Hey, I get it. Sometimes we are doing so much we feel like our head is spinning. But, guys, you can’t forget to do your daily rounds. It is THE one thing you can do that will give you your biggest return on investment of time.
First, give a copy of what you will be inspecting (your daily and your weekly audit sheets) to your nursing assistants and your floor nurses. Let them know what your expectations are. My best practice was to put a folder each unit with the “learn it now” 1-minute in-service with a sign-in sheet for each shift. Put the inspection sheets (with a “take one” sticker over the sheets) along with a sign-in sheet. This gives you a written record of who got the sheet so you can hold them accountable for doing what you are requesting.
Then, get out there daily. Say, for instance, you go in the shower room and it looks like a “dirty” bomb (literally, dirty) went off. Like, there are used adult briefs on the floor, wheelchairs with nasty clothes, sheets, towels etc. piled up on them, crap thrown in the tub, and unidentifiable brown stuff on the floor of the shower, etc. (You get the picture.)
Go out in the hall, grab every GNA assigned to that hall, and tell them they have 10 minutes to make that shower room right. After doing this a few times, you won’t need to do it again, especially when peer pressure takes over (if it’s due to just one or two bad apples).
What about call lights? I cannot tell you how many times in my career I’ve done spot rounds and see call lights on the floor, or pinned to the privacy curtain. You want to bet that I got someone in the room immediately? Come on, I know you see it too; but what do you do about it when you see it time and time again? Or, I must ask, do you make rounds and take a look?
What about the oxygen tubing labeling or are the nebulizers clean, or are the G-Tube feedings labeled and dated, is that oxygen tank on empty, are the oxygen tanks in the storage room in appropriate holders?
How about the medications in the carts and med room? Is anything expired? I know you all have a policy that assigns someone from one shift to go through them at least weekly but who’s auditing to ensure it’s done? And you can’t audit an audit sheet! You need to use your eyes.
Every day, as a nurse manager, you should be going out and looking at your residents at least twice a shift. How do they look (catch that change of condition early, gang)? What do the rooms look like? What do they smell like? (You are not allowed to go “nose blind”) What does the equipment in the room look like?
Look at the shower rooms at midday. Look at major things at least once a week. Make an audit schedule for yourself and stick to it, because you know what flows downhill. And if something happens to a resident or if you get cited, it’s you they’ll come after, not the staff.
Oh, and while you’re making those rounds, start rewarding those who are doing a great job. Verbally and maybe with a unit contest, like who consistently does a great job? Small gift cards or scratch-offs make a great incentive. People want to know you notice the good stuff too.
A nurse leader I know always says, “What you inspect, they will respect.” So take some advice from Nurse Jackie and get out there and look, check and hold your team accountable! You’ll be glad you did.
Just keeping it real,
Nurse Jackie
“The Real Nurse Jackie” is written by Jacqueline Vance, RNC, CDONA/LTC, Senior Director of Clinical Innovation and Education for Mission Health Communities LLC and an APEX Award of Excellence winner for Blog Writing. Vance is a real life long-term care nurse. A nationally respected nurse educator and past national LTC Nurse Administrator of the Year, she also is an accomplished stand-up comedienne. The opinions supplied here are her own and do not necessarily reflect those of her employer or her professional affiliates.
