Anticipatory and intentional patient-centered care

WHEN YOU MAKE it a habit to check in on your patients regularly—not in response to a call light—something shifts. Patients feel cared for. Call lights go quiet. Your shift runs more smoothly. That’s the promise of purposeful rounding, and the evidence supporting it is stronger than you might think.

Purposeful rounding (hourly rounding or intentional rounding) is a structured practice in which nurses visit patients at scheduled intervals to address needs before patients have to ask. Rather than waiting for the call button, you proactively check on pain, positioning, toileting needs, and access to personal items.

The practice isn’t new, but its importance has grown. Under the Centers for Medicare & Medicaid Services (CMS) Hospital Value-Based Purchasing Program, your hospital’s reimbursement is tied directly to how patients rate their experience on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Hospitals that score in the bottom quarter nationally on these surveys risk losing up to 2% of their Medicare payments, a significant financial consequence that nursing practice directly influences. Nurses aren’t a line item on a hospital budget; they’re the frontline drivers of the patient experience, which determines whether reimbursement is protected or lost.

What the evidence shows

A survey of peer-reviewed literature confirms that structured nurse rounding consistently improves patient satisfaction. Most of the available studies were conducted before the COVID-19 pandemic, when staffing ratios, care models, and patient acuity looked different from today. The core finding that nurses who check in proactively improve how patients experience their care has held across settings and time periods.

What’s changed post-pandemic is the context: Higher acuity, increased travel nursing, and stretched staffing strengthen the case for an organized, consistent rounding structure. The most relevant recent evidence comes from quality improvement studies and systematic reviews conducted across medical–surgical, oncology, and rehabilitation settings.

Rounding reduces call lights, and that matters

When nurses round proactively, patients use their call lights less. A study by Johnson and Bryant showed that, on a 15-bed oncology unit, nurses who adopted a five-Ps framework—a nurse-developed structure addressing potty, pain, position, possessions, and pumps—reduced call bell use by 22% and total alarms by 28%, both statistically significant results. During the same period, patient satisfaction scores on promptness of response improved by 22.5%.

An earlier foundational study by Ford showed a 52% reduction in call-light use after the introduction of hourly rounding on a medical–surgical unit. Patients consistently described nurses as more attentive and responsive. These findings matter because every unanswered call light represents a patient whose need went unmet and a nurse whose attention was pulled away from another patient.

A 2024 systematic evidence synthesis by Reed and colleagues, conducted for the Veterans Health Administration and appraising 43 peer-reviewed articles, identified patient satisfaction as the outcome most consistently and positively associated with purposeful rounding. Of 24 studies that measured satisfaction, 19 reported improvement. Call-light reductions were documented in six of eight studies that measured it.

Rounding and HCAHPS: The numbers

According to a recent systematic review by Christiansen and colleagues, intentional rounding was associated with improved patient perceptions of nursing responsiveness and reduced call-bell use across multiple care settings. These improvements map directly onto HCAHPS domains, particularly responsiveness of staff and communication with nurses, that determine hospital reimbursement under value-based purchasing.

A quality improvement initiative by Peng and colleagues demonstrated that when rounding adherence improved from 77% to nearly 92% over 12 months, patient experience indicators followed. The authors also found that sustained adherence required more than staff effort, it needed systemic support, including automated reminders,real-time monitoring, and regular audits.

Why rounding works: Three drivers

Understanding why rounding improves patient satisfaction helps you use it more effectively. Three factors drive the results.

It gets ahead of the call light
Multiple studies confirm that most call-light requests are for basic needs—help getting to the bathroom, pain relief, repositioning, or reaching a personal item.

When you address these needs during a scheduled round, the trigger for the call disappears. Patients are less anxious, you experience less workflow interruption, and the entire unit becomes calmer. According to a landmark study by Meade and colleagues, more than half of all call-light requests relate to toileting, positioning, and comfort needs, which structured rounding directly addresses. Johnson and Bryant, Ford, and Reed and colleagues confirm these findings.

It meets the needs patients care about most
Patients don’t judge their care by the complexity of your interventions. They judge it by how well you met their basic needs. According to Meade and colleagues, and confirmed by Blakely and colleagues, patient satisfaction depends principally on patients’ perception of how attentive nursing staff were to their physical comfort. Rounding makes that attentiveness visible and reliable. When patients know you’ll return within the hour, they can wait, and they feel reassured rather than abandoned.

It communicates care
Of the three reasons rounding works, this is the one patients notice most. How you enter and leave the room during a round has real effects on satisfaction scores. Using an opening script that references something the patient mentioned last time (“You mentioned you wanted to try sitting up today. Shall we do that now?”) signals that you remembered and you care. A closing script that tells the patient when you’ll return and asks if there’s anything else needed addresses the anxiety that comes with uncertainty. In Notes on Nursing, Florence Nightingale wrote that “Apprehension, uncertainty, waiting, expectation, and fear of surprise do a patient more harm than any exertion.” Rounding provides the systematic answer to that observation. (See Rounding checklist.)

Download Printable Rounding checklist

How to make it work on your unit

Knowing that rounding works and actually sustaining it are two different challenges. The evidence is clear about what makes the difference.

Adapt the Ps framework to your unit

The most widely used rounding frameworks focus on a structured set of Ps—typically pain, potty, position, possessions, and sometimes pumps (for oncology or ICU settings). Think of these as a mental checklist, not a rigid script. McLeod and Tetzlaff, whose work on purposeful rounding implementation remains foundational in this field, emphasize that the specific Ps should be customized to your patient population. A rehabilitation unit might add a mobility check; a pediatric unit might substitute family communication. Focus on consistency, not uniformity.

Keep in mind that rounding doesn’t require a perfect moment. Consider a shift with seven patients: four have medications due (two antibiotics to gather and hang), one has a family at the bedside waiting to discuss discharge, and the others have routine needs. In that reality, rounding is less a scheduled event and more a structured habit layered into what you’re already doing.

When you enter a room to hang an antibiotic, that’s a round—take 60 seconds to ask about pain, check positioning, confirm the call light is in reach, and tell the patient when you’ll be back. When you step into the room with the discharge family, open with a brief patient comfort check before beginning the conversation.

Rounding in a busy shift isn’t about carving out extra time; it’s about maximizing every contact. A quick, structured check at each bedside visit captures the Ps, keeps the patient informed, and prevents the unmet need that might otherwise trigger a call light 20 minutes later.

Engage your team from the start

Rounding programs fail when they’re handed down without staff input. According to Dyck and colleagues, a first attempt at hourly rounding at a long-term care facility failed because the implementation was too rigid and outcomes weren’t shared with frontline staff. The second attempt, built with interprofessional input, flexible scheduling, and regular sharing of results, succeeded. The lesson: do it with staff, not to staff.

A quality improvement project by Peng and colleagues reinforced this point. Even with strong administrative support, sustained adherence required closing the loop on documentation: Nurses could only record a completed round by scanning the patient’s wristband or bedside QR code, eliminating the possibility of documenting rounds that didn’t happen. This technology-assisted accountability, combined with automated reminders during high-risk time periods, raised rounding rates from 77% to 92% over 12 months.

Leadership makes it last

Rounding programs that become part of the unit’s culture have visible, engaged nurse leaders behind them. When charge nurses mention rounding in shift handoff, when managers share weekly data with staff, and when administration treats rounding adherence as a quality metric rather than an afterthought, the practice sustains. According to Blakley and colleagues, the nursing director actively engaging and framing rounding as a patient-need anticipation tool, not an add-on task, were key factors in maintaining the program through periods of high census and staffing pressure.

Nursing implications

The evidence has direct, practical implications for nurses at every level. For bedside nurses working in today’s postpandemic environment, where staffing is tighter, patient acuity is higher, and care delivery has been redesigned, the most important takeaway is straightforward: Proactive rounding, one of the most impactful bedside practices nurses can use to improve patient experience, safety, and quality of care, has the potential to reliably improve how patients experience their care. You don’t need new technology, additional staff, or administrative approval to start. You need a checklist, a script, and a commitment to check in before the light goes on. (See Rounding checklist.)

For charge nurses and nurse managers, evidence points to your role in sustainability. Mentioning rounding in handoff, following up with staff on adherence, and sharing patient satisfaction data in team meetings signals that this practice matters. Successful programs are visible and valued at the unit level.

For nurse educators, the literature notes training gaps as contributing to rounding program failure. Dyck and colleagues and McLeod and Tetzlaff identify insufficient training and preparation of frontline staff as key reasons for breakdowns in rounding implementation.

New nurses, in particular, frequently lack the specialized assessment skills and risk-awareness needed to make rounds genuinely purposeful rather than superficial check-ins. Focused training during orientation and unit-level precepting on fall-risk assessment, pressure injury prevention, and pain management during rounds transforms a documentation exercise into a clinical one.

Nurses aren’t a cost to be minimized, they’re the primary driver of the patient experience scores that determine hospital reimbursement. Research by Peng and colleagues on nursing value and quality improvement indicates that when nurses operate at the top of their scope and own patient experience as a professional priority, organizations see measurable improvements in both patient outcomes and HCAHPS performance. Rounding serves as one of the most direct expressions of that value: a nursing-led, nursing-owned practice with real and measurable impact on how patients rate their care.

For nursing leadership and administrators, the financial case is direct: In a CMS value-based purchasing environment, every point gained on HCAHPS responsiveness and communication scores has reimbursement implications. Purposeful rounding programs offer a low-cost, high-impact strategy that requires reorganizing how nursing time is used, not adding to it.

Nursing at its best

Purposeful rounding isn’t a new idea, but the evidence supporting it has grown stronger and the stakes have grown higher. When nurses round proactively and systematically, patients feel more cared for, use their call lights less, and report higher satisfaction. The benefits reach every nurse, from the bedside to the boardroom.

The challenge isn’t knowing whether rounding works. It’s making it stick. That requires thoughtful implementation, staff ownership, visible leadership, and ongoing attention to adherence data. Done well, rounding doesn’t add to your workload, it organizes it.

Every round you complete is an act of professional nursing—anticipatory, intentional, and centered on the patient. The next time you finish a round and a patient says, “I never even had to press the button,” that’s not just evidence in action. That’s nursing at its best.
Teresa Brasac is chief clinical and informatics officer at Sonitor Technologies in Orlando, Florida.

American Nurse Journal. 2026; 21(10). Doi: 10.51256/ANJ102648

References

Blakley D, Kroth M, Gregson J. The impact of nurse rounding on patient satisfaction in a medical–surgical hospital unit. Medsurg Nurs. 2011;20(6):327-32.

Christiansen A, Coventry L, Graham R, Jacob E, Twigg D, Whitehead L. Intentional rounding in acute adult healthcare settings: A systematic mixed-method review. J Clin Nurs. 2018;27(9-10):1759-92. doi:10.1111/jocn.14370

Dyck D, Thiele T, Kebicz R, Klassen M, Erenberg C. Hourly rounding for falls prevention: A change initiative. Creat Nurs. 2013;19(3):153-8. doi:10.1891/1078-4535.19.3.153

Ford BM. Hourly rounding: A strategy to improve patient satisfaction scores. Medsurg Nurs. 2010;19(3):188-91.

Johnson BC, Bryant L. Call bell usage: Tracking the effect of hourly staff rounding. Clin J Oncol Nurs. 2020;24(3):328-30. doi:10.1188/20.CJON.328-330

McLeod J, Tetzlaff S. The value of purposeful rounding. Am Nurse Today. 2015;10(11):6-7.

Meade CM, Bursell AL, Ketelsen L. Effects of nursing rounds on patients’ call light use, satisfaction, and safety. Am J Nurs. 2006;106(9):58-70.

Nightingale F. Notes on Nursing: What It Is, and What It Is Not. Harrison; 1859.

Peng Y, Qiu S, Zhao D, Wang J. Improving the effectiveness of intentional rounding: A quality improvement project. Nurs Res Pract. 2026;7573541. doi:10.1155/nrp/7573541

Reed CC, Wayman L, Walsh-Irwin C, et al. Purposeful nurse rounding: A review of the evidence. Medsurg Nurs. 2024;33(2):85-91. doi:10.62116/MSJ.2024.33.2.85

Key words: Purposeful rounding, patient satisfaction, patient experience