Enhance the patient experience by taking the time to sit and listen.

Nursing leaders work to improve patient outcomes, ensure patient safety, and cultivate staff engagement. Patient safety became more urgent with the Institute of Medicine’s (now the National Academy of Medicine) 2000 landmark report, To Err Is Human: Building a Safer Healthcare System. Since its publication, organizations have committed to implementing well-established and novel approaches to patient safety. Currently, the Centers for Medicare & Medicaid Services offer financial incentives for hospitals based on nurse-sensitive quality outcomes and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey scores.

Patients’ perceptions of their care may not correlate to the actual quality of care given but rather their beliefs about what they perceive as quality care. Nurse leaders must address the patient experience with approaches that impact multiple goals simultaneously. One such approach involves nurse leader rounds, or what we call “nurse leader rounds plus” (NLR+). This underutilized initiative can improve the patient experience, enhance the culture of safety, and increase staff engagement.

NLR+ defined

NLR+ serves as an embodiment of your commitment to patient-centered care. High-quality rounds don’t consist simply of checking off a task-focused list of questions to ask the patient or their loved ones. Rather, it should involve making authentic connections that allow the healthcare consumer to feel prioritized and embraced in your genuine presence; the patient’s perspective should take top priority. In addition, according to Littleton and colleagues, NLR+ increases patient satisfaction scores.

Depending on the organization, you may have to complete a certain percentage of patient rounds each day. However, a required quota may sacrifice quality interactions. Perhaps you can efficiently ask all of the required questions on your checklist and move onto the next patient quickly, but have you conveyed presence and sincerity? If not, you can’t make a positive impact on the patient experience. When done right, NLR+ enhances connections between patients and the care team, while simultaneously reducing the patients’ anxiety.

Round this way: NLR+

Effective NLR+ requires planning. Review your calendar to ensure you have no competing priorities. This helps to minimize interruptions and feeling rushed to complete the rounding. For example, set a block of 45 to 60 minutes for a meaningful morning NLR+. In addition, consult with staff for their recommendations on patients who might particularly benefit from rounding. This allows you to obtain key information; it also enhances staff buy-in by letting them know that you value their opinion.

The staff might refer patients who had care concerns overnight, or someone who’s expressed having an excellent hospital stay. If staff have no specific patients in mind, review the unit census. Prioritize new admissions, patients ready for discharge, and those who had a clinical incident overnight (such as a fall).

Before setting out for your rounds, consider collecting a bag of items to give out to patients. They could include novelty items that the organization provides (such as hats, tote bags, and healthcare literature) or patient care supplies (such as a roll of tape, alcohol swabs, port disinfectant caps, and sterile gauze).

Make an entrance

Always knock before entering the patient’s room. Confinement to a hospital bed means giving up certain control of one’s established routines, so staff should always respect their privacy. Giving patients the opportunity to exercise control over their space can help mitigate feelings of helplessness.

After entering, introduce yourself and explain the purpose of the visit. Next, ask the patient for any name preferences and ask permission to take a seat while you talk. A sit-down visit enhances communication by promoting eye contact. Being on the same “level” with the patient conveys a more empathetic interaction and lets the patient know that you’re making time for them.

As you take in the atmosphere of the room, scan the environment for any notable artifacts, such as pictures, personal items, medical devices, and the placement of the call button. If the patient has visitors, include them in the conversation. Setting a social tone for the NLR+ can make the patient and their loved ones feel more welcomed. For example, if you notice that the patient is wearing a baseball hat, you might say, “I see that you have a baseball hat, I’m actually a baseball fan too.” This small talk can spark the start of rapport. People enjoy speaking about themselves; it activates the pleasure centers in the brain.

Without sounding like an automaton, ask open-ended questions, then wait for the patient to answer. Keep in mind the patient’s age, condition, and cultural background, which may impact their willingness to converse. When you let the patient lead the conversation, you allow for a patient-centered interaction. Focus on what’s important for the patient. For example, if the patient expresses concern about the noise on the unit, don’t point out the cleanliness of the room.

Safety checks

The NLR+ provides an opportunity to reinforce evidence-based care bundles to prevent healthcare-associated infections, such as catheter-associated urinary tract and central line–associated bloodstream infections. Quickly scan the integrity of central line dressings or indwelling urinary catheters. If needed, replace any missing central line disinfectant port caps or reposition the urine collection bag. If the patient’s assigned nurse is at the bedside, take a moment to address the plan of care for the shift with the patient’s input.

Listen to understand

During NLR+, don’t assume anything and actively listen to what the patient says. Avoid interrupting while the patient speaks. Allow the patient to express their perception of their hospital stay. If the patient points out lapses in care, offer a blameless apology and try to rectify the situation. Implement service recovery strategies (such as frequent rounding) in collaboration with the staff.

Enhance health literacy

Health literacy refers to the patient’s ability to acquire, process, and understand their own basic health information to make appropriate healthcare decisions. Hospitalized patients experience high cognitive loads as a result of multiple interviews, physical exams, procedures, and other treatments. Nurses strive to provide adequate patient education but can, at times, miss key information. With that in mind, repetition and teach-back can help reinforce previous education. Using the teach-back method, ask the patient to explain health information in their own words. This will give you an opportunity to ascertain whether the patient understands any new medications or the plan of care.

In patient teaching, use no more than a sixth-grade language level. Keep in mind that instructions that make sense to you, such as, “Take one tablet by mouth twice daily,” may prove confusing for patients, even those with adequate literacy levels. Statements such as, “Take one tablet in the morning and one tablet at 5 pm,” however, provides more clarity, and lends itself to paying special attention to the explanation of medications and their potential side effects. This also presents an opportunity to offer medication literature based on the patient’s literacy needs.

Acknowledge the patient

At the end of the NLR+ visit, thank the patient for their time and ask if they need assistance with anything else. Taking a minute to summarize any need deliverables or follow-up actions will help the patient feel heard and valued. This not only enhances satisfaction with the care received but also provides a boost to the patient’s overall well-being.

Acknowledge any negative encounters, express a willingness to understand the situation, inform the patient of any next steps, then address the patient’s overall experience with the nursing staff. Make note of any nurses mentioned for going above and beyond in service to the patient and share those acknowledgements with the staff during the next huddle meeting. These shout-outs will help reinforce behaviors that positively impact the patient experience.

Circle back

Circling back with the patient shows your sincerity in dealing with any concerns and also closes the communication loop. The NLR+ serves as one of the many landing pads for personally addressing the HCAHPS domains of responsiveness, discharge information, and communication of medications. If you identify opportunities for improvement, schedule a staff debriefing session.

Essential to safety and care

The NLR+ can become an essential part of a nurse leader’s day, and organizations should ensure that they have the bandwidth necessary to perform this essential element of patient safety and quality care. A well-executed NLR+ has the potential to boost patient experience satisfaction, improve staff morale, and allow the nurse leader to practice to the fullest extent of their education and role competencies.

Gary Camelo is a patient care director in the surgical stepdown unit at New York Presbyterian Weill Cornell Hospital in New York City. Fidelindo Lim is a clinical associate professor at New York University Meyers College of Nursing in New York City.

American Nurse Journal. 2025; 20(2). Doi: 10.51256/ANJ022541

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Key words: nursing rounds, nurse leaders, patient satisfaction, patient safety