Nurse Satisfaction vs. Patient Satisfaction: Can the Two Go Hand in Hand?

[Jb4564]

Demands of Nursing

The demands of nursing are great and often the recognition for a job well done is minimal. Why do it? Why give the extra time or effort? Why go the extra mile for a patient or family? Have you become disengaged? resentful? apathetic? Burnout can be insidious and may not be recognized early enough to make a change to avoid the all too common pitfall of one of the most rewarding professions. The standard recommendation is to get more sleep, exercise, eat more healthily, learn something new, transfer to a new department and learn to say "no". There is another answer. Hospital systems have the ability to invest in their greatest resource, the frontline staff, and help to avoid and potentially remedy this difficult problem.

Happy and Engaged Nursing

A happy and engaged nurse leads to a happy, satisfied patient that will become a return customer. By investing in the front line staff, a hospital's bottom line will improve. The hospital is a business and wants a return on their investment. Patient satisfaction scores are an integral measure of how well a patient perceives a hospital is providing care. A hospital system that invests their resources and support in their clinical staff create an environment of support and respect. An environment of happy, satisfied employees is quickly sensed by the patient and family. This creates a quality experience for the patient and family. In the finding of "The Relationship Between Employee Satisfaction and Hospital Patient Experiences" by Jimmy Poltier, Andy Dahl and Frank Mulhern, a direct correlation was found between employee satisfaction and patient satisfaction. The quality of patient care improved with happier employees. "By viewing the employees as internal customers" the needs of the staff were met which led to higher patient satisfaction. So how does a hospital achieve this lofty goal?

Some Suggestions

Here is a partial list of suggestions made by bedside staff:

• reward and recognition (Daisy Award, Patient First Award, Lifesaver Award)
• reimbursement for educational programs
• promotion from within, clinical ladder
• tuition reimbursement for certifications and renewals, conventions
• paid education days, additional paid education days for staff with advanced certifications
• promotion of community events, volunteerism
• compensation for additional skill sets (ECMO, chemo, precepting, PALS/NALS/ACLS instruction)
• nurse involvement in decision making (interviews, department decisions, system and process changes)
• transparency, keep employees informed of changes, future plans, successes, opportunities
• fair and timely evaluations with a credible performance evaluation tool and biannual one-on-one conversation with direct manager
• adequate staffing, aggressive recruiting for staff vacancies
• self scheduling
• employee assistance program
• celebration of achievements (personal and professional)
• support for personal tragedy
• support through system and process changes
• free flu immunization vaccines
• privately counsel and publicly praise
• provide team building exercises at monthly staff meetings
• communicate with staff regarding errors and process improvements
• listen to staff concerns and respond in timely fashion
• recognize the day to day acts of kindness
• manage up
• be available
• managers set the example (be respectful, pitch in)
• provide safe working environment, convenient free parking in well-lit parking areas
• discounted meals in hospital cafeteria
• embrace family centered care
• provide space for employee break room, staff meetings
• keep facility clean/organized/stocked with needed supplies and current equipment
• recognize and immediately deal with bullying, inappropriate behavior and negative attitudes
• provide de-briefing after stressful events, deaths
• daycare facilities

Why Empower Nurses?

This is just a short list of suggested ways to encourage and empower staff. A happy and engaged nurse is a loyal nurse and can directly affect a hospital's bottom line. Staff retention improves, patient satisfaction scores are higher and an overall culture of support is created. Patients will refer their friends and family to your facility. An investment in the front line staff is a wise business decision with a multifaceted return in the investment.

[sweetie13]

I just have to respond to this article. I was a bedside RN for 30 years. I always went far beyond what I had to do for patients. nursing changed for the worse when PCT 's were dreamed up. no longer could nurses depend on their assistants to do their job correctly. the majority of PCT's I worked with believed their knowledge was equal to the RN. yet RN's has no power over the pct's but we are responsible for what they do or don't do. and patients being customers is ridiculous. the last hospital I worked at would call nurses into the "office" to respond to "not satisfied" complaints . and we would have this held against us on our yearly review. I was called in because a patient said he was thirsty and I did nothing about it. that jerk was npo, after a full breakfast for an ultrasound. I printed out the ultra sound instructions and explained he would get his lunch as soon as he returned. this man was 30 years old and was to be npo for 6 hours. so how was I at fault???????? ridiculous !!!!!!!!!!! and I had called his doc 4 times with the patients complaints , the doc refused to speak with the patient on the phone and called him a jerk. but , the RN was blamed. this kind of stuff made me so furious and very glad I am not a nurse anymore. on the other hand I became very ill and cannot even begin to explain how nurses appear to patients. the majority were ok but some were so bad and could not get out of the room fast enough. and one hospital had the nurses and techs wearing a small communication transmitter pinned to uniform so I never knew if they were talking to me or someone else. just crazy. I am an old nurse who enjoyed so many years of bedside nursing ...........but not anymore. no nurse satisfaction and patient satisfaction cannot go hand in hand. not when patients are customers and not patients.

[DavisaRN9]

On that lengthy list of "things" geared to ensure nurse satisfaction there is one important way to empower, show respect, and promote retention that is missing:

Mandated "Nurse-Patient Ratio Limits". 49 out of 50 states CAN LEGALLY assign every and any nurse with as many patients as hospital management wants....and does. A floor nurse can be given a humungous patient load, but is shamed by 'nurse culture' in saying anything about it; they fear being labeled "needy", "incompetent", "a whiner", "lazy" ect., by other nurses. And if that nurse states he/she is already at their maximum, is already overwhelmed with providing safe, diligent care to his/her existing patients and cannot take an additional one---they (management) cite: "patient abandonment". Oh, and claiming "Safe Harbor" may inform the hospital of a unsafe assignment being issued to a nurse, but if that nurse claims "Safe Harbor" the hospital WILL find a way to get rid of that nurse.

[she244]

I agree with most of the threads on here since I have moved into a different Nursing positions to gain additional training. Working for Orthopedic Surgeons and ER Physicians has done nothing for me but enforced my belief that about 96% of Physicians are mean, narcissist demeaning people. There were a few who were nice to the staff but most either ignored you when you asked for clarification of an order when you knew what was ordered was incorrect, or they threw things in a temper tantrum when you brought in another patient. I have lost a lot of respect for management, Physicians and at this time, am making my time until I can get out of Nursing. No matter what my inner feelings are my patients come first and I take care of them the best I can. At times they will ask my opinion of the Physician and I struggle hard not to want to recommend they go somewhere else to be seen. When I am not at work I am honest without actually going so far as to not jeopardize my job. I do let my family know the truth as to knowing they may be skilled with their hands, but actually caring about your health or life they do not care.

[FloridaBeagle]

As I wrote not long before, the whole concept of "patient satisfaction" is going to fall down pretty soon, just like every other "health care fashion" did over the last 30 or so years.

The sooner, the better. Patient's satisfaction shouldn't be taken into consideration because they have no concept of reasonable expectations or health care roles. For example, I recently had a patient who was annoyed with me because I wouldn't clean her dentures. She had a broken hip, not a broken hand. I'm sure she won't give us all 5's because I chose to spend more time with my fresh post-op instead of playing maid.

[madscientist82]

Great Article! Inspired!

[AuDDoc]

I remember in nursing school having to be on a post op step down floor where they did ortho surgeries on Medicaid patients. Many came in and thought a steady diet of McDonalds, Mt. Dew, cigs, and beer was a healthy diet. They didn't see these as part of the reasons they were morbidly obese and their joints were failing in the their late 30's and early 40's. Of course they would get put on a health diet, hounded to do PT and OT daily while in the hospital, and then after they got out. Many magically thought a knee or hip replacement was going to be a magic bullet to make them be active. They didn't want to put the work in.

If you did mention diet they would be insulted.....

[llg, PhD, RN]

Just to throw some actual facts into the discussion ...

In 2014, Press Ganey bought NDNQI. Press Ganey has measured patient satisfaction for years. The NDNQI Annual RN Survey measures nursing job satisfaction. Now that both data sets are under 1 roof, they are reporting that the scores correlate well. Satisfied RN's and satisfied patients tend to appear together. When the staff is unhappy, the patient satisfaction scores tend to be lower.

Now we just need to learn how to harvest the power of those statistics.

[canigraduate]

I see your point, and I get frustrated as well. However... from their standpoint, the price that they will be paying for healthcare, even if it's just a deductible ENTITLES them to top notch care.

Those that aren't paying... Eh... Excellent patient care is STILL my job, so I will deliver it indiscriminately.

Huh. You get what you pay for. With insurance and government cuts in spending, patients get Wal-Mart service instead of Waldorf service.

If patients want the Disneyland/Hotel experience, on top of keeping them alive and as well as we can, then reimbursement needs to match expectations.

[traveler782]

No, because the third element missing is budget and staffing. If nursing unstaffed the demands of the patients are not lessened but the nurse work load increased. So you end up miserable staff who are over worked and patients who mad they are not being waited on. The nursing becomes about just meeting the patient's healthcare needs at that point. The model of patient satisfaction means patient should be happy as if it was hotel stay but the reality could not be farther from the truth. Hospital are meant to get the patient through their health crisis not as measuring stick for if hot towels were delivered immediately, free coffee taated just right, the painting on the wall was pleasing, and so on.. Hospitals should not be miserable but in this age of business model run hospitals the patient's actual health reaon is almost secondary to the patient and their families pleasure. Normally the staff are left to work short and reprimanded for not making the families or patient happy. People expect hospitals to be hotel or resort like while hating the bill or simply not paying..same time management expect employees to work short staffed to maxmize the dollar all while.maintaining the patient satisfaction portion. We have perverted the general public perception of hospitals. Hospitals are viewed totally different. Though a patient may have had surgery successful, no aide effects, complications and returned home to baseline health they may have been upset the call light was not answered immediately or that the unit was out of their favorite color jello (list goes on and on). I don't think those are fare assessments of the true meaning of hospitals and patient care.

[traveler782]

I agree, patient satisfaction needs to go away. It is unrealistic and provides very little constructive feedback. Plus those who are satisfied rarely fill them out. The ones mad the discharge physician was not there immediately, hated the hospital food or disliked one of the nurses because she/he didn't bring their family coffee (yes seen that complaint) are the ones who fill it out. Healthcare has given the public the wrong expectations of nurses and hospitals.