U.S. News ranks hospitals with best nurses

I work at Mayo Clinic and I can vouch that care is superior to other hospitals I have worked at/visited. Mayo treats their nurses well through benefits and nurse-patient ratio and it makes nurses love their job that much more and want to do their job better.

Most patients have no idea how smart you are or how good you are at your job or that you are the best at IV skills. But they do remember if you were nice, helpful, caring etc. I had a nurse working in the ED once who was an idiot. As far as skills, she was terrible but the patients were in love with her. Because she was so nice. On the patient satisfaction surveys she was always listed as the most competent or best nurse.

I also worked with a physician once who made errors constantly. Dose errors, treatment errors, you name it, he screwed it up. But his patients thought he walked on water. He would go in their room and sit by them, hold their hand, say "Well, Mrs. So-in- so, I gave you the wrong dose of whatever and that is why your blood pressure is so low and you had that little stroke but now we are going to try X and see how that works for you". These patients would be patting him on the hand "oh don't worry about it doctor. You work so hard. I trust you. What ever you say". He would sit in there and chat with them. Almost killed these people and not one of them ever called a lawyer.

First I'd like to point out the article was written by Avery Comarow the idiot who focused on the Sister Nurse experience-the nursing instructor whose daughter received poor nursing care...a truly crap article.

Secondly, while patient opinions seem to be all the rage....they have no clue what nurses do....what education is required....and how many other patients we have.

Thirdly, to have a survey based on someone liking you and using that as best hospital...OMG! What happened to good journalism and real reporting?

Fourth....NO WONDER WE HAVE PRESS GANEY AND HCAPS...idiot administrations read this and continue the myth of hotel service in acute areas.

While I am all for patient communication, I am also for stating the facts and the realities of someone's time with me. Some people need a reality check....I guess some magazines do too!

M

Instead of the "fluffy bunnies and butterflies" BS, look at the cold hard numbers -- survivability to discharge. Ford used to say "Quality is Job 1." Well, in nurse, job 1 is heart beat and respiration. If we can't keep you alive, all the fluffy pillows and flat screen tvs are just background noise. We need to focus back on what we need to do the job to keep the patients alive -- VS machines that work, FSBS machines that aren't older than my car, available supplies that you don't need a note from the CEO to get to on 3rd shift (like the right sized NG tube for a person with an upper GI bleed, SCDs, cooling blankets, the right kind of feeding fluid for PEGers). Keep the pharmacy open all night; people need critical stuff mixed up at 3 am, and it doesn't say "pharmacist" on my tag. Have adequate security, not less -- ever heard of "sundowners?" Meet the same head count ratios as daytime -- I never get folks that sleep.

If I was going to eval a hospital, this would be my questions to the patient:

1) If you came in with a decubitus, did the size increase during your stay? Was it treated by a specialist in wound care?

2) Did you develop a decubitus during your stay? What caused it, were you seen by a wound care specialist?

3) Did you comply with your ordered diet, meds and treatment? If not, why not?

4) How many days have you been in the hospital during the last 60 days? (to pick out the frequent flyers, good or bad, for out of hospital follow up to prevent readmission).


What I'd look for in terms of charting:

1) For patients who do not live to discharge (unplanned, not DNR, not hospice), pull the name of the nurse at time of death, doc in attendance/on call at time of death. Look for patterns. Do you have an idiot nurse who can't tell an MI from an anxiety attack? Do you have a doc where there are constant entries in the chart that the doc was paged multiple times without being called, or was notified of abnormal labs and no new orders (ex. WBCs of 29, KCLs of 2.5 -- and what made the doc give me antibiotics for the WBCs was when I told him I was going to chart that I'd informed him of the WBC and temp of 101 that I couldn't get down despite tylenol and had rec'd no orders for antibiotics on a pt with NKDA).

2) Do you have resp pt that go into distress when specific RTs are on that shift?

3) Look at the time the orders where written, and when they were c'd off, when stats were actually done. Look to see if it's a doc that ghosts in, writes orders, and never tells someone, or if you've got nurses who just blow off looking that the chart. Do you know how many times I've found stats not done for no reason? It scares me to death.

4) Some patients won't like me as a nurse. If she's a COPDer with emphysema, I don't let her go out and smoke with her nicotine patch on, dragging an O2 tank. The diabetic I don't get candy bars for, the CHFer I don't give gallons of soda, no they won't be happy with me. But they will be here to be unhappy.

Now, is the goal to make the happy before they die? Or keep them alive and let them be healthier at discharge than they were at admission, even if they didn't get the boston cream pie they wanted?