Award round is a key feature in the care of patients in hospital, an important organisational process, providing a link between a patient's admission and discharge or, if needed, transfer to another care provider. The ward round provides an opportunity for patient review and is the main focus for hospital multidisciplinary teams (MDTs) to undertake assessments and care planning with patients (Royal College of Physicians and Royal College of Nursing, (RCP and RCN), 2021).
Ward rounds are complex clinical activities, critical to providing high-quality, safe care in a timely and relevant manner. They enable the MDT to review a patient's progress, clarify diagnoses, determine use of resources (ie medications and investigations), review problems and develop a coordinated plan of care, while enabling patients and carers to take an active part in shared decisions. Ward rounds also provide openings for effective communication, information sharing, undertaking clinical safety checks. These opportunities should not be underestimated.
They offer a valuable forum for communicating and disseminating important information that impacts patient health and wellbeing, so they need to be conducted in a way that is meaningful and beneficial for all stakeholders. A ward round has to be conducted in a democratic fashion: the domination of one group (professional or otherwise) over another must be avoided. However, a number of competing constraints can adversely affect the delivery of ward rounds, including gaps in workforce, inadequate planning, unwarranted variation in practice, as well as the absence of the training of skills needed to deliver complex MDT care. Such constraints can lead to errors in care, longer hospital stays and readmissions, as well as frustration for staff, patients and carers.
The review by the RCP and RCN (2021) discusses good practice being delivered in the NHS and offers guidance that clinical teams can use to self-assess and identify priorities for improvement. To provide effective practice requires considerable change in most ward rounds in UK hospitals, and the report discusses how care can be delivered in a way that ensures partnership with patients, families and carers, so as to improve outcomes. The review recommends medical consultant-led delivery, but acknowledges that in some settings it may be senior nurses or therapists.
Ward rounds are important for patients and the nurse's function should not be limited to providing information for medical staff. Patients should be more involved, given more explanations and encouraged to ask questions. Nurses can sometimes be perceived by medical staff to be too busy with nursing tasks for increasingly complex patients, however, nurses have expressed frustration at not always being involved in wards rounds. Nurses should assert themselves, and all professionals should aim towards more democratic, equal discussion (RCP and RCN, 2021).
The day of the nurse as doctors' handmaiden is long gone, but this outdated notion contaminates all professional interactions and can be detrimental to outcomes and job satisfaction. The media may be responsible for promulgating the notion that we are merely physician's subordinates, mute servants, subservient helpmates, but we too have to share some responsibility. We have a responsibility, indeed it is a requirement of our Code (Nursing and Midwifery Council, 2018), to promote professionalism and trust and to uphold the reputation of the profession at all times. Nurses who value what they do and what the profession stands for should use all resources available to them to advocate and uphold our professional values.
Nurses educate, manage and regulate themselves. We have a unique focus and scope of practice, which includes practising autonomously, with the patient central to all we do, making every contact count.
The ward round needs to be restored to a position of central importance (as ever it was) in how we all, as a collective, care for and communicate with patients.