Hourly Rounding

These changes are then reinforced to employees by the Charge Nurses in Morning Huddles and in special called Safety Huddles throughout the week. While management is very open to change, implementation of the changes must be carried out by the actual hands-on personnel, and this often times leads to fear of the unknown. As Yoder-Wise (2015) states, “All changes, whether perceived as positive or negative, large-scale or simply, are scary and generate fear” (p. 307). In the short time I have worked in the ED, I have seen both support and resistance among co-workers regarding change processes. While some embrace change, others resist, and are set in their ways viewing change as inconvenient and an addition of time-consuming steps to an already stressful environment. Most whom I work with, when presented with the facts and evidence behind the change, view it positively and have no problem implementing it.

“ The ADKAR model of change includes Awareness of the need for change, the Desire to support the change campaign, Knowledge of how to make this successful, the Ability to implement new strategies, Reinforcement of change implementation, and periodic re-evaluation (Hait,2006). These four elements promote evidenced- based practice change and the commitment from nurses to participate in professional activities.”(Robert & Pape, 2011, p. 43) A APRN’s we will have to be agents of change to provide the best care for our patients. When we identify a issue or concern we must have the ability to address it

Implementing a change in practice within these environments can produce anxiety or fear of failure in nurses, leading to a resistance to change. Several studies (Bozak, 2003; Lehman, 2008; Spetz, Burgess & Phibbs, 2012) expounded the need for a concise plan and clear communication between nurses and management when implementing a change of this nature. The use of Lewin’s Change Management theory can support nurses through the transitions and identify areas of strengths and resistances prior to implementing change. Without a framework for guidance, it can be difficult to keep on track.

Change is a hard concept for most, but change in the hospital setting can be beneficial for both staff and patients. According to Mclean (2011), “Every change begins with an ending” (p.79). How people respond to change can make the process easy or hard depending on how the change is presented.

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).

A positive force for change centers on the nurse’s strong desire to change current practices. The combination of the turnover rate, low morale, and higher percentage of new nurses, is the driving

The purpose of this paper is to describe quality improvement strategies as they relate to the nurse scheduling process. A process flow map of the six-week schedule process will be reviewed. Strategies surrounding the gap in scheduling will be the focus, as ultimately having sufficient staff affects patient quality of care.

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.

The staff as well as students coming onto the unit for a rotation will need to be educated on this new policy of interdisciplinary team rounding. It is extremely important for the physicians and nurses to be fully educated on this change as well as the other staff members so they all can work together to decrease the amount of disturbances in the morning for the patients. In order to provide this education, the nurse manager will hold a meeting regarding the change and why it is going to happen for all staff members. The nurse manager will send out an email with different time slots that the meeting will take place to make sure every member goes to at least one meeting. For the students that will be doing a rotation on the unit, the nurse manager will provide a PowerPoint that will need to be read and a short quiz to follow in order for the students to follow the policy as well. Once every staff member completes the education, then the change can begin to be implemented on the unit. After the change was implemented I would evaluate the success of the change six months after the implementation and then again at one year. Being the unit manager, I would use two tools to evaluate the success of the change. First, I would observe morning rounds and speak to the patients during the manager rounds regarding the healthcare team’s rounding. I would also look over the discharge surveys or the past six months to see if

It is very true that lack of communication and not being honest with your staff can lead to frustration. It will be more appreciative if the manager will come and recognize that some of the new things are new for him/her to instead of just making it mandatory without any preparation. We understand that many times policies and procedures are coming from higher levels, but discussing with the ones which will be affected will have a better outcome in terms of accepting new changes. "The person who has to deliver the often unpleasant news determines whether to call the unit and leave a brief note on the assignment sheet or go to the nurse to talk directly about the change".

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).

While the concept of hourly rounding in not new, hospitals are trying to find new ways of reintroducing the concept of it. Hourly rounding is a great policy priority; however, as you have mentioned, staff resistance and noncompliance could be major obstacles with the implementation of this policy. According to Hutchings (2012), “hourly rounding or intentional rounding had negative connotations; for many staff it was prescriptive and insinuated that care was inadequate” (p. 12). After visiting many hospitals and looking at the different models of rounding that they have, Hutchings stated that she was able to develop and implement her “Caring around the Clock” policy at the Nottingham University Hospitals Trust. The author stated that it was

Staffing needs affect the nursing department’s budget, staff productivity, the quality of care provided to patients and even the retention of nurses (Jooste, 2013). The nurse manager has to explain to the management of the benefits of change in providing adequate staffing all the time. Adequate staffing helps staff retention. Staff retention saves a lot of money in terms of orienting new people to the unit. Safe staffing always helps in the reduction of falls, infection rates, pressure ulcers, decrease hospital stays and death. Flexible and creative scheduling is essential for retaining staff and promoting a positive work climate (Grohar-Murray & Langan, 2011). Adequate staffing with good staffing ratio will help nurses to concentrate on their patient care which may help in a reduction in medical errors and lawsuits to the hospital.

Hourly rounding contributes in several key areas to achievement of high levels of patient satisfaction, including quality of care and patient safety. This puts patients at the center of care by building on the fundamental aspects of care, which are so important. Thus by checking in on patients in wards regularly to see whether they are comfortable and have everything they need can produce a number of positive results. Nurses

The nursing staff will have the most important role in this process change. The nurses are the ones who see the patients first. The nurses will need to be onboard and understand that this process change will help us give our patients the knowledge they need as well as increasing their satisfaction. Each nurse will be responsible for maintaining the educational materials while making sure the information is accessible to our patients. An important part of this process change is to make sure the staff is onboard and the patients are receiving the information. The nurses will be able to influence and hold each other accountable for this process change. The nursing staff has the best interest of the patients and want to provide the best care they can. The nurses have the power to either bring this project along or they can hinder this