Practical Nursing Guide to Patient Rounds

Rounds are the cornerstone of hospital communication. They enhance both care and safety by giving members of the health care team the chance to meet and collaborate on patient needs.

When everyone is on the same page, outcomes improve. However, because no one spends more one-on-one time with patients than nurses, their input is among the most essential.

What Are Patient Rounds?

The purpose of rounds is to assess patients’ progress. Members of the multidisciplinary health care team—from doctors and nurses to therapists and nutritionists—get together to discuss changes in condition and review plans of care.

In a hospital, patients are acutely ill and need a higher level of medical supervision, so rounds are done daily. The process is quick and to the point.

Most days, rounds include only the staff members working most closely with the patient, typically doctors and nurses, while the entire team, including patients and their families, meet regularly to fill in the gaps.

How Do Patient Rounds Work?

The logistics of doing rounds can be tricky. The days when only a few physicians served wards full of patients have passed. Movies depicting doctors and nurses moving from room to room reviewing patient cases are largely inaccurate except in teaching hospitals.

Today, hundreds of physicians share privileges at multiple hospitals, something that enhances patient choice but makes scheduling rounds a challenge.

In most facilities, daily rounds are informal. Nurses touch base with doctors when they visit to chat about how patients are doing. They review diagnostic test results, discuss responses to treatment, and make changes in the plan of care based on progress.

In the interest of time and to ensure essential details aren’t missed, some hospitals have developed scripts or checklists.

Rounds may occur at the bedside to encourage patient involvement, but in today’s fast-paced hospitals, it’s increasingly rare for the patient and providers to be available at the same time.

Instead, rounds are often held at the nurses’ station or in a conference room both for convenience and to ensure confidentiality. Technology now allows providers to participate in rounds remotely.

The Role of Nurses in Rounds

Once, only registered nurses rounded with physicians. But the Institute of Medicine, a U.S. based non-profit, nongovernmental organization that provides evidence based recommendations for public health policy, has since recommended that nurses at all levels, including LPNs, be involved.

As front-line caregivers, LPNs are often the most familiar with how patients are responding to care. During rounds, they offer a summary of patient progress and describe changes in condition that may need to be addressed.

Doctors can then, in turn, respond to issues with new orders or requests for information. When rounds are complete, nurses follow up by

  • Gathering needed information
  • Transcribing new orders into the medical record
  • Amending the nursing plan of care
  • Informing other team members about changes
  • Educating patients and their families about new orders
  • Determining the best approaches to implement an evolving plan of care

The Benefits of Rounds

Studies credit rounds for a wide range of improvements in patient care, including preventing errors, reducing costs, decreasing readmission, and supporting team based health care.

Preventing Errors

Physicians can access patient charts remotely, but because they contain only limited, objective data, they don’t tell a complete story. So much of the patient experience is subjective, and it evolves quickly.

Without the input of the nurses who provide 24/7 care, nuances are easy to miss. Rounds give doctors the most comprehensive, up-to-date information with which to interpret findings and make clinical decisions.

Face-to-face communication is also proven to be more accurate than written words. Communication failures are cited as a contributing factor in nearly a quarter of serious medical errors, so any process that improves accuracy and allows participants to clarify points before making life or death decisions is worth pursuing.

Reducing Costs

Rounds ensure efforts among all members of the health care team are coordinated. Information is disseminated in real-time, minimizing redundant services and delays that extend hospital stays unnecessarily.

Redundant medical services, such as diagnostic tests, are estimated to cost up to $500 billion annually. Studies identify the chief causes as lack of communication and poor planning between providers. Rounds reduce unnecessary expenditures by helping primary care physicians, specialists, and consultants avoid writing duplicate orders.

Decreasing Readmissions

Rehospitalizations occur for many reasons, but the failure to address each of the many issues that impact health is cited as a top contributor.

Modern health care is complex, with multiple professionals collaborating on care. Team members strive to work together, but without opportunities to share thoughts face-to-face, information is easily lost. Patients benefit when team members communicate with each other and work toward the same goals.

Supporting Team Based Health Care

Participating in rounds benefits members of the health care team on more than a professional level. It encourages collaboration and makes the most of what each discipline has to offer. Care is optimized, and the patient benefits, but no one member must shoulder the burden.

For nurses, rounds are an opportunity to tap into what physicians and therapists are thinking. Understanding the general direction in which care is moving helps nurses keep patients and their families well informed while ensuring providers are aware of patients’ changing needs.

Skills for Success During Rounds

Nurses participating in patient rounds benefit from a set of skills that help them contribute successfully. These skills include good communication, organizational skills, confidence, and compassion.

Communication Skills

Rounds take an average of five minutes per patient. For a busy day nurse with an average caseload, that’s up to an hour per shift. In that time, everyone participating has a chance to contribute, but each team member’s time is limited. Getting the most important points across requires being concise and accurate.

Listening skills are also a must. Nurses are asked not only to implement orders from a range of providers, but also explain them to patients and their families. Details count.

Organizational Skills

Because rounds can consume such a large part of a nurse’s day, preparation is critical. Nurse-to-nurse reports at the start of a shift highlight changes in patients’ conditions, but there’s no substitute for assessment.

Nurses should plan to see each patient, at least briefly, and collect pertinent data before the rest of the team arrives. Organizing tasks in a way that gleans the most information before rounds begin helps the process stay on track and be more productive.

Confidence

With a broad base of knowledge, nurses are ideally positioned to serve as liaisons between patients and other members of the health care team, but they do more than follow orders.

Nurses are independent professionals whose primary role is to serve as patient advocates. They should not only share data during rounds, but they should also ask questions and make recommendations within their scope of practice.

Surveys in major hospitals reveal that entry-level nurses, including LPNs, feel uncomfortable speaking during rounds because they believe they have nothing to offer or that their suggestions will not be valued.

But the culture of health care is changing, and physicians are increasingly accepting the expertise of other disciplines. Studies show that up to 25 percent of nursing recommendations are accepted. When nurses speak confidently on behalf of their patients and the nursing department, care improves exponentially.

Compassion

Rounds are a clinical process. Information is distilled into a snapshot of data that’s medically meaningful, but devoid of emotion. For clinicians, it’s how they stay in the know while saving time, but for patients, it can feel detached.

On post-hospitalization surveys, lack of compassion and feeling like no one is listening are consistently among patients’ top complaints. Health care is an intensely personal experience, and it’s up to nurses, as advocates, to act as patient representatives during rounds.

Final Thoughts

As medicine becomes more technically complicated, nurses are taking a leading role in patient care by actively participating in rounds. In an industry that depends so heavily on the accuracy and timeliness of information, the time it takes is less of an expense than an investment in team building and quality health care.

Did learning about performing patient rounds by a licensed practical nurse (LPN) interest you? Ready for an exciting new career in the health care field?

The Practical Nursing certificate program provides the graduate with the knowledge, skills, and attitudes needed to function as a licensed practical nurse, or LPN.

Part of the Practical Nursing training curriculum is devoted to theory and the rest to hands-on laboratory skills practice and off-site clinical externship rotations. These rotations include work at long-term care and rehabilitation facilities, hospitals, and childbearing and pediatric outpatient settings.

Upon successful completion of NCLEX-PN, the National Council Licensure Examination, which is a nationwide examination for the licensing of nurses in the United States, the licensed practical nurse (LPN) works under the direction of a registered nurse or licensed physician in a variety of health care settings.

Contact us today to find out more about how to become an LPN on Long Island.