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Considerations for Pediatric Leader Rounding

Leader rounding allows staff to proactively connect with patients and families. It fosters unit communication and reinforces a commitment to family-centered care and excellence in patient experience. Along with identifying opportunities for improvement, leader rounding also provides a way to recognize individual staff members who receive positive patient feedback.

At Nobl, we recognize that pediatric environments pose a unique challenge to the traditional leadership rounding model. In pediatric settings, leaders must assess when it’s appropriate to round, who to round on, and how to tailor the conversation to the patient and family needs. Rounding technology should empower leaders to make these decisions during leader rounds.

Consider the following questions as you build your leader rounding program for pediatrics:

What time is appropriate to round on each unit? 

Many facilities are designating a “sacred hour” as a time for leaders to round on patients (and employees) prohibiting meetings or other activities that pull leaders off their units. Finding a single time that aligns with the workflow on each individual unit is nearly impossible. Sometimes the needs of acute care adult units take priority over the needs in the Women’s and Children’s tower or units. Nearly every leader can tell you their most “productive” time of day. If the sacred hour falls during that time, attention to other responsibilities may suffer. If planned rounding intervals overlap with peak times for medications or physician visits, leader rounds may represent distractions or interruptions that impact patient safety and satisfaction. It also doesn’t make sense to round in some pediatric areas when parents or family are not present. Find a time that works for your patients and schedule and put it on your calendar.

What are the expectations for rounding when parents or family members are not present? 

Most pediatric areas are positioned for parents to stay 24/7 with their child, if desired. But even if they want to stay, some parents have obligations at work or other small children at home who need their time and attention. If parents are not present, it may not be appropriate for leaders to attempt a round on children or adolescents, or different question sets may be needed. Leader questions can be leveled for children or written to focus on family rounds instead. 

Leaders may need to use the leader round to assess the environment for safety risks or to audit staff compliance with standardized processes or expectations. Environmental assessments may vary depending on the level of care, i.e. critical care versus general pediatrics, or the unique risks or processes being used. 

Are there considerations for leader rounding when staff members are working arm-in-arm with parents? 

No one cares more about the safety and care of sick children than their parents. Using leader rounds to capture the observations or impressions of parents who see staff members in action is an often-overlooked opportunity. Adding customized questions to leader rounds that invite candid feedback from parents can uncover care trends or concerns that would otherwise go unnoted. This is especially important when children are admitted for long periods of time. 

Rounding in the absence of parents is also an opportunity to validate key nursing practices such as bedside shift report, white board documentation, central line care, skin assessment and infection prevention. 

How do we tailor the frequency and content of questions for leader rounding for long-term patients?

Not all “long-term patients” are created equal and that is especially true in pediatrics. Critically ill neonates and infants have very different safety needs from older children and adolescents. The comfort and satisfaction of their parents is the primary goal. Mapping the care and concerns for critically ill children and their parents over time can guide the development of a leader rounding program that anticipates their needs at each phase of care. Content, frequency, and response types may all need to be periodically revised. 

Leader rounding in pediatrics presents an opportunity to build a better experience by respecting the needs of the whole family, demonstrating empathy and caring, maintaining trust and opening lines of communication. Using these and other techniques make it possible to build a sustainable and impactful nurse leader rounding program in pediatric settings. 

At Nobl, we partner with our hospitals to understand the unique needs of their patient populations to customize solutions for each unit. Our approach, along with insightful analytics and support for process improvement, empower Nobl users to accelerate goal achievement in patient experience, staff engagement, and consistency of care. 

Blog written by Dr.Teresa Anderson, Chief Nursing Officer and Katie Haifley, Co-founder of Nobl