Intentional rounding, presented as a strategy that puts the patient at the centre of ward activity, requires nurses to undertake regular and standardised checks on individual patients at set intervals to assess and manage their fundamental care needs. It is a ‘package of interventions’, a political intrusion to provide a simple solution to a multifaceted problem. It is an organisational initiative that does nothing more than to tell nurses when and how to interact with the people they offer care and support to, and above all it is an absolute insult to nurses the world over.
The Francis Report (2013) considered masses of evidence regarding the reasons for failures in patient care that occurred at Mid Staffordshire NHS Foundation Trust between 2005 and 2009. One of 290 recommendations for improvement was that ‘regular interaction and engagement between nurses and patients and those close to them should be systematised through regular ward rounds’ and thus intentional rounding, a phrase that is synonymous with regular ward rounds, was introduced in almost all trusts in England as part of a larger quality-improvement initiative.
Intentional rounding—an import from the USA—is a tick-box exercise at its best. High-quality, effective nursing is so much more than a series of documents to be signed. In the UK, the focus was put on registered nurses undertaking rounds, with the support of nursing associates (NAs) and healthcare assistants (HCAs). In some hospitals registered nurses, NAs and HCAs may undertake rounds alternately each hour, in other hospitals the whole interdisciplinary team is involved—there is no set procedure or protocol. The frequency of rounding and which patients are included also vary. When introduced there was no guidance on how to implement rounding or how to measure the impact, and that ambiguity remains today.
Evidence for the effectiveness of intentional rounding has always has been weak. According to Harris et al (2019) it makes only a minor contribution, if any, to how nurses engage with patients. They noted that it has the potential to promote consistency in the completion of patient documentation, but there was also evidence of staff not following the protocols. The approach can bolster accountability for care and offer assurance about risk management for senior managers, but it does little to support the nurse–patient relationship (Willis et al, 2016).
There are concerns that it oversimplifies nursing, and the priority becomes the completion of documentation as evidence of care delivery. The knee-jerk reaction from the care failures detailed in 2013 took the form of intentional rounding, bells, dashboards and whistles. This is not the panacea for all ills that befall the profession.
Person-centred care is the gold standard of patient care and rounding has brought back and promoted task-oriented care, routinised and ritualistic practice that fails to address the intended aim: to encourage and enable relationships between staff and patients. We should emphasise and value an intuitive method that considers each patient's needs; we need meaningful conversations that facilitate an enabling approach to care provision and the acquisition of useful knowledge about the person.
Intentional rounding requires nurses to go round their patients on a regular basis to see how they are. Is this not something we have been doing for years? Where more effort is needed is to find out why it is that some nurses may leave some aspects of care ‘undone’ and to develop new ways of providing effective inpatient care. Leaving care ‘undone’ might, perhaps, have something to do with the more than 40 000 nursing vacancies in England alone.
This gross affront to nurses and nursing practice has now seen the final nail in its coffin. It should never have been given the light of day and must be confined to the dustbin.