Nursing grand rounds (NGRs) were commenced in a northern Australian health service in November 2010 as one strategy to support the developing evidence-based culture within nursing and midwifery. A previous publication (Smyth & Abernethy, 2013) explained the reasons for the choice of the grand round format and operational requirements related to hosting NGRs. That article also presented a summary of the evaluations of the first 17 grand rounds and suggested actions required to maintain the initiative across the health service that encompasses “diverse facilities located in regional, rural and remote settings across an expansive geographical area” (Smyth & Abernethy, 2013, p. 204).
Those initial grand rounds were considered successful while acknowledging the need to sustain and evolve the initiative. In 2015, the name of the initiative was formally modified to “Nursing and Midwifery Grand Rounds” in recognition of the fact that in Australia, midwives have additional requirements related to continuing professional development and maintaining their registration as health professionals (Nursing and Midwifery Board of Australia, 2015). However, for clarity, this article continues to use the term NGR.
Nurses and midwives can meet their obligations to keep up to date with contemporary developments within their professions, and management can support such initiatives in various ways. NGRs, in their various formats, have been adopted as one way to meet these obligations (e.g., Armola, Brandeburg, & Tucker, 2010; Iacono, 2008; Odedra & Hitchcock, 2012). However, despite an apparent increased adoption of grand rounds in nursing and midwifery, the current authors could locate only one article (Laibhen-Parkes, Brasch, & Gioncardi, 2015) published since the initial evaluation of this NGR initiative in which grand rounds were introduced with a similar intent to increase nurses' engagement with research evidence.
The current article presents an update on the NGRs held between September 2012 and November 2015, considers the relative merits of the strategies as proposed following the initial NGRs, and suggests options for the initiative in the future. As a service evaluation activity, there was no requirement to gain approval from the Human Research Ethics Committee.
The Evolving Model
This model of NGR has evolved over the past 3 years (Table 1), with perhaps the most significant change being the incorporation of case study presentations by recently qualified nurses and midwives. In 2014, these junior nurses stepped up to fill a last-minute gap in the program, and 11 case studies were presented over two sessions. Owing to the success of these presentations, it was decided in 2015 that a 10-minute presentation by a junior nurse or midwife would be incorporated into each grand round, linked to the topic of the main presentation. To support these novice presenters, a guide to the information to be included in the case study was devised by the nurse researcher and the nurse educator. This has been successful in guiding the nurses to focus on the nursing–midwifery care provided to a particular patient to describe how that care was person centered and linked with any of the standards applicable to the national health care accreditation process.
Changes Over the Past 3 Years, Since the Initial Evaluation of Nursing Grand Rounds
The inclusion of this particular group of nurses and midwives has required, on a regular basis, the active involvement of the nurse educators and clinical facilitators in the grand rounds initiative. They are largely responsible for nominating which nurse might present and encouraging and assisting with preparation of their presentations. The requirement to attend a predetermined minimum number of NGRs in the graduate year has also been incorporated into that broader program. This, in turn, has meant that we are guaranteed of a reasonable attendance at NGRs. However, feedback has been received that some nurse managers do not encourage attendance at NGRs because they are incorrectly perceived to be the domain of the graduate program.
Despite attendance at NGRs temporarily falling in 2013 (Table 1) from a previous average of 30 attendees per session over the initial 17 grand rounds (Smyth & Abernethy, 2013), overall attendance at the NGRs has increased since their inception, which necessitated finding a larger venue. The venue used in the first 4 years of the initiative was above a patient care area and even though attendees at NGRs were asked to minimize noise when entering and leaving the venue, the general noise level was potentially disruptive to unwell patients.
The time of the NGRs has also changed. In the initial years, the NGRs occurred during the lunch period. Nurse managers of inpatient areas requested that they be moved a little later, to be held in the shift changeover period of 2:00 pm to 3:00 pm. When the NGRs moved to the larger venue, there was only one time slot available on a regular monthly recurrence, so the day of the week also changed.
Evaluations have remained very positive over the past 3 years. Over that time, the evaluation form has been simplified and currently asks attendees to:
- Rate the content of the session and the presenter of the session on a 4-point scale: disappointing, average, good, excellent.
- Indicate reasons for attending the particular session, with the options of Interesting topic, Work in the area, Know the presenter, and Other.
- Identify the information presented that was of the most relevance to them (free-text responses).
- Identify the major benefit gained from attending nursing and midwifery grand rounds (free-text responses).
The summary of the responses to the rating questions is presented in Table 2. However, it is a little disappointing that despite simplifying the form and reminding attendees of the value of feedback to the presenters, in 2015, fewer than half of the attendees completed an evaluation.
Collated Responses to Evaluations, 2013–2015
The free-text responses mirrored these positive evaluations. For example, responses to the question asking what they found most relevant related directly to an aspect of that specific presentation. Supporting their colleagues was the most frequently noted major benefit of attending grand rounds. From those written comments, any disappointing ratings were related to the attendees' expectations of the content being different to those of the presenter and different to the description on the advertising flyers.
Incorporating the Strategies Proposed to Sustain the Initiative
Five aspects of the NGRs initiative warranted consideration to sustain the initiative (Smyth & Abernethy, 2013):
- It was proposed that the nursing executive needed to more visibly support each NGR. Actions taken to facilitate this proposal included asking nursing directors to introduce speakers from their areas and chairing those sessions; placing appointments in all senior nurses' electronic diaries at the beginning of each year; reminding nursing directors at their meetings of the importance of their support of NGRs; and requesting nursing directors to be part of the NGR organizing group. The nursing director who was part of the organizing group in 2015 did assist with chairing of the sessions when the nurse researcher was not available. Unfortunately, this proposal for greater nursing executive support has not been achieved to the extent anticipated on a consistent basis. From the attendance sign-on sheets, it was clear that few nursing directors were able to attend more than a couple of sessions in a year.
- The membership of the organizing group needed to be expanded, to represent the diverse areas across the health service. This also proved difficult, but the inclusion of the nursing director, responsible for the health service's rural facilities, actively promoted NGRs to nurses working outside the main hospital, as well as directly to the nursing executive.
- The resources required to sustain the initiative needed to be reviewed. However, no additional resources have been able to be allocated to the initiative; and indeed there is one fewer staff member in the nursing research department in the past few years. The nurse researcher and the administrative assistant for the nursing research unit continued to coordinate the sessions. This included planning the yearly program and organizing presenters for each session, securing a venue at a recurring time for each year, developing and distributing flyers advertising each grand round, and booking the videoconference links to all health service sites. The nurse researcher collated evaluations of each session and provided this feedback to all presenters, usually that same afternoon or the next day.
- The option for recording the presentations was explored. This was deemed not feasible because under the health service's guidelines for recording, all participants needed to consent and confidential information (such as that presented in case studies) could not be discussed. Also, recordings only remain available for a short time. Videoconferencing the sessions was not offered in 2014 because of the many and varied problems encountered with this mode of delivery and the poor uptake of this option. It was offered again in 2015 when the NGRs moved to a different venue, but the uptake continued to be poor.
- Greater interdisciplinary participation was envisaged. In 2015, two pharmacists and one medical officer participated in presentations; health professionals other than nurses and midwives attended some of the sessions over the 3 years.
The value of having a regular forum for nurses and midwives to share information about their areas of work and local research has been established. We have now hosted 50 NGR sessions, which have been evaluated positively by the attendees. Some individuals have valued NGRs so much that they have committed to attending as many sessions as possible, often to support their professional colleagues. Others have not made such a commitment. However, despite increased average attendance and relocation to a larger venue with more reliable videoconferencing equipment, only a small fraction of the nursing and midwifery workforce of approximately 2,500 is involved in NGRs.
Over the years, several nurses have presented more than once, and it is not too difficult for the organizers to secure presenters for the 10 NGRs per year. The standard of the presentations remains high, although we do not provide formal support to experienced nurses as has been done in other NGR programs (Iacono, 2008; Lannon, 2005). We continue to include presentations in styles other than case studies (Thistlethwaite et al., 2012), as appropriate to the topic and our audience. The inclusion of the presentations from the more junior nurses and midwives has contributed to a greater diversity of topics.
When NGRs were commenced in this health service, fewer supports were provided to local researchers from any professional group. Over the past 3 years, an annual multidisciplinary research symposium has been held, and in 2015 a Health Service Research Support Unit was established. These initiatives are intended to support and highlight local researchers and local research; hence, there are now other avenues for nurses and midwives to disseminate their research. In addition, it is envisaged that a day-long nursing forum will be held once or twice in 2016, following a successful trial in late 2015. Such a forum provides the opportunity for nurses and midwives to share information about their clinical areas, as well as to include information about research findings and evidence-based practices. All these activities provide support and presentation opportunities for nurse researchers that were not available at the time NGRs were introduced. The changing nature and direction of NGRs would allow time and resources for the nurse researcher to concentrate efforts to increase capability of nurses and midwives to undertake independent research.
One might question why we are proposing to make changes to the established NGR. We had considered continuing NGR as is; however, it is no longer sustainable for nurse researchers to continue to undertake the organizational tasks associated with coordinating NGRs. Because the needs of our clinicians are changing, and that the supports available to engage clinicians in evidence-based practice are expanding, we are proposing some alternatives to how NGRs have been conducted in this health service for the past 5 years. Those options include:
- Involve the health librarians and explore the implementation of a modified grand rounds format at the bedside. We anticipate commencing this slowly, in a clinical area that expresses interest in such a venture, and believe that the clinicians will value the opportunity to have their clinical queries answered in real time. This concept of embedding librarian and other expert support at the bedside has been proposed and explored elsewhere (Bridgen, 2014; D'Arrietta, 2005).
- Move responsibility for NGRs to the staff development unit to reflect the evolving emphasis of presentations on education and information sharing. This option has been agreed on by the nursing executive for 2016.
- Develop NGRs as part of the graduate nurse program. The novice nurses have responded well to presenting in front of their colleagues and focusing NGR on, for example, two case studies presented by recently qualified nurses per month could be a beneficial professional development activity for this group.
- Incorporate interdisciplinary research grand rounds every couple of months into the research education program organized by the newly established health service research support unit.
Given the topics of the NGR presentations, it is not possible to identify any changes in practice from the attendees; however, as a professional activity for nurses and midwives, the NGR initiative has been successful. Attendance has increased progressively, nurses volunteer to be presenters, and NGR has been supported by key persons over the 5 years. By adapting to the changing needs of our workforce, NGRs have retained their relevance as a format for ongoing nursing education, and we anticipate it to continue to evolve over the next 5 years.
- Armola, R.R., Brandeburg, J. & Tucker, D. (2010). A guide to developing nursing grand rounds. Critical Care Nurse, 30(5), 55–62. doi:10.4037/ccn2010486 [CrossRef]
- Bridgen, R. (2014). Keeping up-to-date with current practice. Health Information and Libraries Journal, 31, 89–91. doi:10.1111/hir.12067 [CrossRef]
- D'Arrietta, L. (2005, December). Librarians at the forefront of clinical patient care. HLA News: National Bulletin of Health Libraries Australia, pp. 1, 4.
- Iacono, M.V. (2008). Showcasing nursing talent: Nursing grand rounds. Journal of PeriAnesthesia Nursing, 23, 349–354. doi:10.1016/j.jopan.2008.07.007 [CrossRef]
- Laibhen-Parkes, N., Brasch, J. & Gioncardi, L. (2015). Nursing grand rounds: A strategy for promoting evidence-based learning among pediatric nurses. Journal of Pediatric Nursing, 30, 338–345. doi:10.1016/j.pedn.2014.07.008 [CrossRef]
- Lannon, S. L. (2005). Nursing grand rounds: Promoting excellence in nursing. Journal for Nurses in Staff Development, 21, 221–226. doi:10.1097/00124645-200509000-00007 [CrossRef]
- Nursing and Midwifery Board of Australia. (2015, March 2015). Fact sheet: Continuing professional development. Retrieved from http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/FAQ/CPD-FAQ-for-nurses-and-midwives.aspx
- Odedra, K. & Hitchcock, J. (2012). Implementation of nursing grand rounds at a large acute hospital trust. British Journal of Nursing, 21, 182–185. doi:10.12968/bjon.2012.21.3.182 [CrossRef]
- Smyth, W. & Abernethy, G. (2013). Nursing grand rounds: The North Queensland, Australia, experience. The Journal of Continuing Education in Nursing, 44, 203–208. doi:10.3928/00220124-20121217-44 [CrossRef]
- Thistlethwaite, J.E., Davies, D., Ekeocha, S., Kidd, J.M., MacDougall, C., Matthews, P. & Clay, D. (2012). The effectiveness of case-based learning in health professional education. A BEME systematic review: BEME Guide No. 23. Medical Teacher, 34, e421–e444. doi:10.3109/0142159X.2012.680939 [CrossRef]
Changes Over the Past 3 Years, Since the Initial Evaluation of Nursing Grand Rounds
|Involvement of recently-graduated nurses and midwives||Nil specific. One Bachelor of Nursing (Honors) student presented||11 nurses presented case presentations at two nursing grand rounds||10-minute case presentations incorporated into each monthly grand round|
|Venue||Meeting room, maximum of 40 people, located above an inpatient area||Meeting room, maximum 40 people, located above an inpatient area||Main auditorium, maximum 200 people, located in education block of main hospital|
|Day and time of sessions||Second Wednesday of the month, 12:30 pm–1:30 pm||Last Wednesday of the month, 1:00 pm–2:00 pm||Every third Thursday of the month, 2:00 pm–3:00 pm|
| Total at main venue||202||368 (although only 281 signed-in)||555|
| Average per session||20 people per session||37 per session||56 per session|
| Range per session||11–29||23–65||41–83|
|Evaluations||154 completed||196 completed||252 completed, form simplified, fewer questions|
|Overt involvement of nursing executive||Two sessions chaired by a nursing director; two presentations by nursing directors||No specific involvement||Nursing director who was part of the three-person organizing group chaired two sessions; two presentations by nursing directors|
|Responsibility for organizing grand rounds (membership of organizing group)||Nurse researcher, assisted by nursing director, infection prevention and control||Nurse researcher assumed full responsibility||Nurse researcher, assisted by nursing director for the rural facilities, and a nurse educator|
|Videoconferencing to off-campus sites||Offered (a remote site linked in on five of 10 occasions)||Not offered||Offered (a remote site linked in on three of 10 occasions)|
|Professional development certificates||Provided and completed by nurse researcher, distributed in return for a completed evaluation form||Provided and completed by nurse researcher, distributed in return for a completed evaluation form||Not provided. Individuals are expected to record their own reflective learnings in personal records|
Collated Responses to Evaluations, 2013–2015
|The program was rated (N = 565):|
|The presenter was rated (N = 559):|
|Motivation for attending the session (N = 842):|
| Interesting topic||451||53.6|
| Worked in a similar area as the topic||118||14|
| Knew the presenter||123||14.6|