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The Value of Nurse Leader Rounds During Crisis

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.

Every human connection to vulnerable patients and their families is more than just a check in, it’s a lifeline. 

Just this morning I was reading an article about senior citizens in long term care facilities that have died, not from Covid-19, but from neglect by care providers who are overwhelmed trying to care for Covid-19 positive patients with skeleton staffing crews. These are patients who died of dehydration or missed signs of other critical illnesses. Just two weeks ago, an out-of-town friend drove her 89-year-old father six hours to reach our academic medical center after he suffered a mild stroke and tested positive for Covid-19.  The rural critical access hospital was either overwhelmed by patients, or so afraid of the disease that they sent him home with a swallowing disorder, left-sided weakness, agitation, and the inability to speak clearly. 

He was one of the lucky (or tough) ones, staying just six days, receiving the post-stroke follow-up assessments and care that he needed. My friend was in self-quarantine when she arrived, and no hotel would allow her to stay. Because we recently purchased a retirement home, being remodeled but livable, my husband and I were able to host my friend there for the week. She’s not in the healthcare field, couldn’t fully comprehend the pace of a COVID-19 unit and felt helpless and afraid. On the second day, she too became mildly symptomatic and all I could do was check in with her and try to answer her questions. On the third day, after she wept with fear and frustration, the facility arranged for a daily phone call from the provider team to report progress and answer her questions.  

Let’s consider how a daily call from a nursing leader might have positively impacted her experience. She said that being powerless to reach anyone just escalated her fears, and just knowing that a phone call would eventually come each day alleviated some of her stress. 

It wasn’t about the fear of what the news would be, but just no news that was devastating. If someone from the nursing staff had reached out to listen to her, to learn about her father and his preferences and needs (remember he couldn’t clearly speak when admitted) she would have had greater confidence in the team from the beginning.  

This example illustrates why nurse leader rounds on patients and families are still important, if not more important, during these difficult times. Having been a director and manager, I know that there are those days when safety first is all you can accomplish. We also know that at Nobl.  From the beginning of the pandemic we have shared with our clients a wide array of options to support them to continue to round during the covid-19 pandemic. 

Here are some of those ideas that continue to be best practices for rounding during the pandemic. 

  • Developing custom rounding question sets for the non-Covid-19 patients and families to address concerns and fears, with their unique situation of being in the hospital, about contracting the disease from staff.  

  • Granting permission for other nursing formal and informal leaders to virtually round on patients and families, when directors and managers are consumed just ‘keeping the wheels on the bus.’ Teaching those new rounders how to put more emphasis on listening and recording, than asking standard questions and filling squares. Helping them to see that promising a touchpoint and meeting that goal, can be all it takes to help everyone through this with less stress. When families know that someone will call them at an appointed time, they spend less time interrupting nursing care or switchboards with frequent calls trying to find someone who will talk to them. 

  • Helping facilities to develop standard processes to communicate key information gained during rounds that might impact the physical, emotional and financial future of the patient, so these virtual rounders know what to do with the information they collect. In the Nobl Rounding Platform the results of the round, including comments, concerns and praises are immediately available so staff with boots on the ground can have reports pushed out to them or easily review those rounds to provide better hands-on care.  

  • Setting up processes so staff can use their personal devices to safely round on patients from home or outside the unit.  

  • Completing audits of room sanitation protocol compliance, observations of staff donning and doffing PPE, or even real time reporting of PPE par levels. 

I have always believed that frontline nursing leaders face a constant challenge to balance availability with accountability. Finding ways to be accountable for all the responsibilities of a leader to keep patients and staff safe while also finding time to be available to support the team and the families they serve is never easy, but nearly impossible right now. Patients and families don’t care as much ‘who’ is checking on them, but more importantly that ‘someone’ is doing it regularly. Your nurse leader round just might be a lifeline for a patient in need.

 

Written by Nobl Chief Nursing Officer Dr.Teresa Anderson, MSN, NE-BC

 


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