Nursing Practice Keywords: Ward rounds/Admission/

Discharge/Handover
Review
Ward rounds
Ward rounds are an essential aspect of good-quality
care. Nurses play a vital and central role in the process

The nurse’s role in

hospital ward rounds
In this article... 5 key
Why ward rounds are necessary points
1
Stages of the ward round process Ward rounds
The nurse’s role on a ward round provide a link
between patients’
admission to
Author Liz Lees is consultant nurse and within individual wards will vary hospital and their
senior clinical research fellow, Faculty of according to patient acuity and the volume discharge or
Education, Heart of England Foundation of admissions, discharge and transfers transfer elsewhere
Trust, Birmingham.
Abstract Lees L (2013) The nurse’s role in
hospital ward rounds. Nursing Times; 109:
received by the area. Ward rounds provide
a huge opportunity for interprofessional
learning and informal continuing profes-
2 Nurses have a
vital role in
ward rounds and
12, 12-14. sional development not only for junior should make it a
Ward rounds are a crucial aspect of acute doctors in training but also for the whole priority to attend
care, but nurses’ involvement varies. While
their responsibilities on ward rounds may
vary from ward to ward, nurses have a vital
multidisciplinary team (RCP, 2012b).

Ward round or individual patient

3 Ensuring
patients/carers
are fully involved
role to play and should make it a priority to review? in care decisions
attend. This article discusses key aspects The traditional ward round, which took is a nursing
of nurses’ responsibilities and the different place perhaps once a week, is outdated. responsibility
stages in the ward-round process. Rounds now take place more frequently –
4 When patients

W
sometimes twice a day – to reflect the pace are transferred
ard rounds are an estab- of patient turnover. or discharged,
lished, but sometimes It is important to distinguish between nurses ensure
fragmented, core activity ward rounds and ad-hoc individual clin- information is
of inpatient care during ical reviews of individual patients: unlike communicated
which decisions are made and tasks allo- clinical reviews, ward rounds should to the next stage
cated that aid the daily running of wards. involve the multidisciplinary team, while in the pathway
They require a well-organised multidisci-
plinary team to take part in the rounds,
and nurses play an essential role in their
individual clinical reviews – which are
additional to ward rounds – take place
when the registrar or another specialist
5 A rushed round
or one with no
nurse present will
smooth running. In 2012 the first inte- (perhaps a consultant or nurse specialist) have a negative
grated guidelines for ward rounds were needs to review specific investigations effect on the team
published, giving best-practice recom- with the patient in question. Ward rounds
mendations (Royal College of Physicians have a number of characteristics, which
and Royal College of Nursing, 2012). are discussed below.
A ward round is an essential organisa-
tional process providing a link between Stages of a ward round
patients’ admission to hospital and their There are three distinct stages to ward
discharge or transfer elsewhere. In the rounds, each of which has equal importance.
absence of ward rounds there would be
inertia in the patient flow, particularly for Antecedents (before)
unplanned (emergency) activity for which Key activities before a ward round takes
the preplanning of care is not always pos- place are:
sible (RCP, 2012a). » Establishing results of investigations;
The emphasis on rounds and frequency » Preparing patients – in most cases this

12 Nursing Times 26.03.13/ Vol 109 No 12 / www.nursingtimes.net

 Nursing For articles on the Francis report,

Times.net
go to nursingtimes.net/francis

Chaperone
As with any other examination or inter-
vention, protecting patients’ dignity and
privacy is a priority for nurses during ward
rounds (Lambert, 2010). If this role is dele-
gated to another team member, that
person should be aware of what chaper-
oning involves, which is as follows:
» P reparing the patient for examination
through communication and posi-
tioning;
» T aking responsibility for dignity and
privacy;
» M inimising any anxiety and potential
embarrassment;
» R especting cultural wishes throughout
the process.

Transitions
The need to minimise the length of inpa-
tient stays means there has never been
Involvement may vary but nurses have a vital role to play in hospital ward rounds greater emphasis on patient progress
along the care pathway. Multiple hand-
simply involves letting them know the are due to take place at the same time as overs during transitions between wards
round will be taking place; the ward round. However, the presence or between acute, intermediate and com-
» Encouraging patients to think about and participation of registered nurses munity care can lead to care being
any questions they may have, which increases their commitment to patient- fragmented. The continuity and safe
may help to avoid their forgetting what centred care. transition of information between care
is important to them; Nurses’ workload has increased over
» Chasing up any multidisciplinary per- recent years, and patients in hospital beds
spectives of care to discuss on the ward are more acutely ill; as such, ward rounds FRANCIS ON…
round. must be taken into account alongside WARD ROUNDS
numerous other skilled interventions
Critical attributes (during) when staffing levels and patient depend- ● Ward rounds are an opportunity for
This refers to the key activities, and per- ency are being reconsidered in relation to the multidisciplinary team to review a
haps type of structure, that is integral to a budget setting. patient’s condition and develop a
ward round: The key aspects of the nurse’s role on coordinated plan of care, while engaging
» Review of unstable or deteriorating ward rounds can be defined using the patients and/or their carers in making
patients; acronym ACTION: shared decisions about care
» Decision making and documenting of » Advocate; ● Ward rounds should be seen as a
care; » Chaperone; priority by all team members
» Review of patients going home (pre- » Transitions; ● A senior nurse should be present at
discharge); » Informative; every bedside patient review as part of a
» Review of patients’ progress during » Organiser; ward round, and the senior nursing team
their inpatient stay. » Nurse-centred. should be informed of all key decisions
made on the ward round
Consequences (after) Advocate ● No consultant ward round or visit
Once the ward round is over, a number of As members of the ward team attending should take place without the presence
activities will be necessary: the round, nurses need to know their of the nurse, or an appointed deputy or
» Team organisation; patients. “Knowing” arises from taking a other replacement, in charge of the
» Progression of tasks; nursing handover and looking after patients to be visited
» Communications; a group of patients, so handovers and ward ● As well as improving communication
» Repetition of information to the patient; rounds are inextricably linked if nurses and the flow of information between
» Motivation of the ward team. are to successfully represent those patients medical staff, nurses’ involvement in ward
in their care (Jugessur and Iles, 2009). In rounds is an important learning tool
Nurses’ role in ward rounds the context of ward rounds, being an advo- ● Senior nurses should ask student
There should be no debate about whether cate involves: nurses to present bedside updates. This
or not nurses should be involved in ward » Adequately preparing for the ward ensures students nurse are fully informed
rounds. The only debate, perhaps, is how round (safeguarding patients’ interests); about their patients, and gives them
to reinvigorate the nurse’s role among » Empowering patients to ask questions experience while providing the senior
what are often regarded as competing pri- on the ward round (being included); nurse with an understanding of the
orities such as medicine rounds, theatre » Communicating with the multidiscipli- student nurse’s abilities
Alamy

lists, observations – particularly if these nary team after a ward round.

www.nursingtimes.net / Vol 109 No 12 / Nursing Times 26.03.13 13

 Nursing Practice
Review

settings depends on the nurses who par- Nurse-centred nursing activities involved in ward rounds,
ticipate in the ward round, making sure Nurses at the bedside during ward rounds nurses will delegate and/or lead the actions
all relevant information is communicated must be clinically competent to under- that arise. The energy created by a well-run
to the next stage of the pathway (Hind- stand and anticipate the complexities of ward round will resonate across a whole
marsh and Lees, 2012). This may involve multifaceted patient situations, and able ward team, while a rushed round or one
the following: to view the patient and carer situation that has no nurse presence will have a neg-
» Noting any ongoing investigations and holistically rather than as a series of unre- ative effect, such that related actions
communicating these to the patient lated tasks. Systems such as team nursing, maybe fragmented.
and team; task-allocated nursing or primary nursing In busy ward environments it is a con-
» For patient transfers, documenting any may require some adaptation but for stant balancing act to prioritise the jobs
incomplete investigations/actions on a nurses to properly represent their patients, that need to be done within the ward rou-
handover checklist; they should be one of the following: tine; if, however, nurses lead by example
» For patient discharges, documenting » A nurse responsible for a bay or allo- and are present on ward rounds, it is likely
any relevant information on the dis- cated number of patients, who will that discipline will be instilled in the entire
charge checklist (NHS Institute for undertake the ward round for those team and an expected standard of practice
Innovation and Improvement, 2009; patients; for this core activity created. NT
Lees et al, 2006; Department of Health, » A nurse in charge of a whole ward or
References
2004); unit who is clinically overseeing all Department of Health (2004) Assisting Timely
» For specialty referrals, completing a areas of the ward and will feed back to Discharge from Hospital: A Multi-disciplinary
management plan indicating any next nurses after the ward round; Toolkit. London: DH.
Hindmarsh D, Lees L (2012) Improving the safety
steps in the care pathway. » A nurse who is not responsible for any
of patient transfer from AMU using a written
The aim is to promote transparency patients but is acting in a coordinating checklist. Acute Medicine; 11: 1, 13-17.
and continuity, and to reduce potential capacity for the shift and will be respon- Jugessur T, Iles L (2009) Advocacy in mental health
duplication or omissions of care during sible for feeding back information after nursing: an integrative review of the literature. Journal
of Psychiatric and Mental Health Nursing; 16: 187-195.
transitions. the ward round to the nurses who are in Lambert J (2010) Chaperones: practice, policy and
those bays. training. Practice Nursing; 21: 7, 347-349.
Informative In each of the above functions, having a Lees L et al (2006) Using post-take ward rounds
to facilitate simple discharge. Nursing Times; 102:
Nurses also play a crucial role in ensuring nurse at the bedside during ward rounds is 18, 28-30.
patients have realistic expectations of pivotal to enable and empower the team. NHS Institute for Innovation and Improvement
ward rounds, and receive and understand Although there will be some variation (2009) High Impact Actions for Nursing and
all the relevant information about their according to how the ward is organised Midwifery: The Essential Collection. Coventry: NHS
Institute for Innovation and Improvement. tinyurl.
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actively involved in making decisions nurse will focus on the “here and now” Royal College of Physicians (2012a) Hospitals on
about their care rather than being passive during the ward round, and anticipate and the Edge? The time for Action. London: RCP.
tinyurl.com/RCP-hospitals-on-edge
recipients. In order to execute this process, respond to related actions. Royal College of Physicians (2012b) Acute Care
nurses should: Toolkit 5: Teaching on the Acute Medical Unit.
» Reiterate information during or after a Conclusion London: RCP. tinyurl.com/RCP-AMU-toolkit
Royal College of Physicians, Royal College
ward round; Nurses and the multidisciplinary team are
Nursing (2012) Ward Rounds in Medicine:
» Prepare the patient for the next steps in central to ward rounds. Although this Principles for Best Practice. London: RCP/RCN.
the care pathway; article has attempted to define the core tinyurl.com/RCN-ward-rounds
» Explain anything (along the way) that
the patient may not understand;
» Encourage the patient to ask questions Unlimited access to learning units
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