satisfaction (Blakley, Kroth, & Gregson, 2011). It serves as a method to improve quality of care by allowing nurses to routinely visit their patients and provide for any needs while also anticipating any safety concerns. Patients’ overall perceptions of hospital experiences are heavily dependent on how successful nurses are in satisfying the basic needs (Blakley et al., 2011). Rounding permits nurse-patient interaction and communication periodically, allowing observation and exchange of relevant information and also implementation of proper interventions. Nurses must practice rounding competently

Prior to the hourly rounding implementation, all the clinical staff (staff involved in patient care) will attend an hour workshop, which will cover the advantages and significance of hourly rounding to patient safety, reduction of falls, increase patient satisfaction, improved health outcomes, and financial impact to the organization. A video on how to do the hourly rounding properly and what behavior to avoid will be shown. After the workshop, the staff will do return demonstration, playing the role of the staff, while being checked off to ensure that the expectations during hourly rounding are met. This includes how to properly introduce oneself to the patients, informing the patients that the staff will be rounding every hour till 2200 then every two hours till 0600, to address their pain, possession, position, and potty needs. By performing return demonstrations, the validators (nurse managers, educators) will be able to ascertain that the staff understood and will

Nurses are especially vulnerable to several related effects of stress, such as burnout, job dissatisfaction, increased interpersonal problems, increased health complaints, disturbances in sleep patterns, as well as clinical depression and anxiety (Villani, Grassi, Cognetta, Toniolo, Cipresso, & Riva, 2013). The potential for stress can be reduced by resolving difficulties in the workplace promptly, addressing staff shortages, turnover and absenteeism, and developing clear objectives and plans (McIntosh, & Sheppy, 2013). Learning to manage and reduce stress by developing insight and coping strategies will help to maintain and promote nursing integrity and consistent patient care (McIntosh, & Sheppy, 2013).

For some nurses, mandatory overtime can be an advantage due to financial instability but mostly mandatory overtime can cause fatigue, burnout, injuries, errors, inadequate sleep and deficits in performance. According to research working long hours which consists more than 40 hours a week or over 12 hours a day leads to an increased medication errors and patient mortality. The probability of making medication errors increases tremendously when nurses work longer than 12.5 hours a day. During surveys regarding reasons of overtime, 60 % of nurses stated that overtime was obligatory as part of their job, 29 % of nurses stated that they volunteered and 41% of nurses stated that they were “on call hours” (Bae, 2012)

The first topic focused on in an article by Stimpfel et al. (2012) looked at the effect of longer shifts on nurses. Compared to the past, nurses are working twelve-hour shifts, instead of eight-hour shifts. The reason for these changes in shift lengths is for it to allow for nurses to have more flexibility in their schedules and to give them more time at home. This study revealed that the hours actually worked by nurses are unpredictable. Due to the fluctuations of patient needs and unanticipated staffing on the unit, leads to nurses having to work over their scheduled time (Stimpfel et al. 2012). This study also pointed out that there are no national policies for nurses that dictate the maximum number of hours a nurse can work. Nurses often end up working several hours over their shift because they feel forced into working those hours and thereby leading to burnout.

Work related stress has an impact on the health and wellbeing of nurse’s. It is a response to work demands, and pressure that may not match the employee’s knowledge, skills or ability and challenge their ability to cope (World Health Organisation (WHO), 2017). Stress within the workforce is regarded

It is a common scenario to hear nurses complain that they are burdened with the heavy patient workload and they are at risk for lowering the professional quality of life. This might be due to various factors like under-staffing, increase in the demand for nurses as the population ages, inadequate supply of available nurses, intentional lowering of staff on roll to reduce costs, and more needs due to shorter hospital stays. Nurse patient ratio should be kept at a manageable level in the best act to practice safe. Professional fatigue for the nurses and the resulting errors can only be reduced by keeping the nurse patient ratio in the recommended range.