Copyrighted care

I’m not sure about you, but the concept of hourly rounding – going in to lay eyes on your patients to make sure they are ok, are they comfortable, do they need anything (including for you to leave them the hell alone) has always been a part of my practice. It’s competent care to know what’s happening with your patients, and for that extra CYA, I chart every 2 hours at minimum that my patient was breathing. I also finish my day with a nursing note with a more detailed description of what has happened on my 8, 12 or 16 hour shift, mundane or not. That way, should anything come back to bite me in the ass, I have a plethora of written word by my own hand, showing whomever is interested the entire aspect of my day.

However, there are administrators and managers who believe that nurses don’t do this type of care. As evidenced by 1 or 2 entires on the daily log, a one-line mention of a 12 hour shift that ‘nothing happened’, or worse: falls, gross incontinence, excruciating pain, missed medications and unresponsive patients. It’s unfortunate that in every profession there are good people and there are bad people, and in light of tightening purse strings and increasing public scrutiny, the load on the backs of nurses must increase in order to satisfy the public.

Enter so called “Hourly Rounding” – the copyrighted concept of scripted, timed appointments kept with each of your patients throughout the day. Down to the words spoken to patients, this administrative concept is set to save the nurses from answering call bells, picking up fallen patients, and satisfying the managers, administrators and guests with the consistent attention and service from your health care provider… ie me.

It all sounds lovely doesn’t it? As an RN on a heavy oncology unit, it should come as a ray of light to ease my work load of running back and forth in my confusion, unable to satisfy the needs of my patients on my own by critically thinking out my day and prioritizing the health & safety of each patient, the most critical first to the ‘stable’ (I say stable with a grain of salt – one minute they’re fine, the next they’re dead!), the tasks to be completed and the care to be given mixed in with appointments, visits, meals and nap times.

Except that I find this forced implementation of an office workers idea of nursing (position, pain, provisions and toileting) to be insulting, humiliating, and degrading not only to someone who has a BSc, but to those who are actually in the trenches day after day critically thinking about how to best care for the 4 or 6 patients in their care.

I’m not saying that the above Ps and 1 T aren’t a part of nursing care – they are. But to copyright that those 4 aspects of my day are now the MAIN focus of my nursing existence is absurd. How can all of nursings knowledge be pushed aside in favor of diaper changes and dispensing pain medications?

It kind of feels like I’m back in nursing school. I can remember one teacher, she was the only one to make me cry every shift but in the end made me and continues to make me a better nurse, break us down to square one to rebuild the critically thinking, organized, highly efficient intelligent practitioners of nursing. One of the many questions that still rings in my head, besides “What would ___________ do” in times of crisis, is “What do YOU want YOUR practice to be?” How do I want to handle this? How am I going to think this through and solve this issue?

Critical thinking is what separates the RN from CNAs, from Orderlys, and what gives our profession its right to be respected. Anyone can take a vital sign, change a diaper, give a medication. But it’s how a nurse thinks that makes her so invaluable. With this Hourly Rounding, with all its useless paperwork, its make-work waste of time, it’s micromanagement by Big Brother who has a dated idea of what nurses do & why we do it? It’s making me feel… well, worthless.

Ok, maybe not worthless. I feel like a nanny. I feel like the patients now have 1:1 care beyond their wildest imaginations. It calls to mind a Simpsons quote, after Homer sneaks into Grandpa’s retirement residence and stays for a number of days. “Marge, when I get old you gotta PROMISE that you’ll put me in a home. It’s like you’re a baby, except you’re old enough to appreciate it!”

Instead of reading the chart to gain an understanding of your history, your home life, and what I can do to help you either get home or to a place of care… I’m chasing after the potatoes you didn’t get with lunch.

Instead of discussing your latest blood results with the MD on call, anticipating a re-draw to check for infection or hidden bleeding… I’m cleaning your room.

Instead of participating in our ‘interprofessional rounds’ where each respected profession gives their opinion about your case in a collaborative attempt to give patient centered care… I’m walking a perfectly capable person to the bathroom, then staying to wipe their bum.

None of these tasks would bother me if sprinkled throughout the day… but every hour? You’ve GOT to be kidding me. Along with the fact that I have significantly more work to do, and no extra resources to aid me in completing these tasks. Just more missed breaks, which in turn solidifies the opinion that I’m disorganized & can’t get my work done, thus needing a step-by-step breakdown of how my day should go.

Which brings me to my long winded point. A nurse is a knowledge worker, not a task monkey. She is a qualified, independent health care practitioner, not a beast of burden with a vitals cart and a diaper. But it’s getting harder and harder to not feel like one, especially with systems like this intruding on my ability to think for myself. At this point, I may as well be an orderly.


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