Patient satisfaction: a new priority

  1. So I just want to rant really quick about my disgust with reimbursement based on patient satisfaction scores. Obviously, as a bedside RN i could care less about whether or not we get reimbursed. My priority is the care I provide my patient- their safety, wellbeing , and comfort. However, after three years of nursing, my sanity is starting to become more of a priority.

    Family members are the most rude, ungrateful, and disrespectful members of the healthcare team. Not only are they stupid, but they think they know what is best for the patient, yell, cuss, pay no mind to established rules, will silence my monitor alarms, will disconnect the patient from their IV's, etc. Bottom line: family members are truly getting in the way and all because of patient satisfaction, physicians and nursing management make us deal with it instead of supporting us in setting boundaries.

    Have any any of your hospitals (I'm in a Neuro ICU) moved more towards letting the families do whatever they want? I'm truly sick of it and have applied to many non-patient care areas. I don't want to interact with rude people anymore- and that includes our ungrateful patients.
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  2. Poll: Patient satisfaction scores are a terrible way to determine actual care given.

    • Yes

      100.00% 26
    • No

      0% 0
    • I don't know

      0% 0
    26 Votes
  3. 22 Comments

  4. by   Scottishtape
    Sounds like you leaving the bedside is the best thing you can do for your patients with an attitude like that.

    Family members are "stupid" and patients are "ungrateful"?

    Wow.

    No, I do not think patient surveys accurately depict the level of care a patient has received. However, after having dealt with nurses who have attitudes similar to yours, I am glad surveys are being utilized.

    I also do not think families should be kicked out of patient care. Family members are a valuable assets we can utilize to properly care for our patients. Family members have a wealth of knowledge specific to that patient that we wouldn't be able to access otherwise.

    Some family members can absolutely cross lines (turning off alarms, etc), however that needs to be dealt with in a calm and professional way, educating them what is and isn't appropriate in the hospital enviornment. Many family members are the main caregivers of these patients and are used to doing these things in the home environment. And, believe it or not, they are not "stupid". Many times they are more versed on the care required for that patient's disease process than your every day run of the mill nurse. Why? Because that's what they do all day, every day at home!

    I guess I'm most shocked by how jaded you are after only three years.

    Maybe I'm off base, but this post really rubbed me the wrong way.
  5. by   crazin01
    I completely agree, that patient satisfaction has become the priority and that is not the way it should be; but nothing is perfect in real life as it is on paper or in theory. And it gets very old, to constantly try to explain why they cannot bring mcdonalds in for patient, day after a heart cath. Or why patient can't have a regular soda, but a modified diet to keep her blood sugar in check. Patient/family education is so important, (and if you print them out papers on diabetes/heart disease, you can proudly check that as done in the care plan- two birds with one stone).

    Yes, we meet the patients & family while they are under a good amount of stress & that alone can result in a snarky tone of voice, etc that maybe gives the perception the patients/family are not the friendliest or appreciative of the care provided. I think all nurses have had a past experience where they cared for a difficult patient/family, just like all nurses have had a pure angel patient/family. Gotta take the thorns with the roses...

    I'm sure the family & patients stress level affects their comprehension of disease process; I feel like a broken record some days...

    Does your charge nurse/assignment maker know of the PITA patient/family & rotate different staff to them, so one nurse isn't always with that less-than-friendly family? I'm sure that's common place everywhere.

    When they are changing/silencing alarms, IV's etc, they just need a polite reminder that for the best patient care, it is inappropriate & could have a very negative outcome for their loved one. I've also seen (and done it myself as a patient) family/friends that will disconnect and IV, or silence the alarm AFTER ensuring patient is ok. I guess that's sort of a personal choice, if a nurse is ok with patients' child doing so or not, as that nurse is ultimately the responsible person for the patient. (all i did was measure my I/O's and disconnect my antibiotic tubing when it was infused.)

    I am sorry you seem so upset/negative about nursing only 3 years in. Probably in your & patients' best interest to work in another area.

    I'm not sure if it is a quote, or just common sense, that if you want to find the negative, you will. Even in the most ideal of situations. Not just nursing, but if you're looking, you can find negative aspects about anything. If you really wracked your brain, i'm sure you could think of a few patients/families that were really kind/appreciative etc. Perception is reality....

    Best of luck!!!
    Last edit by crazin01 on Dec 16, '16 : Reason: goof...
  6. by   AnnoyedNurse
    Crazin01- I love my patients even when they're rude, loud, disrespectful and am a staunch advocate for their needs and usually the needs of their family. My main issue is with the entitlement families have now. They all know about the surveys and although as nurses surveys don't affect our pay checks, it does affect our unit. Obviously I want great care for my patients and great surveys for my unit. These family members simply have learned the system and are taking advantage of the system. It's completely inappropriate for 10 family members to be in an ICU room, plus making rude and loud request for beverages for themselves- what happened to what's in the fridge is for our patients? What I am discontent with is not necessarily the rudeness, I can handle rudeness, but the insistence of management that I must cater to these people like it's the 4 seasons- it's not. Sorry, the milk you request for your coffee is not a priority of mine- please walk to the family coffee station and get what you need. This is obviously only one example. We have people literally sleeping on the floors of the patient rooms- it's ridiculous. A line needs to be drawn and it's unfortunate that yourself and the post before you feel as though it's "my issue" and going to another area would be best. What if I told you that I am the most competent nurse on the unit? Even more competent than the ones with 10 years experience? (My trauma icu skills really go far). so nursing is losing yet another "good" nurse. Nurses are leaving for this very reason - please refer to the terrible rate for nurse retention. This is not a problem that I must deal with but is a problem that must be dealt with by administrators and law makers. Patient satisfaction has gone too far.
  7. by   crazin01
    The entitlement attitude is seemingly very popular these days. Until management develops new policy, or starts to enforce those already in place, the problem will remain. I'm sure it's everywhere and many others find themselves in your shoes, of being sick of such folks. I am well aware of this issue & the poor retention of nurses. You stated yourself:
    This is not a problem that I must deal with but is a problem that must be dealt with by administrators and law makers. Patient satisfaction has gone too far.

    And you're attempting to find a position elsewhere, that you won't have to interact with these patients & family as much. You're trying to solve the problem that you're currently experiencing. I'm sorry if my post came across as rude or anything other than offering up a few things that have helped me in the past. I try to give everybody the benefit of the doubt (the family members/patients), which is why I just listed what I've done/seen work in the past.

    If you think you are the only nurse to be annoyed by family members thinking they are the center of the universe you are sorely mistook. and you are stereotyping how ALL family members are stupid, and ALL patients are ungrateful for the care you give. I have had both my share of needy patients & family members, but I realize this is not all of those I have cared for. I am able to remember quite a few very nice & appreciative patients/family members, as well as the not so pleasant ones. If you honestly cannot recall one patient that was a joy to help, then it truly is an issue with you. Or maybe I'm the one with the issue, since I can recall almost as many good individuals as the negative. This stereotyping may occur in others's minds, but you brought it up and asked if other nurses have had the same issues. So, then it is your issue, because you are the one grouping ALL families together as stupid, rude etc.

    I don't mean to sound rude, but I have trouble believing you (a nurse, with THREE years experience of practicing nursing) is more competent than others with 3X your experience. If you speak the truth, that you are THEE best nurse on your unit, that's great. I'm sure your co-workers love working with you, if you're that good. Maybe it's time to brush up on people skills since you've got everything else under control???

    If you truly dislike people to this extent, you will have trouble with any position (nursing or otherwise). Until all occupations can be filled with robots and computers, you will have to deal with people at some point; unless you work from home, have groceries delivered and become a hermit.

    Best of luck in finding a new position that may be a better fit for you. If you truly are an amazingly competent nurse with trauma, what about education? Teaching new ICU nurses and pre-cepting them to the ICU? Then your skills would be truly utilized in a great way, to help others learn and grow. (not being snarky at all, just a thought that could benefit you and many others).
    Last edit by crazin01 on Dec 17, '16 : Reason: typo
  8. by   klone
    Preventing family from interfering with safe patient care has nothing to do with patient satisfaction. You can still provide good compassionate care that makes your patient leave feeling satisfied with their care, and still establish boundaries.
  9. by   Ruby Vee
    Quote from Scottishtape
    Sounds like you leaving the bedside is the best thing you can do for your patients with an attitude like that.

    Family members are "stupid" and patients are "ungrateful"?

    Wow.

    No, I do not think patient surveys accurately depict the level of care a patient has received. However, after having dealt with nurses who have attitudes similar to yours, I am glad surveys are being utilized.

    I also do not think families should be kicked out of patient care. Family members are a valuable assets we can utilize to properly care for our patients. Family members have a wealth of knowledge specific to that patient that we wouldn't be able to access otherwise.

    Some family members can absolutely cross lines (turning off alarms, etc), however that needs to be dealt with in a calm and professional way, educating them what is and isn't appropriate in the hospital enviornment. Many family members are the main caregivers of these patients and are used to doing these things in the home environment. And, believe it or not, they are not "stupid". Many times they are more versed on the care required for that patient's disease process than your every day run of the mill nurse. Why? Because that's what they do all day, every day at home!

    I guess I'm most shocked by how jaded you are after only three years.

    Maybe I'm off base, but this post really rubbed me the wrong way.
    Good luck with all of that family education. Some family members are absolutely stupid, uncaring and respond poorly to any sort of redirection, boundaries or rules. Calmly and professionally educating them isn't going to have any impact on their behavior. A lot of it depends upon where you are located. Families I worked with in suburban areas of the midwest were much more pleasant, grateful, cooperative, friendly and easy to work with than some of the families I've worked with in inner city hospitals on the east coast.

    The original poster has a point -- perhaps poorly expressed and somewhat of a rant. But a very good point.
  10. by   Ruby Vee
    Quote from AnnoyedNurse
    Crazin01- I love my patients even when they're rude, loud, disrespectful and am a staunch advocate for their needs and usually the needs of their family. My main issue is with the entitlement families have now. They all know about the surveys and although as nurses surveys don't affect our pay checks, it does affect our unit. Obviously I want great care for my patients and great surveys for my unit. These family members simply have learned the system and are taking advantage of the system. It's completely inappropriate for 10 family members to be in an ICU room, plus making rude and loud request for beverages for themselves- what happened to what's in the fridge is for our patients? What I am discontent with is not necessarily the rudeness, I can handle rudeness, but the insistence of management that I must cater to these people like it's the 4 seasons- it's not. Sorry, the milk you request for your coffee is not a priority of mine- please walk to the family coffee station and get what you need. This is obviously only one example. We have people literally sleeping on the floors of the patient rooms- it's ridiculous. A line needs to be drawn and it's unfortunate that yourself and the post before you feel as though it's "my issue" and going to another area would be best. What if I told you that I am the most competent nurse on the unit? Even more competent than the ones with 10 years experience? (My trauma icu skills really go far). so nursing is losing yet another "good" nurse. Nurses are leaving for this very reason - please refer to the terrible rate for nurse retention. This is not a problem that I must deal with but is a problem that must be dealt with by administrators and law makers. Patient satisfaction has gone too far.

    OK, I was with you until you told us you were the most competent nurse on the unit, even more competent than the ones with 10 years of experience. Now, not so much.
  11. by   WKShadowRN
    While I agree that patient satisfaction scores should not be a measure for reimbursement, it is not the sole indicator for it.

    Morbidity and mortality are considered as well.

    My feelings on core measures (another prong in the reimbursement strata) vary. They sound good and they have some grounding in evidence, but it does lapse into cookbook medicine, leaving the art out of the caring of the person as an individual. A prudent provider will recognize that and hopefully address the measures as needed and appropriate. I don't think not meeting core measures should determine a loss in payment, but outcomes instead.

    Literally one quarter or one month we failed one core measure on our unit because of a typo. (In some date/time fields we can shortcut the answer by hitting N for now or T for today, so for the flu shot the nurse typed T for today. But that documentation screen was not built for that specific intervention and the date literally read T.)

    Should we try to please patients? Sure, but not before providing the care that is necessary.

    I was told several times today that I am nice and pleasant, kind, patient. It was nice to hear and easy to do today. Not always.

    Unfortunately as essential services, we seem to have little say in how we are measured. In other hospitality industries our satisfaction as customers makes sense and we can boycott their services if we don't like them. (Such as choose a different hotel). In many areas, choosing a different health care entity is not as easy. It stinks.

    Anecdotally, I have noticed in our sister hospitals the patient population makes a big difference as to how we are perceived. I'm in the newer of the two hospitals which just happens to be located in an area that has achieved significant growth in the past decade. The average customer are the osteoarthritic retirees who are new to the area. (Read insured either privately or with M'care and supplements). The other hospital is older and the aesthetics show its age. But the population is poorer and more grateful for any help. I don't know if this amounts to a hill of beans, but for our organization there seems to be a clear dichotomy in both the patient population and perception of facilities. For the higher socioeconomic participants at the other hospital, their scores reveal dissatisfaction because of perceived lower quality due to aesthetics. The lower socioeconomic visitors to the newer hospital have glowing appreciate for our newness and bigger rooms and what not, but with that comes the expectation of even better services. It's just a strange phenomenon and I don't quite know what to make of it.
  12. by   SobreRN
    You said it sister! Of the 820000 regulations and policies governing everything from the percentage of successful bar code scanning to how frequently we are observed to be slathering on hand sanitizer it was tying patient satisfaction to reimbursement which drove me to run away from hospital nursing forever!

    Last I checked I lack the God-like ability to render anyone a happy camper. They acquired and lovingly nurtured their disagreeable character traits long before I met them
  13. by   DeeAngel
    Families, scripting and the whole customer service is the reason I left nursing forever at 60 and no longer work at all. It became no longer worth it for me. My last hospital, new staff would come in work a year or less and then leave. Hospitals simply ask too much of their floor nurses anymore.
  14. by   Here.I.Stand
    Families who despite education are interfering with safe patient care, are dealt with by our amazing security staff. I recently filled out a survey following my son's surgery, and nowhere did it ask if I were freely allowed to obstruct care. The survey did not ask if I was freely allowed to abuse staff. It did ask if I was told what his meds were for, how easily I was able to ask questions of the MD/RN, if they answered my questions in a way I could understand. That sort of thing.

    I personally don't put up with nonsense, let alone pander to it. However I can count on one hand the number of patients/families over the years who have been upset with my care. To the contrary, I'm usually the one that the difficult families like because they know that their concerns are heard, and I do "nice" really well -- even while setting limits. Most people do NOT want to put their loved one in danger, so they are explained why the RN needs to hear the alarms. It's about their loved one getting prompt, safe care; it's not about their auditory comfort.

    Most of the people who have gotten angry at me were for enforcing visitor restrictions for gang-related assaults. Per my hospital policy, they are allowed two visitors. I've had angry family members on the phone demanding to be added to the list, I've had to have security remove people who Houdini'ed their way into the unit. They are not receiving surveys, so it doesn't affect anyone if they're ticked. And if the patient is mad, you know what? Safety trumps the survey. Every time. And we advise them that we are doing this for their safety AND ours. End of discussion. I just don't act like a ***** when I say it.

    Now your generalizations about families...not cool at all. If that's truly how you feel about most/all families, that most likely is more about you than about them.
  15. by   Daisy4RN
    I agree with you that patients and families are out of control and admin does nothing about it (for what ever reason). This leaves the bedside nurse to deal with families with no back up what-so-ever. I have experienced those type of attitudes also, family thinking you are there to cater to them, not following hospital rules/policies (no matter how politely you ask), basically doing whatever they want because they know they can get away with it. Any staff who does not see this as a problem is probably not a bedside RN. The RN is made responsible because we are there for 12hrs. Other ancillary staff (lab, RT etc) come and perform their task and leave, I have even had then tell me, room 120 wants water etc, really?? . This trend of patient satisfaction hurts patient care because all patients will suffer when nurses are running around attempting to please patients/families with trivial matters instead of using that time for nursing tasks/critical thinking etc.. It hurts the nurse also because we are placed in a no win situation, some families wont be happy no matter what you do, but you still end up being held responsible. This is exactly why nurses are leaving the bedside. The ultimate hyper-stress of being held accountable for things that are out of your control!

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