How to Use Nurse Leader Rounding at Your Facility

When was the last time you made rounds?

You may feel like making rounds as a nursing manager or director should be at the bottom of your to-do list—something you do only if there’s time.

What if we told you that a consistent rounding schedule could improve both patient outcomes and staff engagement? Nurse leader rounding has been associated with numerous benefits for both staff and patients. Learn why nurse leader rounding is so important and how to effectively implement this practice in your facility.

What is nurse leader rounding?

Nurse leader rounding is a process whereby administrators, department heads, directors of nursing, nurse managers, and other healthcare leaders talk directly with staff members and patients or residents regarding care and other services. Leadership rounding allows healthcare leaders to hear firsthand about the organization’s strengths and areas for improvement.

With patients, nurse leaders may focus on the following areas during rounds:

Safety
Patient experience
Cleanliness
Wait times
Pain control
Communication with healthcare providers

Regarding staff, nurse leaders may be involved in the following:

Bedside reporting
Handoffs
Hardwiring of new processes and policies
Supervising adherence to safety initiatives
Verifying the use of communication tools, such as whiteboards and call lights
Collaborating with staff to identify barriers to the successful implementation of different processes and find solutions
Giving feedback to staff in real time

Types of rounding

Rounding can be categorized in different ways and can be adapted to suit the specific needs of your healthcare facility.

One categorization is based on the area of interest (e.g., patient care, environmental services, facility management, discharge planning, etc.).

Another categorization is based on the location of the rounds (e.g., patient’s bedside, unit hallways, conference rooms, etc.).

An important type of rounding for healthcare leaders is rounding for high reliability. This type of leader rounding involves regularly scheduled and structured visits with interdisciplinary teams to address high reliability, safety, and improvement efforts.

Leader rounding for high reliability has the following benefits:

Improving leadership visibility across the organization
Demonstrating a commitment to high reliability
Building trust and relationships with staff through transparent dialogue
Providing and receiving real-time feedback from staff and patients
Increasing staff accountability and engagement
Identifying and addressing issues before they escalate
Increasing leadership understanding of operational, clinical, nonclinical, and patient experience issues, as well as safety-related concerns

When leader rounding is properly conducted, the result is a united healthcare team that collaborates effectively to improve patient safety.

The importance of nurse leader rounds

Nurse leader rounding provides various benefits in relation to both patients and staff.

Concerning staff, nurse leader rounds improve the following:

Nurse retention and recruitment efforts
Staff engagement and job satisfaction

Take a moment to think about the cost of turnover for healthcare facilities. Nurse leader rounding can significantly reduce those elevated costs by helping facility leaders better understand and improve the nurse’s experience from day-to-day tasks to standard operating procedures.

In regard to patients, analysis of survey results, including the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), indicates that nurse leader rounds are associated with improvements in patients’ perception of care.

These results, published in “Improving the patient experience through nurse leader rounds” in the Patient Experience Journal, indicate that patients who remembered being visited by a nurse leader during their hospital stays rated these aspects of their experience much more positively than patients who did not recall being visited by nurse leaders:

Overall rating of nursing care
Response to concerns/complaints
Likelihood of recommending the hospital

High HCAHPS scores mean increased funding from federal programs.

In short, nurse leader rounds are relatively small investments that yield high returns for facilities.

Adapting rounds for nursing leaders

What is the patient rounding process?

A nurse’s patient rounding procedure ideally occurs hourly and typically focuses on these 4 Ps: pain, potty, position, and placement. Depending on the setting, many of these rounds may be carried out by nursing support staff, such as certified nursing assistants (CNAs).

During rounds, nurses or support staff may ask the following questions to address these 4 Ps:

Pain: How is your pain? Are you having any discomfort?
Position: Are you comfortable? Do you need to be turned or repositioned?
Potty: Do you need to use the bathroom?
Position: Is there anything I can get or do for you? Do you need me to move something for you (the phone, call light, trash can, water, bedside table, etc.)?

What do leadership rounds look like?

Leadership rounds do not involve patient care. They are opportunities for patients to talk with healthcare leaders and provide feedback for improving safety and quality of care.

Leadership rounds typically have the following characteristics:

Leadership rounds should be part of a nurse leader’s daily routine.
If possible, nursing managers or directors should visit all the patients in their respective units.
Rounds usually do not exceed 15 minutes per patient.
One-on-one meetings with staff should not exceed 30 minutes and are not always necessary.
Group rounding may occur at any time of day or night.

The following is a QAPI Leadership Rounding Guide created by the U.S. Centers for Medicare & Medicaid Services (CMS). QAPI stands for Quality Assurance (QA) and Performance Improvement (PI), two mutually-reinforcing aspects of a quality management system.

Here are questions healthcare leaders should consider before rounding:

Who will conduct rounds?
How frequently will rounds take place?
What do you want to ask when rounding a patient, and why?
What barriers or issues have already been identified that leaders should ask employees about to gather input on solutions?

During patient and staff rounding, healthcare leaders can use the following checklist:

Conduct rounds as planned, building relationships with staff by taking the time to listen and respond to employees’ and residents’ needs and maintaining a positive tone.
Ask questions and document key issues.
Assure employees you will follow up on concerns or requests for help.
Follow up on previous issues or requests by sharing with staff how the issues were addressed or resolved.

Healthcare leaders should follow up on their rounds in the following ways:

Identify frequently noted issues/themes.
Prioritize issues (e.g., by level of urgency, threat, and ability to resolve).
Conduct a follow-up to show responsiveness to the issues raised.
Consider ways to acknowledge outstanding employee/unit efforts (e.g., thank you notes or other rewards/recognition).
Identify training or coaching opportunities for employees/units.
Plan the next rounding sessions.

How to get the most out of rounds for nursing leaders

For rounds to be effective and worth the investment of resources, strive to follow these tips.

1. Engage both patients and staff

The end goal of leadership rounds is to gather insights that may help improve patient care and safety, as well as the staff’s work experiences.

Open communication with both staff and patients can provide comprehensive insights from diverse perspectives. Open, transparent communication among members of interprofessional teams and with healthcare leaders is crucial to providing safe and effective patient care.

Leader rounding can improve communication, which, in turn, can reduce medical errors and poor patient outcomes.

2. Be consistent to build trust

As much as possible, nurse leaders should carry out rounding as planned.

Canceling rounds sends the message that these valuable interactions with patients and staff are a low priority for healthcare leaders.

Although nurse leaders should strive to maintain consistency in rounding, they must also remain flexible with the rounding process, especially when direct patient care is being provided.

3. Lead with curiosity and ask questions

Nurse leaders should recognize rounding as the irreplaceable opportunity that it is.

Rounding provides leaders with real-time feedback about the quality of care being provided in their facilities or specific units. It also allows them to recognize staff providing exceptional care and coach staff who can further develop their abilities to meet patient expectations.

However, the effectiveness of the rounding practice depends on the openness of leaders’ minds and the quality of the conversations.

4. Standardize your process, but be genuine

Ideally, rounding should be both structured and spontaneous.

Preparing questions or a checklist in advance is helpful to ensure key topics are covered, especially when healthcare organizations are beginning to implement nurse leader rounding.

At the same time, conversations should be spontaneous enough that they feel natural and comfortable.

5. Recognize and celebrate the positives

Take the opportunity to recognize and celebrate staff members who are upholding desired principles, practices, behaviors, and attitudes.

Remember that rounding can help reduce nurse turnover.

With the ongoing nurse staffing shortage, retaining and attracting staff is essential for smooth operations, quality patient care, and financial viability.

6. Record insights and follow-up

Essential aspects of a healthcare leader’s role include assessing progress, recognizing improvements, and addressing gaps in performance.

Regularly collecting feedback from patients and staff can keep leadership on track in fulfilling these aspects of their role.

Furthermore, following up on an area or discussion promotes a shared understanding of information and improves patient safety. Effective leader rounding includes summarizing issues and opportunities, deciding on resolution dates for open action items, and identifying who is responsible for taking action.

7. Lead by example

Healthcare leaders set the tone for their facilities’ culture.

Do you want staff members to be forthcoming regarding needs and challenges? Then, you must be open and transparent in your own communication.

Do you want staff members to follow through with assigned responsibilities? Then, be consistent with your rounding and follow up with tasks you have committed to address.

Demonstrate the desired behaviors and attitudes you want to see in your team.

Key takeaways

Quality healthcare and smooth operations depend on effective communication and collaboration.

Nurse leader rounding for high reliability is a useful, evidence-based strategy for promoting communication and collaboration, both of which improve healthcare facilities’ culture of safety.

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Nursing leader rounds: Improve patient and nurse engagement