By continuing to use the site you agree to our Privacy & Cookies policy

Should a nurse always be present on a doctors' ward round?

Posted by:

8 October, 2012

Should a nurse always be present on a doctors’ ward round?

The Royal College of Physicians (RCP) and the Royal College of Nursing (RCN) have suggested there has been a gradual erosion of “good ward rounds” and have launched new guidance to ensure that there is a standard of practice across all hospitals. The quality of rounds must improve to ensure that patients are seen as people and not conditions, they said.

Readers' comments (11)

  • everyone on the other thread about this subject know that a nurse should go on the doctors ward-rounds.

    we all think it's vital but we can't because there are not enough of us.

    our consultant comes on the ward at 9am, we have 2 staff nurse to 28 patients, at 9am we are still doing the drug-round, we are also getting patients ready for procedures and all the other stuff we have to do. The consultant cannot come onto the ward at any other time - he starts his rounds at 07.30 on other wards.

    suggestions please from those who say the quality of rounds must improve - more staff please, less patients please, supernumerary shift co-ordinator please.

    does the new guidance insist that more trained staff are employed and the nurse-patient ratio is increased? no, of course not.

    Unsuitable or offensive?

  • since Cameron did the rounds of the hospitals and insists on intentional rounding perhaps the importance of doctors rounds should also be brought to his attention so he can figure out how nurses have to the time to do these as well.

    Unsuitable or offensive?

  • Yes indeed there should be a nurse on the doctors ward round.
    Not enough nurses for all the jobs though.
    When a consultant insist a nurse to go around with his/her team. I am pluck off my other jobs and no one steps in for me. If I do not have the time to do something I get looked at as an incompentent nurse. I rush around like a mad woman not as a nurse should work. I so much want to work as a nurse.
    Ward managers also do not seem to have skills in organising work loads and be able to deal with flexability of work load. Most times the ward is understaffed but there are times when there is sufficient staff, if they are distributed according to work load and not according to the set pattern.
    I think Ward managers need training in allocation of staff to work load and its flexability and there should be senior sisters/ manager supervision not just on an early shift but late and nights. Also as we all know we need more hands on the job.

    Unsuitable or offensive?

  • yes as we as nurse see the service user more and know more about them.

    Unsuitable or offensive?

  • Yeah I think they should be present on ward rounds, nurses can bring symptoms and trends to the doctors attention and provide a unique insight into the patients day to day life, also nurses can advocate for the patient and family

    Unsuitable or offensive?

  • Yes RNs on the docs round essential so those that make the decisions to understaff......PLEASE fund UK hospitals with adequate RNs per unit!
    1 RN to 4:5 patients!!
    Australia did it because of the evidence out there....whats holding UK up?
    Or should I say which political party this time?

    Unsuitable or offensive?

  • of course they should be present they are the patients representative. With regard to Mr Cameron's regular ward rounds .i believe he was a bit over the top,I believe a middle of the road approach could be initiated. lets say when the handover occurs. so the patient will be asked about their status at least three times a day.each nurse will hand over each patient at the bedside.

    Unsuitable or offensive?

  • While I agree with all the comments above I have seen traditional ward rounds work really well on general medical wards. This is usually due to a set up when each wing is allocated to a different consultant and they do a lengthy round with the notes trolley and coordinating nurse. My only problem with these is they can be too long and the nurse in charge does not always know the patients as well as other staff. Doctors should be told any lengthy deliberation over complicated patients should be conducted after the round and the nurse looking after each group of patients should be encouraged to attend where possible.

    I have more recently worked on a surgical and cardiology ward. They both suffer from the problem of having 5-6 consultants and no standard times/practice for ward rounds. Most consultants want a nurse on their ward round but expect to jump when they click their fingers like their juniors. As everyone else has stated we are too busy for this approach. Cardiology is the worst I have experienced, patients are lucky if they see a senior doctor more than once a week. The cardiologists don't even ask for a nurse to accompany them and seem to show little interest in our opinion. The junior doctors learn from this approach and it is common to discover changes to care, often requiring nursing actions from the notes several hours after the patient was seen.

    I believe this is a symptom of modern healthcare management that doesn't value nursing teams. wards are frequently closed and reopened with no thought to the time it takes to set up a good nursing team. There is little concordance with medical and nursing targets and management criteria. Ward managers lack the power, time or freedom to make local changes to improve working practices. There should be regular ward MDT meetings to discuss issues and improve the way we communicate and work together. Consultants should provide a schedule of where they are at any given time and who to contact with concerns if they are unavailable. By working together in this way a new agreed protocol for ward rounds/consultant reviews could be made for each ward individually.

    To really transform the ward round and make it better than it ever was in the past we, or rather doctors need to consider radical changes to working practices. For example if ward rounds were all undertaken early to mid afternoon nurses would be free to be fully involved. Also results from the morning blood tests or other investigations would be available for review. This would require complete reorganisation of senior doctors' working practices, but is possible. Bottom line is we need to work together. Currently it feels like nurses, doctors and management (including matrons etc.) are all against each other. I salute any ward or trust that over comes this problem because I have yet to work for one.

    Unsuitable or offensive?

  • With consultants working on the wards, holding clinics, performing procedures, working in several theatres, when are they supposed to be able to even come to the wards to see their patients?

    I've seen consultants doing ward-rounds at 7am before they officially start work for the day, come on the wards during their lunch breaks or at 7pm when they have a break in their theatre list.

    The whole of the NHS is a complete mess, no-one has the time to do anything properly.

    Staff nurses frequently have 12 patients to look after, the ward sister is often confined to the office or spends the entire day in various meetings or speaking with managers - it's a terrible situation that just seems to be getting worse.

    No doubt this 140m technology will be used to replace a nurse on a ward-round.

    Unsuitable or offensive?

  • While I agree with all the comments above I have seen traditional ward rounds work really well on general medical wards. This is usually due to a set up when each wing is allocated to a different consultant and they do a lengthy round with the notes trolley and coordinating nurse. My only problem with these is they can be too long and the nurse in charge does not always know the patients as well as other staff. Doctors should be told any lengthy deliberation over complicated patients should be conducted after the round and the nurse looking after each group of patients should be encouraged to attend where possible.

    I have more recently worked on a surgical and cardiology ward. They both suffer from the problem of having 5-6 consultants and no standard times/practice for ward rounds. Most consultants want a nurse on their ward round but expect to jump when they click their fingers like their juniors. As everyone else has stated we are too busy for this approach. Cardiology is the worst I have experienced, patients are lucky if they see a senior doctor more than once a week. The cardiologists don't even ask for a nurse to accompany them and seem to show little interest in our opinion. The junior doctors learn from this approach and it is common to discover changes to care, often requiring nursing actions from the notes several hours after the patient was seen.

    I believe this is a symptom of modern healthcare management that doesn't value nursing teams. wards are frequently closed and reopened with no thought to the time it takes to set up a good nursing team. There is little concordance with medical and nursing targets and management criteria. Ward managers lack the power, time or freedom to make local changes to improve working practices. There should be regular ward MDT meetings to discuss issues and improve the way we communicate and work together. Consultants should provide a schedule of where they are at any given time and who to contact with concerns if they are unavailable. By working together in this way a new agreed protocol for ward rounds/consultant reviews could be made for each ward individually.

    To really transform the ward round and make it better than it ever was in the past we, or rather doctors need to consider radical changes to working practices. For example if ward rounds were all undertaken early to mid afternoon nurses would be free to be fully involved. Also results from the morning blood tests or other investigations would be available for review. This would require complete reorganisation of senior doctors' working practices, but is possible. Bottom line is we need to work together. Currently it feels like nurses, doctors and management (including matrons etc.) are all against each other. I salute any ward or trust that over comes this problem because I have yet to work for one.

    Unsuitable or offensive?

  • I've seen consultants doing rounds on their own because the junior doctors are elsewhere, catching up with their workload or in clinics.

    what a sham.

    yes, nurses should go on the wardrounds, so should the doctors (in an ideal world which we no longer live in).

    Saying that, sometimes the patient doesn't even bother staying on the ward to see the consultant, they are off to the shop, the canteen, out making personal phone calls.

    Unsuitable or offensive?

Have your say

You must sign in to make a comment.

newsletterpromo