Two Nurse Managers, Two Expert Ways to Round
Melinda Patterson began nursing in Oncology, shifted to ICU, made a right turn to Emergency Medicine and then a sharp left to Hospice. Now she is in her perfect spot—managing Huntsman Cancer Hospital’s surgical floor (HCH 5). Connecting with patients has been a common thread throughout her journey.
Jane Nielsen knew in second grade that nursing was for her. She finds her purpose in caring for patients and creating trusting, collaborative nursing teams. As manager of the cardiovascular medical unit (CVMU), Jane’s continuous focus is making her unit the best place to work and receive care.
Question #1: What’s Your Approach to Rounding?
Melinda: People think of rounding as a formal structure with formal questions. It doesn’t have to be formal. I'd be terrible at that. My process is just sitting down and saying, "I haven't cared for you before. Tell me about you and your experience. Are we doing the right things to make sure that comfortable? Is there any areas that you think we can improve?"
Jane: When I first started rounding it felt scary. As a manager, you're walking into a situation where you’re going to be asking to know about the problems. What makes it scary is making yourself vulnerable to critique. It’s an uncomfortable place. What makes it easier for me is that I round with a buddy, Deanne Monson, who is our CNC, and has been a floor nurse and educator on CVMU.
Jane's Pro tip: "Round with a Buddy"
"I think that two of us rounding demonstrates how invested we are as a management team in understanding our patients’ needs. Deanne is a perfect partner and a great motivator. She shows up, list in hand, and off we go. Because Deanne has worked on the floor for so many years, she knows the processes better than I do. I've trained myself by being on the unit and working half a dozen nursing shifts, but I don't do it every day. Sometimes I get a little awkward with my words, and she's very, very comfortable."—Jane Nielsen on rounding with Deanne Monson
Question #2: How do you connect with patients?
Melinda: Sometimes I just ask patients, "Do you feel safe here?" This question generates a lot of different answers. I find patients relate to safety differently. Some focus on how often we come into the room, others look at it more from a competency standpoint. A few have talked about safety in this context: "Well, we had this one nurse who seemed a little unsure of herself." It's a great opportunity to be able to coach staff in real-time. I say things like, "You have to make sure to come across confident in your skills because patients pick up on it and it can make them feel unsettled about the care."
Jane: Our goal is to engage our patients in a real conversation. We introduce ourselves and then we say, "How is your patient care? It’s open-ended. Most of the time patients say, "Oh, it's just been excellent." I have to say, that’s usually the answer we get. Even though I walk in with my heart pounding like crazy, most of the time patients tell me how wonderful their care has been. We always put our names on the white board, with our extensions (as well as the charge nurse number), and explain that these are constant numbers and they can always reach us.
Question #3: How Does Your Team Feel About Your Rounding?
Melinda: I don't just round on patients. I round on my staff, but in a less formal way. I try to be visible out on the unit. They know that when I'm in the room and I'm rounding. I have no problem taking a tray out of the room. I talk with families. I escort patients to the restroom. They know that my rounding is not just discussing things. They see it as an extension of who I am just naturally - being out and about and chatty, and wanting to know about patients. When I hear something positive about someone, I share it immediately. If they aren’t working, I share feedback by email. We also post patient comments on our Kudos board.
Jane: Rounding is just one of the many ways I am connecting with staff. I start with daily connection—just sitting down with them and hearing about their lives. I’m a people person and they know I’m really interested in them. Every morning after report, we try to connect about the plan for the day. We also have staff and team meetings. When we round we are always looking for opportunities to share feedback with the team. When we hear something positive from the patients, we hunt down the staff members to share what they've said, "Hey Joe, patient room 33 just really thinks you're awesome." They just beam.
"When we round we are always looking for opportunities to share feedback with the team. When we hear something positive from the patients, we hunt down the staff members to share what they've said, 'Hey Joe, patient room 33 just really thinks you're awesome.' They just beam."
Question #4: How Much Is Enough?
Melinda: On a good week I can round on four or five patients a day. On a really good week, I can do maybe ten. On a bad week, it's one or two.
Jane: An hour three days a week, and see about five patients. That's almost half our patient load in a week. I think that’s pretty good.
Question #5: What Does Rounding Give You?
Melinda: Connection. Selfishly, I gain so much from that connection. I hear about our patients, their care and their world outside of here. It’s that moment with a patient that takes you back to when you were first a nurse and you got to talk with your patient and take care of them. Even though I'm not taking care of them, I think by rounding you are taking care of both your staff and your patients.
Jane: Pride. Deep down, what keeps me rounding is happy patients. We will always hear from the patients who are upset; rounding is my way to hear from those who are happy. When I hear their stories, it’s almost like that proud parent moment for me, I think, "Oh, my gosh! I’ve got good kids." I just feel this breath of fresh air, and I feel it in my heart. I feel proud. I think I am just on the best unit ever, and I love that feeling.
* Morton JC, et al. Improving the patient experience through nurse leader rounds . PXJ 2014. (Above Image from Left: Melinda Patterson, Nurse Manager Huntsman Cancer Hospital with a patient and Jane Nielsen, Nurse Manager Cardiovascular Medical Unit at University Hospital.)