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Striving for greatness

March 3, 2009 -- Today The Huntsville Times (AL) ran a generally good story by Steve Doyle headlined "Hourly nurse rounding is a growing trend around the country." The piece focuses on local hospitals that have established programs to check patients on set schedules for comfort, positioning, and other needs. Some programs include requirements that care givers actually introduce themselves and explain to patients what they are doing! The programs reportedly improve patient outcomes, for instance by reducing falls and bedsores, and they also increase patient satisfaction. The article quotes two nurse managers, in addition to "customer service" directors; it might have also consulted the direct care nurses who actually do the rounding. We thank Doyle and the Huntsville Times for a helpful report on these promising trends, which also have the potential to increase the visibility of nurses and public understanding of the importance of what nurses do.

Nursing Out Loud

The piece focuses mainly on Crestwood Medical Center, one of 119 U.S. hospitals owned by Tennessee's for-profit Community Health Systems, which reportedly may be the first to mandate "hourly nurse rounding" company-wide. (The article is not always clear about who is doing the rounding, at times using the term "caregivers" in addition to "nurses"; to the extent certain tasks, such as checking comfort levels, were performed by those with less health care training, it could affect outcomes.) In any case, the piece explains that the Crestwood program focuses on comfort level, positioning to avoid bedsores, personal needs, and access to possessions, making sure patients have easy access to things they need, including nurse call systems, water, and bedpans. The hospital actually checks hourly between 6:00 a.m. and 10:00 p.m., every two hours overnight.

The article says that Crestwood's year-old program has had promising results, with patient falls down 58% and bedsores down 39% since November 2007, according to "Chief Nursing Officer Martha Walls." The report quotes Walls as saying that even turning patients every hour rather than every two hours "makes a significant reduction" in bedsores because "[i]t doesn't take long if you have fragile skin for a bedsore to start forming." The report might also have explained that keeping patients' pain under control significantly improves outcomes, as nursing research has shown.

The piece says Crestwood's rounding program is part of a broader "Crestwood Cares" initiative to "improve patient outcomes and satisfaction." The initiative also includes having all employees "from nurses to janitors...introduce themselves each time they enter a patient's room, explain what they are there to do and thank the patient before leaving." Walls explains:

The whole concept is to reduce anxiety and make the patient feel less nervous about being in the hospital. It makes the family know you care about that person as a person, they're not just a room number.

The report does not specify whether physicians are included in this initiative.

The report also relies on other Crestwood managers to explain aspects of the program; it is not clear if any of these are nurses. "Guest Relations Director" Veronica Carter explains that the program has reduced falls by ensuring patients need not get out of bed for things they need, and she also notes that "caregivers" stop by often to help patients to the bathroom. The article notes that reducing falls saves hospitals a lot of money, citing a 2006 NurseWeek report. The piece does not say, but helping patients to the bathroom (as opposed to relying on bedpans) also builds their strength, which aids recovery. And it helps patients avoid lying in their own waste products, which can reduce dangerous infections.

Carter notes that patient satisfaction scores have improved, with more "specific compliments, where patients name their nurse and caregivers and say that they went above and beyond." Carter admits that Crestwood nurses were not initially sure they would be able to do their hourly visits given their already busy schedules, but she notes that nurses are being paged less because patients know they will soon get a visit; patient use of call lights is reportedly down nearly 30% since January 2008. The piece might have asked a nurse who actually does the rounding what he or she thinks of it.

The story also reports that Huntsville Hospital, Alabama's second largest, is "experimenting" with hourly rounding. The non-profit hospital's Neuro Patient Care Unit is testing a program that is similar to the one at Crestwood, focusing on patient position, comfort, and personal needs. The piece relies on the unit's Nurse Manager Lee Collins to explain the program. Collins says that if patients respond well, hourly rounding could become standard hospital-wide. Huntsville Hospital also has a patient satisfaction initiative, which has involved bringing in Ritz-Carlton executives to train staff in "customer service." The article notes that "nurses and other staff have been taught to knock before entering patient rooms, introduce themselves, call the patient by name and ask if they need anything." Here again, the reporter might have consulted a direct care nurse for reaction about how the rounding is going. nursing out loudInstead, the hospital's "Director of Customer Service" Pat Jackson explains:

It's a culture and what we want to be. We feel we've been a good hospital for many years, but now we're striving for greatness.  

This culture may not only improve patient care and "customer satisfaction" but also help nurses claim more of the attention and respect they deserve. If nurses were to introduce themselves as nurses, and tell patients exactly what they were doing and why -- which Rhea Sanford, RN, PhD, calls "practicing out loud" and we call "nursing out loud" -- it could help the public see that nurses are skilled professionals. That might in turn help increase the resources available to nurses and relieve the nursing crisis -- which would indeed be "striving for greatness."


See the article "Hourly nurse rounding is a growing trend around the country" by Steve Doyle posted on The Huntsville Times website on March 3, 2009. You can send Mr. Doyle notes of thanks at



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