Nurse Satisfaction comes before Patient Satisfaction

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    This Article is going to review and reference the article titled: Patient Satisfaction Must Start With Nursing Satisfaction. Why do these scores matter? Are you a dissatisfied nurse? How can we make nurses happier?

    Nurse Satisfaction comes before Patient Satisfaction

    Are you in a unit where your patient satisfaction scores are always a struggle? Look around you, are the nurses satisfied with their job? Nurses go into a job to help care for others, but when staffing ratios are unsafe, documentation takes longer than patient care, and you haven’t peed in 12 hours, it can become a daunting job.

    Who’s obsessed with these scores?

    Have you been a nurse for a while and don’t remember such a fuss in the past about patient satisfaction scores. You aren’t daydreaming; it is a newer concept. Hospital administrators, or what many of the nurses refer to as the “bigwigs,” or “higher ups” are overly obsessed with the patient satisfaction scores. Why? Hospitals are a business, and excellent scores mean better reimbursement from Medicaid. Reimbursement equals money, and as nurses, we often don’t think of the hospital as a business because we are in a caregiver role, not a salesperson.

    As nurses, we have to understand this. There is an abundant number of people on the Medicaid and Medicare system, and unfortunately, without reimbursement. Hospitals could not run. Many hospitals are shutting down across the nation because they cannot keep up with the demands.

    It’s not that we don’t want patients to love us

    Nurses love their patients, or they wouldn’t be a nurse. I have a problem with the concept of the “best patient experience” for everyone. I’ll tell you; I don’t treat anyone different. I don't care if you are Donald Trump’s son or a homeless woman on her 4th abortion, I will treat you the same and give you the best care. My vision is never the patient experience; it is “how would I treat this patient if she was my sister.”

    We have to take a look at why we do what we do. When nurses become happier, the vision isn’t so cloudy. We want our patients to be more satisfied, pain controlled, teaching completed, but sometimes it isn’t possible. When nurses are happy, patients will be as well.

    Why can’t we meet our goals

    Hey, “bigwigs,” listen up. You have to take care of your nurses, yeah, the little guys. Do you think patients can’t tell when their nurse is overworked and underpaid? IF not, you need to be a patient. It is written all over the nurse's face. We have a hard time faking happiness, at least most the nurses I work with.

    How to turn the frowns upside down

    If you are a nurse manager, take a look at your staff. Do you have a high turnover? Ask you trusted charge nurses, see what they think the issue may be. Hand out a random survey to your staff:
    • What is your overall satisfaction working at our hospital?
    • What is the most stressful thing about your workday?
    • What can we do to improve your workday?
    • Do you feel rested? Do you have enough breaks?
    • Do you enjoy working with your colleagues? Is there anyone here who drives you down?

    In conclusion, higher ups, stop spending so much money on national “experts” who think they can help us raise our scores. Take a look of the nurses. Are they happy? What can you do to change that? Hiring an extra nurse to be out of staffing to help give lunches and breaks is going to cost less than all the extra lectures and training. According to Hazen’s article, happier people make fewer mistakes because they are more aware of their surroundings, making their workload doable.

    How do you think we should fix nurse satisfaction rates? Do you agree that nurse satisfaction reflects patient satisfaction?
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    42 Comments

  3. by   Daisy4RN
    Quote:
    "Hospitals are a business, and excellent scores mean better reimbursement from Medicaid. Reimbursement equals money, and as nurses, we often don’t think of the hospital as a business because we are in a caregiver role, not a salesperson"

    And this is the first problem!!! Reimbursement should not be based on the satisfaction of sick people who do not understand job descriptions. I agree that happy nurses will (for the most part) make happy patients. Best way to do that is to let the nurse be autonomous in her/his daily activity, and to provide the time to do just that.
  4. by   Susie2310
    I disagree with the OP's premise that Nurse Satisfaction comes before Patient Satisfaction i.e. the facility is primarily responsible for providing the nurse's satisfaction. A number of nurses don't feel any draw to being nurses; they are in nursing primarily for the money and job security/benefits and don't really care about patients or their families. While it's understandable that not everyone is "called" to nursing, nor in my opinion is it truly necessary to be "called"; it is necessary to have some empathy and kindness towards patients and their families, and to have the ability to listen to patients/family and to be able to put oneself in their position. The posts that I read on this forum from the nurses who seem to be the happiest and most fulfilled in their work are also the nurses whose kindness and caring for patients comes through clearly along with their competence. Constantly complaining about patients and their families is not a sign of a nurse who is happy in their work. I believe that many people are in nursing who don't really have the personal qualities to be nurses, and my observation and experience is that the people who don't really care about patients/families to begin with burn out faster. I acknowledge that one's workplace has a lot to do with one's job satisfaction, but hearing the complaints of people who admit to having good working conditions, good/very good salaries/benefits etc. but still continue to complain about patients/families, and contrasting them with the people who speak positively about patients/families and are fulfilled in their work, leads me to believe that fulfillment in taking care of patients/families comes primarily because one cares about patients/families or not. And to a great extent I believe it really is that simple.

    I personally don't have any problem with the surveys/questionnaires etc. that patients fill in as patient experience is a measurement of quality of care. Of course the patient's experience of their care should count when measuring the quality of their care for reimbursement purposes. While patients sometimes can't discern whether they are receiving clinically competent nursing care, patients value nurses who treat them and their families with respect and consideration and say as much on their surveys.
    Last edit by Susie2310 on Feb 15
  5. by   JKL33
    Quote from Susie2310
    fulfillment in taking care of patients/families comes primarily because one cares about patients/families or not. And to a great extent I believe it really is that simple.
    Nope. It is not that simple at all; in fact I'd be willing to say something almost the opposite from my observation: The current environment is insane enough to have worn down nearly all those bedside nurses except ones who don't care. An additional number have already become resigned to apathy as a means of cognitive and emotional survival. Those who really want to serve people (both by treating people with kindness and empathy and simultaneously providing excellent professional nursing/medical care) find themselves in quite a conundrum right now. Not getting an antibiotic for one's cold is not the same thing as not getting cheese on one's hamburger, but both are things that might cause a complaint or a lack of satisfaction - and therein lies the very basic insanity of where we find ourselves.

    Quote from Susie2310
    I personally don't have any problem with the surveys/questionnaires etc. that patients fill in as patient experience is a measurement of quality of care. Of course the patient's experience of their care should count when measuring the quality of their care for reimbursement purposes. While patients sometimes can't discern whether they are receiving clinically competent nursing care, patients value nurses who treat them and their families with respect and consideration and say as much on their surveys.
    You say the patient's perception of their experience is a measurement of quality of care. Then you say patients sometimes can't discern whether or not they are receiving clinically competent nursing care. [IMO "sometimes" is an understatement, but that's beside the point].

    Are you saying that quality (of) care is something different than clinically competent care? I mean, you are saying that when you imply that patients can fairly judge the quality of their care without needing to know the details of whether it was clinically competent or not. Regardless, no matter what level of satisfaction the patient reports on a survey, you are not guaranteed to learn anything whatsoever about whether the medical and nursing decision-making was sound or excellent or way off base, or whether the skills were excellent or lacking. And to top it off, you may not be learning the truth about whether a nurse/doctor tried to be respectful or caring!!

    You also say patients value nurses who treat them and their families with respect and consideration. Well, some do value those types of efforts and interactions, and some don't.

    I respectfully request that you research the theory that patient satisfaction is a good measure of quality of care. That is something that was declared loudly by entities who stood to benefit at the outset of this paradigm shift and is being heavily questioned at this point. Ask yourself who benefits when nurses are forced into what was known to be a losing game....[the entities who are supposed to pay for the care, and the entire industries whose businesses revolve around this.]

    There are some haunting similarities with the 'patient satisfaction' push and the pain management push years ago. Obviously the push to adequately assess patients' pain and treat it appropriately was a very worthy goal and a wake-up call for those who were underestimating the devastating effects of under-treated pain. But we took it too far. We used verbiage such as calling pain a "vital sign", and saying it is "whatever the patient says it is". That served some patients well, and appropriately so. For everyone else, it has been a disaster and we are now being vilified for the fall-out. I believe with all my being that this misplaced emphasis on patient satisfaction is going to produce similar devastating effects for patient care and patients' health, with small benefit in very limited instances.

    Regarding the OP - thanks for starting this conversation; it's so important. We have a huge problem in that we have been placed in a no-win position with 'patient satisfaction'. Meanwhile, because patient satisfaction has recently become crucial to the bottom line, hospitals are desperate and there is no thought of treating us with the same regard we wish to treat our patients. Over the years I have sometimes felt staffing levels were unsafe, or that the pay was a bit low, or that the culture could be improved. But this latest permutation of "nursing" is unlike anything I've seen. It is simply abusive and incredibly more destructive to a human soul because it is personal in a way that having a too-heavy assignment or missing yet another break could never match. It is an abuse of a nurse's humanity to pretend that our value or professional skills or compassion can be measured with these particular unscientific "measurements" we are talking about. For those who love(d) nursing, it is intolerable.

    Disclosure: Yes I am passionate about this, and no I have not personally had any trouble/discipline in my career, patient satisfaction or otherwise.
  6. by   smartassmommy
    Although patients feeling that they have received excellent care is important, it should not be allowed to factor into reimbursement. It costs just as much to pay the nurse who actually delivered quality care to the opioid addict who claimed that they got subpar care when the nurse wouldn't bring pain meds 2 hours early as it does to pay "Susie Sunshine" who isn't as competent to give less than stellar care to the little old lady who wouldn't dream of complaining
  7. by   Susie2310
    The patient is the recipient/consumer of the health care services and they/their insurance are paying for their care, so yes, they have the right to express their opinion about the quality of the care they have received, and it is reasonable that their experience should count as part of quality of care measurements for reimbursement purposes. And don't forget, without the patient bringing income into the facility, the nurses wouldn't get paid! Yes, nurses wouldn't have jobs - I know this is a shock to some.

    Patients often do have the option of where to receive care, so it is pretty foolish to say that their opinions about the care they received shouldn't count for reimbursement purposes. It's actually pretty insulting to patients to assert that they are so ignorant/biased/unaware that they can't determine their quality of care in any meaningful way and are unqualified to comment but should just shut up and gratefully receive health care services (nursing care/medical care). Yes, of course some patients for a number of reasons (illness, infirmity, etc.) may be less able to objectively appraise the quality of their care, but they as patients/consumers of health care services have the right to express their opinions about the quality of care they have received just like other patients/consumers.

    Patients and their authorized representatives also have other means by which they can express their opinions about the care they have received. They can contact their insurance company and they can file a formal grievance about the quality of care they received with various organizations.

    I graduated from nursing school over 20 years ago, and I see patients/family members being treated with a lot more respect now than in the past.

    What I see happening is that nurses, doctors, administrators, are learning that they need to LISTEN with respect to patients and their families, and I see patients and their family members being treated more respectfully. I think it's wonderful. I see positive changes happening for patients and family members.
    Last edit by Susie2310 on Feb 19
  8. by   Daisy4RN
    Quote from Susie2310:
    "so yes, they have the right to express their opinion about the quality of the care they have received"...."Patients and their authorized representatives also have other means by which they can express their opinions about the care they have received"

    This is exactly the point. Patients can and should complain/file a grievance if they think they have one, and it should be addressed through the proper channels (at the hospital/facility). Is it a legit complaint or not, and then go from there. Complaints should NEVER be considered related to payment. I don't think that anyone who works bedside would ever think that this is a good idea because we see first hand the types of complaints patients/families have, and they have nothing to do with receiving good medical/nursing care. This type of non-payment doesn't fly anywhere else, why for medical care? Ridiculous!!
  9. by   Susie2310
    Quote from Daisy4RN
    Quote from Susie2310:
    "so yes, they have the right to express their opinion about the quality of the care they have received"...."Patients and their authorized representatives also have other means by which they can express their opinions about the care they have received"

    This is exactly the point. Patients can and should complain/file a grievance if they think they have one, and it should be addressed through the proper channels (at the hospital/facility). Is it a legit complaint or not, and then go from there. Complaints should NEVER be considered related to payment. I don't think that anyone who works bedside would ever think that this is a good idea because we see first hand the types of complaints patients/families have, and they have nothing to do with receiving good medical/nursing care. This type of non-payment doesn't fly anywhere else, why for medical care? Ridiculous!!
    Patients absolutely should express their opinions and experiences of the care they receive on the surveys. This provides information to the payor about the services they are paying for by the person receiving them, the patient.

    A grievance filed by a patient with an outside organization/entity is likely to result in financial or other types of penalties too for the facility, and possibly various other consequences, and could also result in consequences for individual licensed staff. It is likely that it would be more beneficial for the staff to receive negative comments on a survey than for the patient to use the other methods available to them to report dissatisfaction with quality of care.
  10. by   MunoRN
    I don't think it's unreasonable to pay less for a product that falls well below average quality.

    What the HCAHPS survey essentially asks patients is whether or not the facility is staffing properly for their workload and providing the necessary support to provide adequate care; Did the staff have time to teach you about new medications, discharge teaching, answer call lights, etc.

    The way HCAHPS surveys work, is that even if your scores are "poor", you don't lose any reimbursement as long as they are about as poor as everyone else's, if a facility is doing a significantly worse job at providing patient care, then they get paid less, I don't see any reason why they should get paid the same as those providing a better, or even just average product.

    There's certainly some improvements that could be made, but as a basic premise I don't see a problem with payers providing financial incentive for facilities to provide more support for those providing care.
  11. by   billswife
    Quote from JKL33
    Nope. It is not that simple at all; in fact I'd be willing to say something almost the opposite from my observation: The current environment is insane enough to have worn down nearly all those bedside nurses except ones who don't care. An additional number have already become resigned to apathy as a means of cognitive and emotional survival. Those who really want to serve people (both by treating people with kindness and empathy and simultaneously providing excellent professional nursing/medical care) find themselves in quite a conundrum right now. Not getting an antibiotic for one's cold is not the same thing as not getting cheese on one's hamburger, but both are things that might cause a complaint or a lack of satisfaction - and therein lies the very basic insanity of where we find ourselves.



    You say the patient's perception of their experience is a measurement of quality of care. Then you say patients sometimes can't discern whether or not they are receiving clinically competent nursing care. [IMO "sometimes" is an understatement, but that's beside the point].

    Are you saying that quality (of) care is something different than clinically competent care? I mean, you are saying that when you imply that patients can fairly judge the quality of their care without needing to know the details of whether it was clinically competent or not. Regardless, no matter what level of satisfaction the patient reports on a survey, you are not guaranteed to learn anything whatsoever about whether the medical and nursing decision-making was sound or excellent or way off base, or whether the skills were excellent or lacking. And to top it off, you may not be learning the truth about whether a nurse/doctor tried to be respectful or caring!!

    You also say patients value nurses who treat them and their families with respect and consideration. Well, some do value those types of efforts and interactions, and some don't.

    I respectfully request that you research the theory that patient satisfaction is a good measure of quality of care. That is something that was declared loudly by entities who stood to benefit at the outset of this paradigm shift and is being heavily questioned at this point. Ask yourself who benefits when nurses are forced into what was known to be a losing game....[the entities who are supposed to pay for the care, and the entire industries whose businesses revolve around this.]

    There are some haunting similarities with the 'patient satisfaction' push and the pain management push years ago. Obviously the push to adequately assess patients' pain and treat it appropriately was a very worthy goal and a wake-up call for those who were underestimating the devastating effects of under-treated pain. But we took it too far. We used verbiage such as calling pain a "vital sign", and saying it is "whatever the patient says it is". That served some patients well, and appropriately so. For everyone else, it has been a disaster and we are now being vilified for the fall-out. I believe with all my being that this misplaced emphasis on patient satisfaction is going to produce similar devastating effects for patient care and patients' health, with small benefit in very limited instances.

    Regarding the OP - thanks for starting this conversation; it's so important. We have a huge problem in that we have been placed in a no-win position with 'patient satisfaction'. Meanwhile, because patient satisfaction has recently become crucial to the bottom line, hospitals are desperate and there is no thought of treating us with the same regard we wish to treat our patients. Over the years I have sometimes felt staffing levels were unsafe, or that the pay was a bit low, or that the culture could be improved. But this latest permutation of "nursing" is unlike anything I've seen. It is simply abusive and incredibly more destructive to a human soul because it is personal in a way that having a too-heavy assignment or missing yet another break could never match. It is an abuse of a nurse's humanity to pretend that our value or professional skills or compassion can be measured with these particular unscientific "measurements" we are talking about. For those who love(d) nursing, it is intolerable.

    Disclosure: Yes I am passionate about this, and no I have not personally had any trouble/discipline in my career, patient satisfaction or otherwise.

    This!!!!! This is exactly what I wanted to say, but I'm not as eloquent!!!

    You are so right when you say that our current emphasis on "patient satisfaction" will be disastrous in the long run. I also believe that those of us who care too deeply burn out quickly in the current climate of health care. The original post sounds a great deal like a managerial pep talk to convince nurses to work longer hours in worse conditions with less pay and no breaks, and without question or complaint.

    After twenty five years at this job I can tell you that the practice of determining quality of care by asking about "patient satisfaction" is the worst thing that has happened to quality patient care during my career.
    Quality medical care cannot be "rated" on the same criterion as fast food. Sometimes "have it your way" isn't the best treatment we can offer our patients. We simply cannot run effective, safe hospital care by offering the same amenities as the Holiday Inn.

    JKL33, you said this way better than I can. It is hard NOT not be passionate about this topic if you really do, in fact, care deeply about your patients.
  12. by   billswife
    Quote from Daisy4RN
    Quote from Susie2310:
    "so yes, they have the right to express their opinion about the quality of the care they have received"...."Patients and their authorized representatives also have other means by which they can express their opinions about the care they have received"

    This is exactly the point. Patients can and should complain/file a grievance if they think they have one, and it should be addressed through the proper channels (at the hospital/facility). Is it a legit complaint or not, and then go from there. Complaints should NEVER be considered related to payment. I don't think that anyone who works bedside would ever think that this is a good idea because we see first hand the types of complaints patients/families have, and they have nothing to do with receiving good medical/nursing care. This type of non-payment doesn't fly anywhere else, why for medical care? Ridiculous!!
    I had a patient once whose daughter literally told me to " her my mother some colder ice".
  13. by   ThePrincessBride
    What's good for the goose is good for the gander. Nurses being the goose and patients being the gander, that is.
  14. by   klone
    I'm a believer that if nurses are satisfied, enjoy their jobs and their colleagues, and have good leadership, then it will trickle down to patient care.

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