A change that a nurse manager could implement that would help improve patient care is hourly rounding. In order to implement this change successfully, the nurse manager needs to clearly communicate the expectations, and then follow up with good monitoring. When the nurse manager sees the staff meeting the expectations the staff should be acknowledged rewarded/recognized and celebrated. On the other side, if the staff is not meeting the expectations they should be reminded, coached, and counseled. Sticking to the communicated expectations can have powerful results when the nurse manager diligently and consistently puts the plan into practice.
Justification to Improve Patient Care and Perspective Theories to Support the Change As a manager an area of change that could improve patient care is hourly rounding. Hourly rounding involves rounding on patients every one to two hours and practicing a series of 8 specific behaviors. There are seven recognized reasons patients use their call bells. These seven reasons include bathroom/bedpan assistance (15%), IV/Pump alarm (15%), pain medication (10%), needed a nurse or CNA (9%), position assistance (4%), accidental hits of the call light (13%), miscellaneous reasons (13%).
Studies show by using the hourly rounding on patients the percent can decrease by – bathroom 40%, pain 35%, positioning 29%, Iv/pump alarms 40%, and miscellaneous 39% (Studer Group, 2010). Hourly rounding is more than just “checking in” every hour. Once this practice becomes part of the nurse’s workflow, the organization will begin to see decreases in lost charges, incidental overtime, med errors, and an increase in nursing and patient satisfaction. Strategies and Internal and External Need for this Change:
The first step to implementing this change is to gather baseline data on falls, hospital acquired decubiti and call light statistics. Falls and decubiti information may be acquired from the quality department, for call lights stats have the unit clerk keep a log on all call light activity for two weeks. This process will allow you to demonstrate the positive outcomes from hourly rounding. Next, explain the rounding process to the nursing staff. Making sure to connect “why” this is being done and “why” it matters.
Ask nurses how often they are in a patient’s room and then reinforce the difference between “checking” on a patient and performing the eight behaviors associated with hourly rounding. Some nurses may state that they are in the patient’s rooms often. However, the nurse manager will still receive complaints from patients about not seeing their nurses. Nurses are in some patient’s rooms often, while not being in others rooms at all. Hourly rounding will help to ensure that every patient sees their nurse hourly.
Assess the Steps in Hourly Rounding As the hourly rounding is being implemented it is important to recognize and reward the nurses who are consistently performing the hourly rounding behaviors. The eight behaviors are (Studer Group, 2010): 1. Use opening key words to decrease anxiety 2. Perform scheduled tasks 3. Address the “3 p’s” – pain, potty and position 4. Assess additional comfort needs 5. Conduct environmental assessment 6. Ask “Is there anything else I can do for you? I have time. ” 7. Tell each patient when you will be back 8.
Document the process in a rounding log posted in the patients room These behaviors help to create a specific desired outcome. Thank your nurses for incorporating this best practice into their daily routines. Ask the nurses what the positives have been, and are there any barriers that the nurse manager needs to address. The Three Stages to Implementing Hourly Rounds There are three stages to implement changes. They are unfreezing, moving and refreezing (Grohar-Murray & Langan, 2011). Unfreezing is the breaking of the old practices and habits.
In order to be successful in this stage, the nurse needs time to process the information along with positive motivation as to why this change is needed. The next stage is moving. This step requires reeducation with exactly what is expected during this change, and the tools that will be needed. As the nurse manager, you will need to reinforce how this change will increase patient care and safety. The last stage is refreezing. This stage shows consistent evidence that the change is stable, integrated, and internalized by the staff. The nurse manager will need to continue to monitor the effectiveness of the change. This can be done by having the unit clerk continue to log the call bells, doing their own rounding on the patients, and evaluating the feedback from the nurses and patients Skills for the Change Agent The skills needed for a change agent are experience, success, respect, and leadership skills, and management competencies (Grohar-Murray & Langan, 2011). A change agent is anyone who has a positive attitude, communicates the goals of the organization and is willing to get involved to help facilitate these goals.
Strategies to Improve Responses to Change Strategies that could be used to improve responses to change could be to continue to educate the nurse on the importance of the change. Another strategy may be to educate the staff on how the change will help to improve patient care and will also give them more time. Make sure to have conversations about what the expectations will be in regards to the extra time the nurses will have. Also, allow them to suggest their ideas, and concerns about the extra time. It is important to identify to each individual nurse how they are doing in the change process.
The nurse manager should discuss the positive areas that they are achieving and where they could still improve. This communication will allow the nurse to know where he/she stands in their performance. It also gives the nurse manager a way to document each nurse’s response to the change and identifies which ones need further education and /or reinforcement of the change. Evaluation of the Change of Hourly Rounding Once hourly rounding has been implemented you will need to evaluate the success of the implementation. This can be done through clinical quality, patient satisfaction, and efficiency.
The nurse manager should think about where to display the number of days without a fall and without a hospital acquired decubiti, what questions on the patient satisfaction survey will be watched closely to evaluate the success, and when to re-measure the number of call lights to ensure the achievement of the decrease. Once this information has been identified and collected, the nurse manager can present it to the staff. This should be done so that the information resonates to the employee’s. An example could be to show a math equation of how many call lights the unit started with, minus the amount of call lights there are now.
Then make this information meaningful by showing how much time was saved and by saving time, how many nurses can now have a 30-minute lunch break! Conclusion Hourly rounds get results. When staff members start seeing the results, they will naturally strive to become even more efficient and effective. Once the staff sees how much happier and healthier their patients are because of hourly rounds, this will increase their enthusiasm. Hopefully, this will make the staff more willing to give other changes a chance, and their organization will keep getting better and better because of these changes.