[ensense]

I have been an ER nurse for 22 years now and this has to be one of the hardest parts of my job, customer satisfaction and Press Ganey. I work in an ED that sees 135 patients daily with the highest volumne during my shift 7p-7a. The problem I am having as well as many of my co-workers is that the hospital has decided for the last two years to use the Press Ganey survey company to evaluate our hospital. That in its self isn't much of a problem but when they start staying on us to the point it is interfering with our jobs it gets to be quite a head ache.
We as an ER have an average wait time of 2 hours or so. I think that is very good considing there are only 5 nurses on each shift . We have 2 doctors during peak times with a fast track open on weekends for even higher volumne.
My question is if anyone else has similiar problems keeping patients happy while still covering the TRUE emergencies. Even when I have a great day and don't let anyone fluster me I still can't seem to make the majority of patients happy. They get mad about the wait time, the lab wait time, the doctor attitude and the list goes on. Has any one out there got any ideas that I can take back to my ED customer satisfaction comittee to improve our scores. This is getting so old and it definitely takes the little bit of fun out of a very demanding job.
Thanks for any help any one can provide.

[cheerfuldoer]

Sounds like the same things that can be done in all hospitals are not being done to bring about true patient satisfaction, such as:

reducing the wait time by providing a better nurse/patient ratio

having more doctors on duty who aren't so "organ specific" to take care of said load of patients

better triage and placement of patients based on their admission complaints to ER and throughout the hospital units as a whole

[canoehead]

Tell them what the wait time is when they sign in, and that life threatening emergencies will go ahead of them.

TV in the waiting room.

Directions to the snack machine and bathrooms, and phone

[MAGIK GIRL]

ensense: i feeeeeel your pain!


what i have learned over the past 12 years is simply
to smile and nod. after all, you can say just about
anything to just about anyone with a smile on your
face. remember all that stuff about smiling from your
customer service manditory classes? well, it can
work to your advantage.
i know what you are saying but unfortunately, management will never change and customers are the ones with the bucks! but i will tell you this, i don't think basing your evaluation on press gainey scores is very fair. i did however work at a place where the nurse manager and the director of the docs were "encouraged" to resign and the scuttle butt is that this was mandated by those scores! that sucks!

keep a stiff upper lip and don't let em get to you!
mg

[athomas91]

the er i currently work in is very aware of customer satisfaction and does everything they can to promote it - but my management ALWAYS stands by the nurses when there are complaints- and i cannot tell you how much that means on bad nites - when you know some dip$^&* is goint to complain -
you go home knowing you did the best you can - and there is no need to worry because your manager is going to tell them like it is - be happy w/ a two hour wait - that is great er time!!

[MAGIK GIRL]

i wish i worked in an er like that.

[fab4fan]

Our ED went to a 15/30 plan...pt had to be triaged within 15 min of arrival and seen by a doc within 30 min of arrival.

What a freaking nightmare! It did not take into account the times when the other ED's would go on divert, jamming us up with ambulance pts., who of course went ahead of walk-ins...the walk-ins still had to be seen, or the hosp wrote off part of the bill.

Run out of beds? Put 'em in the hall...they still had to come back, or else.

[cotjockey]

I think that a lot of customers / patients are dissatisfied for the wrong reasons. I personally am happy when I get into a room and am seen in less than 2 hours. I also like it when the doctor actually examines me and talks to me before ordering a bunch of tests. I like to be told when I just have a virus and need to do symptomatic care like neb treatments and decongestants. I also like it when I am told that I don't have something that I need an antibiotic for. Too many people today aren't happy if they don't get in a room right away, when they don't either get admitted or walk out with a prescription, and when they aren't poked and prodded by lab and radiated by x-ray. Too many patients are also unhappy when we won't run to the soda machines for them or when we don't offer to order them something when we send out for lunch. I've also had people complain that I didn't do anything to help keep their children (not the patient) occupied or that I didn't give the children enough stickers or that the stuffed animal cage was out of kangaroos and their child (not the patient) had to settle for a rabbit. People also want the nurses to spend a lot of time making small talk and are angry when we give toradol instead of morphine...as if we write the orders...sigh. I need a drink...:-)

[marcicatherine]

I have a theory on the Press-Ganey thing, as we are also under that microscope. The main complaint we get in our ER is wait times and the doctors are not attentive to the patients pain needs. I really get aggrivated when I hear at every staff meeting how we need to improve on the scores. My theory is; first of all, do they ever send those things to people who are satisfied with their service? Second, i have resigned myself to believe that unless a patient is carried to the room by the doctor, immediately given a pain shot, warm blanket and a cup of ice, he/she will not give us a good score. It has been so frustruating to hear the same story over and over. Especially when I know I am going above and beyond the call of duty day after day in a generally thankless job. The way I (and others I work with) look at it is........if I can go home at the end of the shift and truely feel that i have done the best I can do for my patients, then I did my job..........and to hell with the surveys. We can't change the world or patients minds for that matter. A lot of patients come in to the ER with a bad attitude in tow.............Just do your best, smile....and when you walk out the door....Exhale.

[Rapheal]

I had to take my teenage kid to to the ED last week (per the primary doctor's request- turned out to be nothing serious) and was surprised by his and my feelings of impatience. We got into a room right away and then had to wait. After seeing the doc- labs were drawn and we had to wait. He started to get angry at the wait. I explained to him why he had to wait. Yet I too felt impatient. This gave me a chance to explore my feelings of frustration as I knew the waiting was justified. Here's what I came up with from personal experience.

Part of our frustration came from not wanting to be in the ED. He was sick and just wanted to be home to sleep- I too wanted him home in his bed- not in a strange place amongst strangers.


We were worried and feared the unknown. Was something seriously wrong with him? How long until we find out something? Are they going to do something that will cause him pain? When can we go home? All these feelings and fears. The anxiety makes the wait seem longer than it is.

Then there is the whole "protect your loved one" type of attitude. When you feel that you are in charge of protecting and making sure your kid or other loved one is being taken care of you may tend to go overboard.

We were lucky and the ED staff was the best. But the most important thing for people to understand when visiting the ED is that they must excersise some self control. Feeling frustrated or scared is not pleasant and is only made worse by taking it out on the staff. Yet some people have such high anxiety at the ED that they find it difficult to control themselves.

I don't think there is any great solutions out there about making people happier in the ED. They are usually running on emotion and when we get more emotional- we tend to use less of our cognative skills. The best rememdies IMHO would be to use any techniques proven to help anxiety. Distraction is good. Provide TV, lots of magazines and other activities if possible. The next thing is communication. Telling people what is going on and explaining that they may have to wait due to an emergency, or explaining that lab work takes some time. Reassure them that although they are waiting- they are in a safe place and if the need arises- they will be brought in immediately. Having a patient liason would be good to help keep people informed without taxing the nursing staff. Another suggestion is to keep the triage desk well lit but to provide a waiting area that has lower lighting to help reduce stress. I realize that some of my ideas may be lame. It was just things I thought of based on my recent experience. Keep up the good work and best wishes.