5 Ways to Build A Culture of Rounding

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As a nurse leader at Illinois-based Carle Foundation Hospital for more than two years, Erin O’Neal always considered patient rounding part of her responsibilities. But during COVID-19, it became a priority. And it became personal. Here, she shares her story of how an organization that always had a strong culture of rounding took patient connection to the next level in order to meet new demands brought on by the pandemic.


Erin O'Neal Nurse Manager Carle Foundation Hospital “Rounding is a core part of my practice as a leader because it’s a core practice of Carle as an organization,” O’Neal said. “Using CipherHealth’s rounding platform, CipherRounds, has been incredible for me. I find comfort in connecting with the patients during all of this because they’re scared and we can be a little scared, too. Acknowledging those fears, validating them, and getting to talk to each patient one-on-one changed the way they viewed healthcare during this time.”

Here is Nurse Manager Erin O’Neal’s advice for creating – and sustaining – a culture of rounding, even when crisis hits.

1. Commit to patient communication

“We were prepared. We met the crisis head on. We immediately asked: How are we going to maintain the work that we do and the quality of care that we give throughout all these additional challenges? In terms of rounding, we had to figure out quickly — how are we going to connect with patients when people are scared to be with other people? How are we going to be in close contact with patients when we’re not sure of their level of exposure to the virus? Should we even be continuing patient communication during this time?

“The answer from our organization was a resounding ‘Yes’.”

2. Adapt when necessary

“We had been using CipherRounds prior to COVID-19. But when the pandemic hit, we had to consider what we could do differently to get to what the patients really needed. We worked with CipherHealth to create and implement a new script with fewer questions to limit the time of the round and glean the most impactful information. We wanted to get to action items as soon as possible to improve their experience. As a result, I’ve been able to capture more meaningful conversations with patients to really see what is going on and how I, as a nurse leader, can help.

“We have an ambitious goal of 90% for every one of our patients getting rounded on at least once by a leader during their stay. Some units even increased the number of rounds they conducted during COVID-19. And there’s value there because as a nurse leader, I serve as another set of nurse eyes on the patient. I’m there to talk to them, find out how they’re doing, and figure out how we can help them. It’s an opportunity that the patient looks forward to, and they feel comfortable talking about their stay. I love looking at it this way from the patient’s point of view, and I love hearing their insights.”

3. Make it operational

“The proactive measures we took early on helped keep us calm during times when we were, quite frankly, feeling overwhelmed with the increasing number of patients who needed help amid an environment of frequently changing information. We have a standardized communication that enables us to know how many patients in-house are COVID-19 positive and how many have recovered. We are aggressive in making sure that all safety protocols are in place and that all patients feel that we are taking their needs into account through communication.

“We met as an organization early on to address the impact of COVID-19. While emergency plans were on the forefront of our mind, there was never a doubt that we wouldn’t continue to round through COVID-19. If we had to stop rounding, that would have only added to the detriment of what COVID-19 was doing to our people.”

O’Neal recommends the following tips for operationalizing your rounding program during COVID-19:

  • Block out a time for rounding each day when things are less busy and stick to it.
  • Explain to your staff that it’s going to save them time and effort on the backend because there won’t be as many patient complaints to attend to – they will be addressed earlier during the rounds.
  • Use the mobile app (from CipherHealth). You go everywhere with your phone, so if a patent starts talking, and it’s something you need to document, you have the app right there.
  • Wear PPE (mask, face shield) and request patients also wear masks when rounders are in the rooms. Maintain a distance of six feet, but pull a chair to the end of the bed because sitting seems closer; it’s more purposeful.

4. Remember that staff needs rounding too

“Healthcare staff received a lot of love during the pandemic – we were seen, thanked, and recognized for what we do. And I think that brought us all closer. Everybody was experiencing it; it wasn’t just patients. We need to make sure that the people who are checking on others have people checking on them.

“I was out there regularly asking staff:

  • What are you worried about?
  • How is this impacting your kids?
  • When was the last time you did something for you?
  • What can we do to help?

“I would say this experience is something that will stay with me as more than a nurse leader. I have already recognized the importance of checking on my loved ones, especially during the pandemic.”

5. Make rounding purposeful

“Prior to COVID-19, I think our nurses saw rounding as a way to conduct audits in the rooms, mark communication boards, and get a feel for how things were with the patients. And, of course, escalate any complaints they had.

COVID-19 put a proactive edge on our rounding. Because you’re in the room, you’re already seeing if there’s something wrong, but now you’re dedicated to asking that patient for feedback. They’re in that bed waiting for somebody to talk to them because providers are coming in and out, but nurses who are rounding stay there. It’s completely revolutionized how patient complaints are handled because we’re able to head off safety and other concerns that would have gotten worse later.

“Rounding is also a way for patients to recognize more nurses as being exceptional caregivers. Just making those connections with our healthcare staff in our challenging world – it slowed us down a bit and made us remember that making the human connection is one of the most important things we do.”

O’Neal shared this story of one patient that illustrates the value of purposeful rounding:

“I remember there was one patient who stopped me and said, “How do you guys do it? How do you keep doing all of the things like talking to me and doing my IVs when all of this is going on?” I just sat down and said, “Because we have to take care of you; that’s what we’re here for. We’re here to make sure that this scary situation is safe and that you feel as supported as possible through this.”

Through rounding, O’Neal believes she’s able to identify barriers for patients that could lead to a longer length of stay or things that upset them – and then fix them. “I get to see the impact and the gratitude from the people,” she said. “And that makes me want to do it more. I think that our nurses really are connecting with patients more through COVID-19, and it’s evident in the rounding. Patients are happier.”




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