Proper patient-rounding training and education are key to resolving the dichotomy between quality and quantity. Patient-experience research shows that patient satisfaction is rated higher by patients who recall being visited by a nurse leader. Studies also show that nurse rounding effectively increases patient satisfaction and quality of care while decreasing patient-safety events. And patients whom a nurse leader visits during their hospital stay are more likely to give top-box ratings across all HCAHPS measures.

The benefits of nurse leader rounding include:

• • Developing/enhancing relationships with staff
  • Proactively meeting patients’ needs (decreasing the use of a patient’s call bell) and building trust
  • Recognizing and rewarding staff
  • Increasing the quality of patient care
  • Decreasing patient injury, medication errors, falls, and inaccurate discharge instructions
  • Diminishing organizational litigation

2022 NRC Health Symposium speaker Pam Collins, MSN, CMSRN, MEDSURG-BC, NPD-BC, Enterprise Service Line Educator with Atrium Health, says a nurse leader rounding strategy is powerful when you have communication feedback, cadence empowerment, and workflow professionalism.

“Patient experience is rated higher by patients who recall,” Collins says. “Are we making it memorable? Only 12% of the adult population is proficient in health literacy skills. That means we must work extra hard to make it memorable. It can’t be something like, ‘How’s it going?’ And there’s something about leaning in that makes it authentic.”

Here are Collins’s top five strategies for successful nurse leader rounding:

Strategy 1: Carve out time to accomplish nurse leader rounding

• Establish a workflow with a consistent rounding time
• Order for rounds with discharges, new admissions, and the remainder of patients
• Round by nurse-patient assignment

“The research strongly suggests a better outcome when we have a designated time,” Collins says. “Even if we don’t make it all, carve out that time. When I was a medical surgical unit manager, we didn’t have a formal name for it. Half of my patients I rounded on in the morning, and the other half were in the afternoon. But my staff knew that between those particular hours, that’s what I would be doing, so they came to expect it.”

Strategy 2: Make that first impression count

• Make a good first impression (well-groomed, clean white lab coat)
• Remember to smile!
• Avoid fragrances, excessive jewelry, and gum, and ensure that clothing fits well

Collins explains that patients will rate the quality of care and the knowledge base higher for care providers who are in a uniform color. “If I have on black scrub pants and a red scrub up top, and you’ve got on blue and blue, they will automatically think you are more knowledgeable and have a higher skill set because of the uniformity of color,” she says. Research shows that patients rate the quality of care higher by care providers who wear a white lab coat.

Strategy 3: Use Atrium Health’s GREAT communication model

• Greet patients with a warm introduction and smile
• Relate to the patient, and connect as best as possible
• Explain nurse leader rounding, so patients know what to expect
• Ask open-ended questions
• Thank the patient with genuine appreciation

“Use your keywords,” Collin advises. “For us, it’s visit and leader, so we repeat that consistently. Everybody who rounds wants to affect a patient’s recall. We’re making it memorable because we have developed a cadence to how we’re going to round.”

Strategy 4: Close the loop

• Give feedback to the patient’s nurse
• Offset one to two opportunities with two to three positives
• Always start with the positive
• Avoid lengthy feedback

“After we have rounded, it’s time to give feedback and some coaching,” Collins says. “So positives should overshadow the areas of opportunity, and the term weakness should never be used, because it does not empower. There are only opportunities, not weaknesses. If several opportunities are identified, then prioritize which ones should be mentioned to avoid the perception of presenting a laundry list.”

Strategy 5: Work to empower your front line

• Enlist from the top, but drive from the bottom
• Manage up
• Partner
• Offer the first olive branch
• Work accountably
• Encourage
• Reward/Recognize

“We can avoid pushback if we EMPOWER,” Collins says. “Our frontline staff are big drivers of our success, actually doing the rounding, medicating, and assessing. We have a tool that collects that data, and they’re supposed to enter the rounds. When a round is done, we encourage that to be done outside of the room, because it makes patients feel a little weird. Nurse rounding leaders enter it, and if they don’t, they don’t get credit for it. So even if they say, ‘Well, I know I rounded,’ it doesn’t count. And they can’t go in the next day to document for the previous day, so it’s pretty hardwired, and it works.”