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Consultants must involve nurses at bedside


Nurses at a large hospital trust have changed ward rounds to prevent consultants from leaving bedsides until they have discussed a series of questions about the patient with nurses.

The change has been brought in by respiratory nurses at Nottingham University Hospitals Trust following complaints about large variations in the way consultants carried out ward rounds.

A questionnaire identified that only four out of 25 nurses – mostly in senior positions – believed information or questions discussed during consultants’ ward rounds were “standardised”.

Just 11 said they felt involved in consultants’ ward rounds, with five saying they did not feel involved and nine that they were only “sometimes” involved. The vast majority said registered nurses did not attend all of the ward rounds.

As a result, consultants have been issued with a checklist of questions to discuss with nurses about every patient.

The questions include whether venous thromboembolism risk assessments have been carried out, whether the patient can move from intra venous to oral antibiotics, and whether their discharge can be nurse-led.

Consultants are not permitted to move on to other patients until each question has been discussed with a senior nurse.

The trust’s specialist receiving unit matron John Gray said: “Standardising consultants’ ways of working is a very big step forward. Their ward rounds were so variable before – some took 45 minutes, others three-and-a-half hours. This has been very empowering for nurses.

“For more junior nurses who don’t feel as confident to challenge a consultant on a canula or on antibiotics, this has given them a way to do that,” he told Nursing Times.

The scheme has also ensured that all consultants start their rounds by 9.30am on each of the three fixed days that they carry out them out, enabling earlier discharges.

Developed by the trust as part of work on the Productive Respiratory programme, it is hoped it will be spread beyond the current three wards it is operating in.


Readers' comments (9)

  • Directors of Nursing take note - they should all be really in charge of the patient's experience.

    Well done this hospital - look what happens when nurses really do focus on what is important to the patient.

    CNO England - please can you note this and ask all other senior nurses to follow suit!!

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  • This article is written in a highly insulting way. Could you imagine the BMJ publishing an article with the headline 'doctors order nurses to nurse'? The real sad thing is that younger nurses don't feel the need to attend consultant ward rounds and quite why they have to ask the consultant if a venous thromboembolism assessment has been carried I don't know.

    Further poor journalism - consultants cannot leave until they have spoken with a SENIOR nurse yet the article claims the initiative has empowered JUNIOR nurses.

    Most consultant i work with would be grateful if any nurse took an interest in their ward round!

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  • I couldn't agree more with Anonymous 10-May-2011 9:40 pm; the language choice is very poor indeed.

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  • It seems like a good initiative but I agree with the above comments. This piece of writing conveys its message badly through a very unfortunate tone, a poor choice of words and a bad turn of phrase.

    "Consultants are not permitted to move on to other patients until each question has been discussed with a senior nurse."

    how is this enforced? there is a suggestion here of coercion!

    "This has been very empowering for nurses."

    and here it looks as though the senior nurses on a 'power trip'!

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  • However the article has been writen, more efficient communication can only be a positive move to improve patient care. I cannot imagine that there was no consultation with the consultants, and that they agreed to it before the initiative was introduced.

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  • sorry first line above should read 'written', typo error

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  • Ah, I notice they have changed the headline/article slightly now!!!!! Hahahaha!!! This really is poor journalism.

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  • Working as a psychiatric nurse on a busy assessment ward I find this article fascinating because everyone on our ward work together as a team, that includes from the Consultant to support worker and everyone's input is seen as important. As for ward rounds the nurse's contribution and advice is just as important as other members of the multidisciplinary team. I am curious if an item is not on the checklist as mentioned in the above article does that mean it cannot be discussed, just a thought.

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  • Anonymous | 13-May-2011 11:49 pm exactly! I think that is the point. We are all part of a multidisciplinary team, with expert opinions within our own fields, whether medicine, nursing, psychiatry, etc, and we all work together and offer our opinions EQUALLY now. We have moved away from the era where Doctors issued orders and we all meekly followed (although there are still some cultural remnants of it in both our professions), and this article does nothing but reinforce that way of thinking with poor language (I don't know if you saw the article before they changed the headline) instead of decent journalism.

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