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Journal of Nursing

Are New Graduate Nurses Being Taught About the Importance of Nursing Rounds? 

by Megan Halacy, Student Nurse and Edith Claros, APRN BC Assistant Professor of Nursing Massachusetts College of Pharmacy School of Nursing [email protected]


Abstract


It has been shown that hourly nursing rounds improve patient care by reducing call light use, increasing patient satisfaction, and reducing falls. However, there is limited research on what new graduates know about the positive aspects of nursing rounds. Therefore, this study helps to determine if new graduate nurses have any knowledge about nursing rounds and if they are using nursing rounds as a way to organize their practice. A survey was given to 35 new graduate nurses that completed the same nursing program in May 2008. Analyses were performed on the results of the survey in order to determine their knowledge of nursing rounds. The survey showed that a majority of the respondents understood the importance of nursing rounds however, only half discussed nursing rounds in orientation and a little more than half participate in nursing rounds now. It was concluded that more research needs to be done in order to determine the best way to incorporate nursing rounds in the practice of new graduates. A protocol for orientation or adding nursing rounds to the curriculum of all nursing schools may increase the amount of new graduates performing nursing rounds and in turn, help to better organize their practice and improve patient care.


Introduction 


  As future graduate nurses, it is important to stay abreast evidence based nursing practice and tuned to the demands of a constantly evolving field. Nursing care has become increasingly complex due to acuity levels and patient assignments, dwindling resources, which require optimal organizational skills for best patient outcomes. The National Patient Safety Goals was developed as a method to improve patient safety requiring refinement in the way nurses assess, perform, and communicate. The view of healthcare is changing and the public is becoming more educated on what they can expect from the system thus demanding change in the way nurses care for patients. To meet this demand, a challenging alternative are nursing rounds, now beginning to come to the forefront in improving patient care. Nursing rounds have been implemented in many establishments in order to assess the status of the patients, provide care, and determine what needs to be done for the patient before the patient feels the need to use the call light (Close & Castledine, 2005).


  Nursing rounds however are still outside of the new graduate nurse’s knowledge radar. There is very little research done on this topic, and whether new graduate orientation programs address nursing rounds, or whether new graduate nurses are aware of the positive aspects of nursing rounds, thus creating a gap in knowledge. Therefore, it is necessary to explore this further to assess common practices of the new graduate nurses orientation programs currently held in hospitals. Learning whether or not new graduate nurses are actually using the nursing rounds as a way to organize their practice, could prove beneficial to patient outcomes. There is a need for empirical information on nursing rounds that address questions regarding the importance of nursing rounds for new graduate nurses during orientation.


This study seeks to fill this knowledge gap through a survey administered to new graduate nurses to assess their knowledge and practice of nursing rounds. The data gathered from this survey will help to recognize the importance of implementing comprehensive orientation programs to new graduate nurses; and to assure dissemination of the positive aspects of nursing rounds that could help organize nursing practice and improve patient outcomes. These findings may provide new evidence that will allow orientation programs and nursing schools to implement this information into their curriculum.


Review of Literature


  In the landmark study performed by Meade, Bursell and Ketelsen (2006), the researchers determined the effects of nursing rounds on patients’ call light use, satisfaction and safety. Before this study had been completed, there was very little information about call light use in relation to patient care (Meade, Bursell, & Ketelsen, 2006). Through a quasi-experimental design, 27 nursing units in 14 hospitals performed nursing rounds at either one or two hour intervals. These nursing rounds consisted of 12 items that were assessed for each patient. The rounding items included such things as assessing the pain level, offering toileting, assessing patient poisition, doing safety checks, asking if there is anything that can be done and telling the patient when the nurse will be back to round again (Meade, Bursell, & Ketelsen, 2006). Results of the study showed that consistent rounding significantly reduced patient call light use, patient satisfaction was increased and patient falls were greatly reduced. The authors concluded that nursing rounds should be implemented in all nursing facilities because it improves patient outcomes, it will help prevent nursing burnout and fatigue leading to enhanced and organized care when the rounds are consistent (Meade, Bursell, & Ketelsen, 2006).


  Furthermore, Meade, Bursell and Ketelsen (2006) state, “Nursing staff members who performed one-hour rounding reported that units were quieter; also, they reported that they were able to be more attentive and respond more quickly to call lights” (Meade, Bursell, & Ketelsen, 2006). Thus nursing rounds, when performed regularly, can have a significant impact on patient care. There has been significant research performed on the impact of increased socialization and the improvement of patient health, and nursing rounds are one way to increase contact with the patient, which will allow for positive health achievements.


  Similarly, stressful experiences and negative emotions have an effect on the immunological response of the body leading to “prolonged infection and delayed wound healing” (Temkin-Greener, et al, 2004, p. 779). If patients are unable to have a positive view of their recovery, and if they do not have the social support that they need, they are more likely to succumb to illnesses and will eventually want to give up (Tomaka, Thompson, & Palacios, 2006). Nursing rounds have been found to minimize the call light use, reduce the risk of falls and increase patient satisfaction, which in turn, decreases negative emotions, improves the patients’ health and allows for better health outcomes (Meade, Bursell, & Ketelsen, 2006).


  Currently there is research on the benefits of nursing rounds; however, there is very little information on whether this type of practice is being incorporated into new graduate orientation. New graduates are faced with many challenges as they enter the field and must take everything that they have learned and start to apply it to real situations. New graduates have stated that they “were afraid they would not know what was going on with each patient. They feared they would not know what the assessment data meant and that if they missed anything and harm came to the patient, it would be their fault” (Etheridge, 2007). Another study found that new graduate nurses with less than one year of experience thought that time management and “learning the pace of the job” was a struggle for them (Etheridge, 2007) and face issues related to time management skills, finding “how to pace themselves most challenging than initially anticipated” (Hodges, Keeley, & Troyan, 2008). Nursing rounds may be a way for the new graduate nurses to get a better understanding of how to manage time and may help to prevent them from feeling overwhelmed by intercepting the potential problems before they occur.


Methods


  This research project was a non-experimental survey, mix method design to assess whether new graduate nurses are being taught about the importance of nursing rounds during orientation. A survey was developed by the author and distributed amongst new graduate nurses to help to collect data about their knowledge regarding nursing rounds and the set up of their orientation program. The survey provides a brief description of nursing rounds and the positive impact on nursing care.


  The questions were developed to allow the respondents to discuss the health care setting in which they practice, the length of their orientation, and their familiarity with nursing rounds. The survey was not tested before administration. Consent to take part in the research project was implied after the survey had been completed and returned. The survey was distributed to a nursing class that had graduated in May 2008. This class consisted of 35 students, four males and 31 females, ages ranging from 21-50. All students were part of the same nursing classes and had successfully graduated in nursing taking jobs in a variety of settings. The surveys were originally sent out through their school email accounts and they were given two weeks to complete the survey. A follow-up email was sent to remind them of the survey. Any responses that were received after the due date were not considered part of the response rate.


  After all surveys had been collected, the results were tabulated using the Statistical Package for the Social Sciences, SSPS, for statistical analysis. Answers to open ended questions were used to determine specific themes and analyzed in that way. After all of the statistical data had been analyzed, the general trends were determined and conclusions were drawn.


Results


  Out of the 35 people who received the survey, 14 people completed the survey, representing a 40% response rate. Responders were all females, ranging in age from 21 to 50. The amount of time that the new graduate nurses had been employed was not determined; however, they were all within 10 months post graduation. There were 12 responses prior to the follow up email and two responses after the follow up email. This low response rate is likely due to the fact that the email account that the survey was sent to was their school account and because they graduated 10 months ago, many of the new graduates do not check the account frequently.


  It was reported that the new graduate nurses were employed in similar health care settings. Hospitals were the most reported employment facility at 86%, while 7% reported that they worked in a rehabilitation hospital and 7% worked in a psychiatric ward. Forty-three percent of the nurses worked on a medical-surgical floor, 21% were in critical care, 7% were in pediatrics, 7% were in oncology, 7% were in psychiatry, 7% were float nurses, 7% were in the post anesthesia care unit and there were no respondents working in the emergency room. Orientations for these floors were not shorter than 5 weeks, with 21% reporting that their orientation was 5-8 weeks, 50% reporting that they had an orientation of 9-12 weeks, and 7% had an orientation of 13-16 weeks.


  Three respondents wrote a separate response. One new nurse (7%) reported that she had orientation for four months and then would continue to take pediatric nursing classes for the next two years. Two other nurses (14%) responded that their orientation was six months long. After orientation, 79% of the new graduate nurses thought that they were ready to work by themselves while only 21% felt that they were somewhat ready.


  Regarding nursing rounds, 71% had heard about nursing rounds prior to working, 14% had somewhat heard about them and 14% had not heard about nursing rounds at all. Only 50% of the nurses were told about nursing rounds during orientation, while 14% had somewhat heard about them and 14% had not heard about them at all. The new graduate nurses did report however, that 64% of them do participate in nursing rounds now, 29% somewhat participate and only 7% do not participate. Eighty-six percent of respondents did know the benefits of nursing rounds and only 14% reported that they somewhat knew the benefits of nursing rounds.


All questions were answered thoroughly with some nurses choosing to include information not originally posted as part of the questionnaire. They wrote their own views of nursing rounds and how they have impacted their practice while others chose to describe the role of nursing rounds within each of the different shifts and in relation to members of the multidisciplinary team on the floor. The data analysis reveals a few main themes. All of them wrote that nursing rounds do help to organize their practice. One new graduate nurse wrote, “If I got one thing out of rounding, it’s that I’m very conscientious about addressing pain right at the start of the day and continuing throughout the day with my reassessment,”.


  The new graduate nurses have made it apparent that when they learn about nursing rounds, they are able to better understand what they need to do in order to provide the best care for their patients. They also stated that each shift tends to have a different view of rounds. Day shifts tend to have more staff on so they are able to do hourly rounds, with positive response from patients whereas, the evening and night shifts are assigned more patients thus limiting the time to round with every patient while getting the rest of their work done.


Discussion


  Data showed that the majority of the nurses who took part of this survey had heard about nursing rounds prior to employment. This demonstrates that nursing rounds may be taught during nursing school and are not always the responsibility of the health care facility. However, teaching nursing rounds must be a shared responsibility between academia and healthcare facilities to ensure consistency in nursing practice as we strive to provide safe patient care.


  Overall, it is apparent that a majority of these new graduate nurses are aware of the positive aspects of nursing rounds and try to participate in them. Hospital orientation programs must improve current orientation programs to assure coverage of this important topic as way to organize practice for new nurses. The benefits of nursing rounds can serve as a way to help new graduates organize practice and acquire good habits of patient assessments early on.


Limitations


  Limitations in this study include the development of a survey instrument which was not piloted thus rendering questionable validity, and reliability. Similarly, the population surveyed is very small and not representative of the larger new graduate population. This sample population was obtained from the same nursing program; therefore, knowledge of nursing rounds would be from the same source.


Future Directions


  More research needs to be done regarding the use of nursing rounds during new graduate nurses hospital orientation and in nursing curricula. With more research, the survey instrument used, or a similar one can be tested for validity and reliability. Nursing rounds are beneficial to the organizational skills of the new nurse, which lead to improved patient outcomes. Programs can be set up so that nursing rounds become a new standard of practice.


References


Close, A., & Castledine, G. (2005). Clinical nursing rounds part 2: nurse management rounds. British Journal of Nursing , 872-874.


Etheridge, S. A. (2007). Learning to Think Like a Nurse: Stories from New Nurse Graduates. Ther Journal of Continuing Education in Nursing , 24-30.


Hodges, H. F., Keeley, A. C., & Troyan, P. J. (2008). Professional Resilience in Baccalaureate-Prepared Acute Care Nurses: First Steps. Nursing Education Perspectives , 80-89.


Meade, C. M., Bursell, A. L., & Ketelsen, L. (2006). Effects of Nursing Rounds on Patients' Call Light Use, Satisfaction, and Safety. American Journal of Nursing , 58-70.


Tomaka, J., Thompson, S., & Palacios, R. (2006). The Relation of Social Isolation, Loneliness, and Social Support to Disease Outcomes Among the Elderly. Journal of Aging and Health , 359-384.


Appendix A


Thank you for participating in my final Senior Capstone Project! The focus of my project is to examine the knowledge that new graduate nurses have about nursing rounds and performing hourly checks on patients. The goal of nursing rounds is to minimize call light use, reduce the risk of falls, and increase patient satisfaction. Your responses will provide insight into what new graduate nurses know about nursing rounds and will allow me to come to conclusions that will help inform all nurses about the importance of nursing rounds.


What is your current place of employment?


Hospital


Nursing Home


Rehabilitation facility


Community Health Setting


Other:_________________


What type of nursing are you in?


Medical/ Surgical


Critical Care


Pediatrics


Oncology


Emergency Room


Psychiatric


Other:__________________


How long was your orientation?


1-4 weeks


5-8 weeks


9-12 weeks


13-16 weeks


Other:____________________


Did you feel that you were ready to work by yourself after orientation was complete?


Yes


No


Somewhat


I don’t know


Had you heard about nursing rounds before orientation?


Yes


No


Somewhat


I don’t know


Were you told about nursing rounds at orientation?


Yes


No


Somewhat


Do you participate in nursing rounds?


Yes


No


Somewhat


I don’t know


Are you aware of the positive aspects of nursing rounds?


Yes


No


Somewhat


I don’t know

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