As the surge of the novel coronavirus pandemic reaches a crisis level in many areas of the country, nurse leaders are barely able to address the day to day operations of their facilities and units, let alone think about if, and how, they can round on patients and families during this difficult time. But right now, the value of these rounds goes far beyond our patient satisfaction goals or standardization of processes.
The term “extended stay” refers to patients who are hospitalized for a longer than expected or desired. In the Emergency Department, an extended stay patient maybe an outpatient who stays longer than 23 hours or is “boarded” while awaiting an acute care bed. In acute care, an extended stay is one that exceeds the accepted length of stay (LOS) standardized by third-party payers and regulatory guidelines.
Decades ago, as a new graduate nurse working in a small critical access hospital, I had the opportunity to assist a general surgeon once a week when he and his anesthetist flew into our small town to perform any needed procedures. I was able to reinforce the perioperative nursing skills I had learned during my training and was intrigued by the functioning of the human anatomy and the expertise of the surgical team.
The need for efficient and accessible mental health services has never been higher. The isolation, fear, and economic impact of the COVID-19 pandemic has further exacerbated needs within an already overwhelmed and underfunded system. It is important that every facility be able to a) provide safe and efficient mental health care to promote the well-being of each patient, and b) to maximize their capacity to provide care to more individuals.
The admission of a loved one into a critical care area can put a family into “crisis” mode, especially when a hospital stay is unexpected. Until the status of the patient is known, the priorities for the patient and family revolve around two areas – information and support. Family members at the bedside are often tasked to keep the extended family and friends informed about the situation or to field multiple calls from those with well-meaning intentions. This is not a time to ask the family how your team is doing.
No one wants to hear a diagnosis of “cancer” but with medical research and new treatment breakthroughs, more and more survivors are winning the battle for long and healthy lives. But until the prognosis and outcome are known, patients and families have many questions and need strong support from the healthcare community. Patient “transitions” are a key component of cancer care as patients are referred from their primary care provider and navigate through a team of specialists who assure that body systems are protected while aggressive treatments are aimed at the disease.
Nurse leader rounding on patients has a strong influence on issue identification and engagement of inpatients prior to discharge. At Nobl, we recognize the unit type differences that exist within acute care facilities, big and small. At a recent onsite visit with a large client, the quarterly data review revealed a “healthy rivalry” between the AVPs of the Medical-Surgical and Critical Care areas for top compliance with rounding goals by nurse managers. For the first time this year, the critical care area leaders were outperforming the medical surgical leaders.
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.
In 2017, Lea Albright, Hospitalist Program Manager, needed to impact physician communication and discharge instruction HCAHPS scores. With limited practice by private physicians, the activities of the hospitalists were driving the data. A lack of provider specific patient comments from HCAHPS scores limited buy-in by physician leaders to enforce needed behavior changes to improve communication.