I get asked whether rounding works often enough that I have started answering with a question of my own: which rounding do you mean?
That is not pedantry. At least three distinct practices in healthcare go by that name. They have different participants, different purposes, and separate bodies of evidence. When someone tells me the research supports rounding, they are usually citing one of them and applying it to another.
Three practices, one word
Patient rounding — also called intentional or hourly rounding. A nurse checks on a patient at set intervals using a standardised protocol, addressing pain, position, toileting and reachable belongings. Participants: clinician and patient.
Leadership or safety walkarounds. Senior leaders visit a unit specifically to surface safety concerns. Participants: executives and frontline staff.
Leader rounding on staff. A manager has recurring individual conversations with the people who report to them about how the work is actually going. Participants: leader and team member.
That three-way split is mine, and I want to be straight about that. The first two boundaries are recognised in the literature — Foster and colleagues (2023) treat leadership walkarounds as a distinct construct, and Bayram and colleagues (2023) explicitly exclude safety walkarounds from a review of manager rounding. Researchers have complained for a decade about definitional confusion: Hutchinson and colleagues (2017) found "poor definitional clarity… with various labels used interchangeably," and Bayram's team counted 88 different terminologies across 72 studies.
But no published typology contains leader rounding on staff as a category. Where "leader rounding" appears in the literature it is patient-facing — a manager at the bedside. The staff-directed version is a practitioner and vendor construct.
I use the three-way split because it is operationally useful. It is not a finding.
Patient rounding: adopted almost universally, and it does not do what it was adopted to do
This is the best-studied of the three, and the results are uncomfortable.
England ran a large government-commissioned evaluation after intentional rounding was introduced on the recommendation of the Francis Inquiry. The programme produced a national survey and realist evaluation (Harris et al., 2019) and a case-study evaluation across acute and older-people wards (Leamy et al., 2023).
Adoption was near-total. 97% of responding NHS trusts had implemented it. 81% had a structured protocol. 96% documented it.
The mechanisms mostly did not work. The team hypothesised eight mechanisms through which intentional rounding was supposed to produce benefit. Two were partially activated — consistency and accountability. Two were inconclusive. Four showed no evidence at all, including the ones the practice was justified by: allocated time to care, nurse–patient relationships and communication, and patient empowerment.
(The 2019 monograph counts three with no evidence; the 2023 paper counts four. I am using the later figure.)
The authors' own conclusion: the effectiveness of intentional rounding, as currently implemented and adapted in England, is "very weak and falls short of the theoretically informed mechanisms."
And their recommendation was blunter than anything I would have written. One option, they said, could be to consider abandoning intentional rounding and replacing it with nursing procedures fit for purpose.
What it became instead
The observational findings are the part I keep returning to.
Researchers watched rounds happen. They found nurses documenting rounds for patients who were asleep or not there. They found completed documentation for patients nobody had spoken to. They found round times written in advance, and six nurses who said they completed the paperwork before or without doing the round.
The gap between record and reality was measured: 86% of interactions were documented, while the actual components of intentional rounding went unobserved in between 26% and 98% of instances — with staff knowing they were being watched.
Sims and colleagues (2020) concluded that the practice "prioritises data collection through tick boxes," that its documentation is "primarily valued by nursing staff as a means of protecting themselves rather than patients," and that it "neither improves the delivery of compassionate nursing care nor addresses the policy imperative it was intended to target."
The form was implemented. The mechanism was not.
One thing that does hold up
Mitchell and colleagues (2014) conducted the only review in this literature to apply formal GRADE assessment. They found moderate-strength evidence that hourly rounding reduces falls — a median 57% reduction across nine studies.
With a caveat that matters: only two of those nine studies reached statistical significance. The single cluster-randomised trial in the field, Di Massimo and colleagues (2022), supports the falls signal on a secondary analysis while its own primary endpoint was null.
So: modest, mostly uncontrolled benefits on outcomes that are easy to count. Consistent failure to demonstrate the practice works through the relational mechanism used to justify it.
Leader rounding on staff: much thinner
This is the practice most organisations have adopted as a leadership discipline. It is the one I teach. Its evidence base is the weakest of the three.
No randomised trial has tested leader rounding on staff as a relational practice. Two randomised trials exist of adjacent walkaround practices, and both point the wrong way. Thomas and colleagues (2005) randomised 23 clinical units in a teaching hospital to executive walk rounds or usual care and found no effect on nurse safety climate attitudes. Tucker and Singer (2015) randomised across 92 hospitals and found the main effect of management-by-walking-around was negative.
Those tested walkarounds, not relational contact. But if you are looking for randomised evidence in this space, that is what exists, and it does not support the practice.
The industry evidence is not what it appears to be. A widely circulated 2023 report from AONL and Crucial Learning, Connection is Retention, is often cited as showing rounding does not affect retention. I have read it. There is no methodology section. No response rate — it reports how many people completed the survey but not how many were asked. No validated instrument. No statistical tests of any kind.
It does report comparisons: one group is 81% more likely to do something than another, another is three times more likely. But nothing in the document tests whether those differences are real. The rounding finding rests on 562 bedside nurses, and the outcome is whether they expected to quit within three years — not whether they did.
It is a white paper, not a study, and it should be described that way.
And the one documented failure is a doctoral project, not peer-reviewed research — a DNP scholarly project in a university repository. Twenty-two nurse managers were expected to round on nearly a thousand nurses at least monthly for three months. Of the 2,979 rounds that implied, 87 happened. Three percent.
Staff-reported perceptions of their leaders declined across every measured dimension over the same period, and the declines were statistically significant. I would not lean on that second finding — the survey drew about a ten percent response — but the completion figure needs no statistics at all.
The finding inside that last one
Read it again, because it is the useful part.
Scores dropped in a programme that barely happened. That is not evidence leader rounding fails. It is evidence that announcing a practice and not doing it fails — and those are different claims.
If you tell your staff that leaders will be rounding, and rounds happen three percent of the time, you have not run a weak version of the practice. You have demonstrated that the organisation says things it does not do.
That is the same finding the English researchers made about patient rounding, in a different practice with different participants. Both versions fail the same way: the form gets implemented and the mechanism does not.
I want to be careful here. That pattern is established directly for patient rounding, where it was observed and measured. For leader rounding it is a reasoned inference — no equivalent evaluation exists.
What I changed
I stopped presenting leader rounding as something that improves engagement, because I could not support the claim.
I teach it now as an execution problem, and the execution has a shape:
Fixed time, fixed frequency, protected on the calendar. A round that happens when there is space for it does not happen.
One standing question, asked every time. The same one, so patterns become visible across weeks.
No agenda item of your own. The moment you bring something to deliver, it has become a briefing.
And a closed loop within a stated window. What you heard, what you did about it, told back to the person who raised it.
That last one carries the practice. Contact that collects concerns and disposes of none is worse than no contact, because it teaches the team that being asked is not the same as being heard. Do it twice and people stop telling you things — and you will not notice, because nothing arrives to tell you that nothing is arriving.
Two questions worth asking about your own programme
What percentage of intended rounds actually happened last quarter? If nobody knows, you do not have a programme. You have an intention. And the English data suggests the honest answer is often far lower than anyone believes.
When someone raises something, what is the defined path, and how long does it take? If there is no answer, you are collecting information you have no route to act on — and your staff have already worked that out.
Neither question requires research to answer. Both are more useful than the literature currently is.
What is your round-completion rate, and does anyone in your organisation know it?
Myrtle Roy speaks and advises on operational accountability and the structures that hold when leaders are stretched. To discuss a keynote, workshop, or advisory engagement, visit myrtleroy.com/booking.
Bibliography
1. Foster M, Xiong W, Quintiliani L, et al. Impact of leadership walkarounds on operational, cultural and clinical outcomes: a systematic review. BMJ Open Quality. 2023. https://doi.org/10.1136/bmjoq-2023-002284
2. Bayram A, Pokorná A, Ličen S, et al. Nurse manager rounding: a scoping review. Journal of Advanced Nursing. 2023. https://doi.org/10.1111/jan.15307
3. Hutchinson M, Higson M, Jackson D, Wilkes L. Rounding in nursing: a concept analysis. International Journal of Nursing Practice. 2017. https://doi.org/10.1111/ijn.12584
4. Harris R, Sims S, Levenson R, et al. Intentional rounding in hospital wards to improve regular interaction and engagement between nurses and patients: a realist evaluation. NIHR Health Services and Delivery Research. 2019. https://doi.org/10.3310/hsdr07350
5. Leamy M, Reynolds E, Robert G, et al. Intentional rounding: a realist evaluation using case studies in acute and care of older people hospital wards. BMC Health Services Research. 2023;23:1341. https://doi.org/10.1186/s12913-023-10358-1
6. Sims S, Leamy M, Levenson R, et al. The delivery of compassionate nursing care in a tick-box culture: qualitative perspectives from a realist evaluation of intentional rounding. International Journal of Nursing Studies. 2020. https://doi.org/10.1016/j.ijnurstu.2020.103580
7. Mitchell MD, Lavenberg JG, Trotta RL, Umscheid CA. Hourly rounding to improve nursing responsiveness: a systematic review. Journal of Nursing Administration. 2014. https://doi.org/10.1097/NNA.0000000000000101
8. Di Massimo DS, Catania G, Crespi A, et al. Intentional rounding versus standard care for patients hospitalised in internal medicine wards: a cluster-randomised controlled trial. Journal of Clinical Medicine. 2022;11(14):3976. https://doi.org/10.3390/jcm11143976
9. Thomas EJ, Sexton JB, Neilands TB, Frankel A, Helmreich RL. The effect of executive walk rounds on nurse safety climate attitudes: a randomized trial of clinical units. BMC Health Services Research. 2005;5:28. https://doi.org/10.1186/1472-6963-5-28
10. Tucker AL, Singer SJ. The effectiveness of management-by-walking-around: a randomized field study. Production and Operations Management. 2015. https://doi.org/10.1111/poms.12226
Not peer-reviewed
Listed so the sources can be examined directly. Both are described in the article as what they are.
11. Crucial Learning and American Organization for Nursing Leadership. Connection is Retention: Lessons from Leaders with Unusually High Nurse Retention. June 2023. Survey administered 1 March – 1 April 2023; 1,559 nurse managers and 562 bedside nurses. No methodology section, no response rate, no validated instrument, no statistical tests. https://cruciallearning.com/resource-center/healthcare/nurse-study/
12. Bluford B, Riebsomer ET. The Impact of Nurse Leader Rounding on Staff Nurse Perceptions of the Work Environment. Doctor of Nursing Practice project, University of New Mexico College of Nursing, 2022. Pre-survey response 10.3%, post-survey 10.1%. https://digitalrepository.unm.edu/dnp/20/