Considerations for Rehabilitation Leader Rounding
In 2008, I was approached by a free-standing acute care rehabilitation hospital to assist them along their initial journey to nursing excellence. In 2013, I celebrated with them as they received their ANCC Magnet Recognition Program™ designation. As I reflect on the five years that I worked with them, I don’t know if I taught them or they taught me. I was humbled at my lack of knowledge about rehabilitation care and the vital role of nursing in this interprofessional collaborative practice. I realized that rehabilitation nurses restore lives that are broken or challenged for a variety of reasons, such as traumatic accidents, strokes, congenital anomalies, invasive cancers, extended hospital stays, and so many other reasons. Rehabilitation nurses care for patients of all ages, diagnoses, and levels of functioning. Many patients are unable to verbalize their needs or control their bodies. Patient length of stay can be several days or several months, and care can be acute or subacute. I know that my elderly mother would never have been able to go back home without the three weeks of subacute rehabilitation that she received after urinary sepsis resulted in a severe fall and a broken shoulder that landed her in intensive care and hospitalization for two weeks. Planning around the regulatory requirement for a minimum of three hours of daily therapy not only creates challenges for direct care nurses, but also for nursing leaders who are attempting to conduct rounds on these patients and their families. As with the other specialties, pre-planning for leader rounds in “rehab” can assist in making leader rounds valuable for the leaders, staff team, and the patients they serve.
Why are you rounding?
Of course, leader rounding in rehab contributes to safety and positive patient experiences. That is almost a “given.” Leaders collect praises of staff performance and a variety of patient concerns, just like in other areas. But the benefit of leader “observations” in this area is sometimes overlooked as a reason to round. Because so many patients in rehab cannot speak for themselves or advocate for the care they need, leaders should be very aware of their role in protecting these vulnerable patients. Environmental safety rounds are only one type of audit that can prove beneficial. Planned, periodic audits of care expectations, such as bedside shift report, patient turning schedules and skin care, bowel training processes and many more, support leaders to make informed decisions about equipment purchases, staff professional development, infection prevention strategies, or staffing levels. Any time a leader is on the unit, interacting with the team, or assisting in care, a “round” can occur to record what they see – good or bad. At Nobl we have labeled these as “praises” and “concerns.” Our Leader platform “quick add” function supports leaders to report and monitor any feedback within or outside a formal round. It offers a quick way to capture those “hallway suggestions” or situations that arise during a patient crisis.
Who should round and what time is appropriate to round in rehab?
The primary barrier for leader rounding in rehab is finding time to visit patients and families between therapy sessions. Every patient has an individual schedule, unique daily hygiene or ADL needs, and different cognitive and verbal capabilities. The most successful rehab leader rounds are accomplished by a “leadership team”, so that a variety of team members can catch patients between other scheduled care, or when visitors are on the unit. Having a family member in any level of rehab can be extremely stressful for family and care partners. They worry about being able to safely care for their loved one when they are discharged home. Leader rounds can identify patient preferences, family worries, and support needs. Nobl Leader provides a record of every previous round for each patient including question responses and other comments or concerns brought forward. The system alerts a rounder if a patient has had a negative response or significant concern or problem at a previous round. This supports all leaders to be prepared to further enhance service recovery and rebuild the trust of the patient or family. Real-time reports of recent department concerns can alert leaders to trends before they become significant safety or patient experience issues.
What are realistic goals for nursing leaders in rehab?
Goal setting depends on the type of round (dialogue versus observation), the appropriate frequency for length of stay, and the outcome measure that rounds are intended to improve. Safety rounds are more rigidly set, and goal expectations are high, maybe even 100% daily compliance. Patient experience rounds for this area are more variable, based on patient ability to respond or availability of family to visit. For patients, for whom a lengthy stay is anticipated, rounds might be conducted at admission, day 3, day 7 and weekly or biweekly thereafter. Goals for these rounds might start at 50-60% for a single rounder or 70-80% for a team. Discussing the advantages and disadvantages of the “what, who and why” of rounds often leads the team to decisions about realistic goals and accountability to those goals.
Nobl is proud to work with award-winning rehabilitation nurses and leaders as our clients. Here is list of some of the unique question sets that have been developed for them with Nobl Leader.
Written by Teresa Anderson, EdD,MSN, NE-BC, Nobl CNO