In October of last year, I wrote about the importance of becoming a clinician leader. As I have thought more about this topic, I have come to realize that a big part of being a leader is being able to empower others. I have witnessed this first hand after our practice’s recent development of daily, bedside nurse-led, multi-disciplinary rounds. A couple of months ago, as a response to several factors, we started this practice on both our stepdown unit and ICU. First, our patient population, as I am sure everyone else is experiencing, continues to get older and sicker. The amount of details that need to be kept straight on two large, busy units continues to grow. Second, more than ever, we are being held responsible for complications like central line and in-dwelling foley catheter infections, as well as statistics like extubation time, and length of stay. Finding an additional way to review all of these details has become paramount. Finally, we wanted to ensure that we could still provide the same level of care to our patients regardless of nurse turnover, or the addition of less experienced APPs.
After much debate, it was decided that the bedside nurse would lead these rounds. A senior staff clinician, the respective APPs on each unit for the day, as well as our clinical pharmacist and, in the ICU, the intensivist attend as well. We created a template for the nurse to present each patient to us in a system by system fashion, stopping after each system for questions, or to address concerns and maintenance issues within that system. I realize that a multi-disciplinary format of reviewing patients is nothing new. In fact, we have always done weekly rounds in a similar format, however, it was clinician led. Our idea started as a way to educate newer nurses and APPs, as well as review patient details to ensure that nothing was being missed. What we did not expect, was the feeling of empowerment that was going to come with these rounds.
Now that we are all comfortable with the format, the newer APPs are often sharing their patient knowledge with the group, and stepping up to answer questions from nursing that are asked during rounds. Our newer nurses are learning to present their patient information in a format that is concise and more familiar to APPS. With the repetition, they are learning what we look for, and what details we consider important. Since they are the ones leading the rounds, they feel empowered as advocates for their patients. Our junior staff feels empowered to be able to assist in the education of the nurses, and to communicate what they have learned about the patients. Now, as a senior staff member overseeing these rounds, I often just watch and listen as the newer staff takes over. Patients often see us as a big group outside of their room, taking time to discuss their case in detail, and this shows them that we are all functioning together as a team to try to give them our best care.
Change is not easy. Rounding in this fashion every day takes a lot of time, and we have all had to adjust our workflow accordingly. It has been a reminder for me that another important part of leadership is to always be supportive of change, even if it is hard, because hard changes can often lead to unexpected rewards.