Running head: HOURLY ROUNDING 1

Quality Improvement Project: Hourly Rounding

Ashley B. Butchello

Bon Secours Memorial College of Nursing

NUR 4144 PRD: Servant Leadership

Barbara Ellcessor, DNP, RN, RNC-OB

March 24, 2018

“I pledge”
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Quality Improvement Project: Hourly Rounding

The healthcare field is constantly evolving due to evidence-based practice, patient

satisfaction scores and responses, and employees who lead the way in organizing efforts to

promote changes in practice. In every hospital, there is much emphasis on improving patient

care and outcomes to prevent readmissions and the spread of infection. To make this possible,

quality improvement projects are established to enhance the care each patient is given and to

create better work environments. These quality improvement projects do not just appear from

thin air; however, they require a strong leader to take on such responsibility and to initiate

transformation.

A good example of the kind of person that would be at the forefront of these quality

improvement projects is the nurse manager. By utilizing the four domains of leadership and the

five exemplary practices of leadership, a nurse manager can implement the type of change

necessary to improve patient care and outcomes. The nurse manager on the Progressive Surgical

and Bariatric Unit (PSBU) at St. Mary’s Hospital has acknowledged that hourly rounding has

been a quality improvement project the unit has been working on to increase patient satisfaction

scores. “Hourly rounding, also known as intentional rounding or comfort rounding, is a process

of interacting with patients on a planned, regular basis to anticipate their fundamental care

needs” (Hutchings, Ward, & Bloodworth, 2013).

Heart Domain

In order for a nurse manager to promote hourly rounding on the unit, the motivation and

intent of the heart must not be one that is self-serving. “People with hearts motivated by self-

interest put their own agenda, safety, status, and gratification ahead of that of those affected by

their thoughts and actions” (Blanchard & Hodges, 2005, p. 40). Therefore, the nurse manager
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must demonstrate that the purpose of hourly rounding is not just to have better patient

satisfaction scores than other units, but to truly make a difference in the quality of care being

given to patients. We are in healthcare to serve others and to help people get back to a better

state of health, not to win some sort of prize. If the nurse manager’s motivation comes from a

good place, then others can believe in the nurse manager’s intent and facilitate the project into

practice to create change.

Head Domain

The next domain of servant leadership is the head and it is compromised of the leader’s

belief system and values. In this position, the nurse manager is able to assume both a visionary

and implementation role. The visionary role allows a course to be set with an end destination,

while the implementation role includes doing things right with the focus of serving (Blanchard &

Hodges, 2005, p. 84). To further envision the success of hourly rounding, the nurse manager

should be willing to teach staff members that falls, pressure ulcers, unrelieved pain, or other

adverse events can be avoided if the patient’s comfort, safety, and environmental needs are fully

attended to (Hutchings, Ward, & Bloodworth, 2013). The values of the nurse manager also come

into play in the head domain because if the nurse manager’s values align with the staff’s values,

everyone can come together with a common interest and endgame in mind. This will not only

improve the cohesiveness and future satisfaction of the staff, but patient satisfaction as well.

Hands Domain

The actions and actual work of the servant leader is included in the hands domain. It is

here that the nurse manager demonstrates trust in the staff and acts as a coach to help others learn

the skills of hourly rounding and its effect on the patient population. The nurse manager may

also act as a role model by executing an accurate display of hourly rounding and then
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encouraging the rest of the team to lead by example. Within this realm of performance coaching,

the nurse manager can provide direction and set goals, help the staff accomplish these goals, and

evaluate the progress based on the staff’s performance (Blanchard & Hodges, 2005, p.121). By

carrying out these actions, the nurses may find that hourly rounds help to organize workflow and

improve productivity due to the anticipation of patients’ needs opposed to the interruption of

patients making requests (Hutchings, Ward, & Bloodworth, 2013).

Habits Domain

One of the most important things a servant leader can do is to take care of themselves

amidst serving others. Nurse managers take on a lot of responsibility, which can lead to

exhaustion and the constant temptation of falling off course. To avoid these negative forces, the

character of the nurse manager must be preserved. There are five habits to promote positive

thinking and purpose in a servant leader’s life and these include: solitude, prayer, study and

application of scripture, accepting and responding to God’s unconditional love, and involvement

in supportive relationships. Not only will these habits encourage the nurse manager to stay on

task, but they can be used to revive the staff and offer self-reflection for all members of the team

(Blanchard & Hodges, 2005, p. 154).

Five Practices of Exemplary Leadership

Along with the four domains of leadership, there are five practices of exemplary

leadership that can be connected to one or more of those domains. The five practices of

exemplary leadership are modeling the way, inspiring a shared vision, challenging the process,

enabling others to act, and encouraging the heart. Found in Leadership Roles and Management

Functions in Nursing, Kouzes and Posner propose that anyone can further their ability to lead

others to get extraordinary things done when the five practices are utilized. The authors also
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“suggest that exemplary leaders foster a culture in which relationships between aspiring leaders

and willing followers can thrive” (Marquis & Huston, 2017, p. 51).

Modeling the Way

By modeling the way, the nurse manager should be able to clarify their values and set an

example by demonstrating behavior that reflects those values (Marquis & Huston, 2017, p. 51).

To implement effective hourly rounding throughout the unit, the nurse manager must

communicate why hourly rounding is taking place and what the benefits of hourly rounding are

to the patients and staff. Along with this, the nurse manager should demonstrate the correct way

to do hourly rounding, addressing pain, potty, prevention of falls, placement of items, and

positioning, in front of the entire team. That way, the staff know what questions to ask in their

hourly rounds and they can learn to anticipate and address patient needs to increase patient safety

and satisfaction.

Inspiring a Shared Vision

In this exemplary practice of leadership, the nurse manager envisions the future and

enlists others in a common vision by convincing the staff that hourly rounding will be beneficial

for both the nurses and patients so that the overall goal can be attained. To encourage others to

participate in hourly rounding, the nurse manager can display a clock at each patient’s bedside so

that it is known when the nurse will be in next and the nurse can plan their care around the due

time of an hourly round. This will not only help to facilitate the clustering of care and

organization, but it will ensure patient safety, enhance their care experience, and reduce the

anxiety felt by the patients and their family members (Hutchings, Ward, & Bloodworth, 2013).

The nurse manager may also note that successful hourly rounding can contribute to decreased

call bell use and patient complaints, which can lead to the nurses feeling less overwhelmed.
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Challenge the Process

Through challenging the process, leaders can search for opportunities and take action by

experimenting and taking risks. A good leader learns from their failures and encourages others to

step into the unknown and learn from their experiences as well. Nursing leadership at St. Luke’s

Episcopal Hospital established an example of challenging the process when they conducted a

study “to determine if a standardized hourly rounding process (SHaRP) implemented through a

formal education program would result in improved efficiencies, patient satisfaction, and quality

and safety metrics when compared to a less standardized implementation process” (Krepper,

Vallejo, Smith, Lindy, Fullmer, Messimer, & Myers, 2014). The nurse manager on PSBU could

create another type of rounding strategy and have the staff incorporate both approaches into their

practice to see which one proves most beneficial.

Enabling Others to Act

According to Marquis and Huston, enabling others to act fosters collaboration, trust, and

the sharing of power (2017, p. 51). The goal of increasing patient satisfaction scores and safety

can be achieved through the combined efforts of the nurse manager, registered nurses, unlicensed

assistive personnel, and other members of the interdisciplinary team. It is not only up to the

nurses to do hourly rounding, it takes a team effort to initiate this task. Nurse managers can use

enabling others to act to strengthen and empower the nurses on their unit by showing those

nurses that there are benefits from hourly rounding for them as well. For instance, rounding

helps nurses identify patient’s needs and solve their problems before adverse events may occur.

In addition, hourly rounds can “improve the nurses’ ability of decision-making based on clinical

observations and patient-centered care” (Negarandeh, Bahabadi, & Mamaghani, 2014).

Encourage the Heart

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An exemplary leader can encourage the heart by recognizing, appreciating, and

celebrating followers and the achievement of shared goals (Marquis & Huston, 2017, p. 51). The

nurse manager can employ this practice by recognizing staff members for their hard work and

commitment to hourly rounding through verbal and written acknowledgement during huddle and

on the weekly manager memo’s. By doing this, the nurse manager is creating an environment

through which everyone’s contributions are noticed and appreciated.

Implications for Professional Practice

Nurses are on the forefront of patient care and are the healthcare providers who patients

see most often while they are hospitalized. Therefore, it is the nurse’s responsibility to meet the

patient’s needs, maintain patient safety, and provide the very best quality of care possible. To

measure the overall effectiveness of patient care, surveys are given out to evaluate patient

satisfaction with their nurses, hospital stay, treatment team, and individual unit they received care

from. Hourly rounding not only promotes patient safety and satisfaction to increase survey

scores, but it also helps develop a sense of trust between the patient and nurse. This trust gives

the patient a sense of relief knowing that they truly matter to the nurse and that their

individualized needs will be met during their hospital stay. One way to check if hourly rounds

are being done consistently and thoroughly is to have the nurse manager create an hourly round

checklist and observe each member of the staff during their rounds. The biggest thing for the

nurse manager to listen for is that the staff member asks the patient about the ‘five P’s’. These

include addressing the patient’s pain, asking if they need to use the restroom and if their

positioning is comfortable, making sure the call bell is within the patient’s reach, and informing

the patient to ring the call bell before getting up to prevent falls. Another way to ensure that

hourly rounding is being put into practice is for the nurse manager to conduct their own survey
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and while doing their own rounds on the patients, ask if the patients have noticed nurses and

unlicensed assistive personnel doing hourly rounding.

Outcome Evaluation

Efficient hourly rounding on PSBU will not only lead to increased patient satisfaction,

but better outcomes for the patients as well. Hourly rounds help to reduce falls, prevent pressure

ulcers, decrease pain, and limit the stress a patient may face while in the hospital. By improving

patient satisfaction scores, the unit may receive more recognition from the hospital itself and the

staff may be entitled to a bonus at the end of the year if the bonuses are based on survey scores.

Moreover, nurses could possibly face less burnout and frustrations at work due to the decreased

call bell volume and clustering of care hourly rounds provide. Quality improvement projects all

begin with a strong leader and nurse managers are in the perfect position to take control of these

projects and incorporate them into their units.

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References

Blanchard, K. & Hodges, P. (2005). Lead Like Jesus. Nashville, TN: Thomas Nelson.

Hutchings, M., Ward, P., & Bloodworth, K. (2013). ‘Caring around the clock’: A new approach

to intentional rounding. Nursing Management – UK, 20(5), 24-30.

Krepper, R., Vallejo, B., Smith, C., Lindy, C., Fullmer, C., Messimer, S., & Myers, K. (2014).

Evaluation of a standardized hourly rounding process (SHaRP). Journal For Healthcare

Quality: Official Publication Of The National Association For Healthcare Quality, 36(2),

62-69. doi:10.1111/j.1945-1474.2012.00222x

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing:

Theory and application (9th ed.). Philadelphia, PA: Wolters Kluwer.

Negarandeh, R., Bahabadi, A. H., & Mamaghani, J. A. (2014). Impact of regular nursing rounds

on patient satisfaction with nursing care. Asian Nursing Research, 8(4), 282-285.

doi:10.1016/j.anr.2014.10.005