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.
i was in er in december....md does not work on fridays usually will tell pts to go to er for eval on any day instead of trying to work u in at office...anyway i had plursey (my dx) and i felt like i was going to die...pair was unbelievable i could not even drive...got there about noon and it was after 6p when i got out/ i will admit that they did have to do scans etc but much of the time was just waiting for before anything was ordered.... i guess that they are use to people wanting drugs but i was anything but satisfied with service
In defense of the ED that you visited, I am guessing since you thought you had pleurisy, that you presented with complaints of either "trouble breathing" or "chest pain" or "pain in my upper back". Any and all of these complaints will be sure to secure you and huge (and expensive, I might add) workup.
At the very least you will need EKG, blood work, x-rays, probably a ct of the chest, an IV, (because if it was pleurisy you would need pain meds) maybe respiratory therapy, in the form of med-neb. If you are cleared of cardiac problems, and your chest xray is ok, then of course the CT is going to be next because we want to know if that pain is the result of a PE.
In my opinion people dont realize that certain complaints will entail, very detailed and time consuming diagnostics... I always cringe when an unexperienced parent brings a baby in to the ER in the middle of the night and says "she has been vomiting with a fever for 4 days, and cant keep anything down". Even though the baby may be afebrile now, have tears, and is wearing a wet diaper, we will still have to do the IV, labs, urine etc. Because we want to be thorough.
AND this bit about sending any and all patients to the ER just because the doc is taking Fridays off is BS in my opinion, people tend to do what they are told and if the office staff (who is obviously able to diagnose over the telephone) tells them to go to the ER, then they do!
In some ED's in my area it's a standard 6 hour wait before you even go back to the core or fast track, let alone see a RN/MD/PA.
I'm about fed up with our fast food, fix-it-right-now, no patience, society. You came to Emergency Room for help, you will get some kind of help, it may not be what you wanted (we are not going to be able to find out why you've heard a cracking noise in ear for the last six years when your primary doc and his referred specialist's couldn't) We are not a drive-thru version of your MD's office. And we are not here to feed you, take personal phone messages for you or give you free stuff to take home. I believe in being a caring and responsible medical professional. If you hurt, I'll do my best to take away your pain, if you're vomiting, I'll get you something to make it stop, if you need psychiatric help, I will do my best to see that you get it. But it's time people understood the Emergency Room is for true medical emergencies and not for things you should see you MD/Local clinic for. It may sound harsh but if we dumped EMTALA and started turning away people who don't need to be in the ED and referred them to he proper channel for their problem it might make a dent in spiraling healthcare costs.
BRAVO!!!!!!! Wonderful post! I totally agree :) BTW, I am in PA and the average wait here is 6 hours. If a patient gets through faster than that and they are complaining I always tell them that they are lucky they made it out sooner than 6 hours!
We all know that the truly torqued patients take a sick, morbid, twisted pleasure from filling out those surveys! And when you work in a small unilt or facility -- one or two of those less than stellar results can drop your numbers rather quickly!!! Patients who have great expeiences will often jot a thank you note, but most patients just don't think to fill out the survey -- unless they are mad about something. The squeeky wheel gets the oil! It is frustrating -- so we try not to let the numbers influence us too much -- the goals are a great idea and so we try to focous on those and do our best -- knowing full well that no matter how hard we try, there will always be SOMEONE who will be unhappy with us.
In some ED's in my area it's a standard 6 hour wait before you even go back to the core or fast track, let alone see a RN/MD/PA.
I'm about fed up with our fast food, fix-it-right-now, no patience, society. You came to Emergency Room for help, you will get some kind of help, it may not be what you wanted (we are not going to be able to find out why you've heard a cracking noise in ear for the last six years when your primary doc and his referred specialist's couldn't) We are not a drive-thru version of your MD's office. And we are not here to feed you, take personal phone messages for you or give you free stuff to take home. I believe in being a caring and responsible medical professional. If you hurt, I'll do my best to take away your pain, if you're vomiting, I'll get you something to make it stop, if you need psychiatric help, I will do my best to see that you get it. But it's time people understood the Emergency Room is for true medical emergencies and not for things you should see you MD/Local clinic for. It may sound harsh but if we dumped EMTALA and started turning away people who don't need to be in the ED and referred them to he proper channel for their problem it might make a dent in spiraling healthcare costs.
It makes me so mad when I get called in the "principal's office" because some moron had some stupid complaint. I would love to know out of the 85plus patients we see every day, how many actually fill out and return those surveys, then how many of those returned surveys contain complaints, then break that down further to the number of survey's from patients who have legitimate complaints. I wonder what the numbers would reflect then? Especially when your numbers are being brought down by the inadequate parking, wait time to be seen, doctor attitude. Rarely do I see surveys that actually have nurse complaints on them, but we're still the ones that get responsibility for trying to bring the numbers up.
If I get three complaints in a 6 month period, I'm supposed to be upset about that?! Does it not count that I took care of at least a hundred people during that 6 month period, had umpteen compliments from patients and families themselves and worked myself to a frazzle almost every shift? Like someone else said, when patients are happy they rarely fill out and return surveys. Plus the fact that we never hear from surveys of patients that end up getting admitted; we only have like one question on the inpatient surveys.
I suggested once that we put our own little comment cards in each room and then have a box for them to be deposited, one at the elevator going to the inpatient units, and one in the waiting room. People thought it was a good idea but that was as far as it went. I used to be on the satisfaction committee but now that committee is composed of people that went to the Studer Conference. What a joke. I haven't seen any of these people that went do jack#$%$ about employee satisfaction that hasn't already been done. At least I was trying things, but now I am over it. I wanted to put up a bulletin board with pics from the employees with a theme for the month. Got no response from anyone, not even the "Studer" crowd. Maybe I wasn't trying hard enough to improve employee satisfaction, but it was a heck of a lot more that those people are doing. Sorry, to go off on a tangent, hit myself in a sore spot.
Anyway, I am so with you wishing we could tell these people that this is an emergency room, and their minor stupid problem isn't an emergency. Course, I'm told that it shouldn't matter why they are in our ER, they're there and we should be thrilled about it. Yeah, right. When the charge nurse tells you that certain patients can sit in the waiting room until hell freezes over before they go back......
I agree, someone needs to educate people on what to come to the ER for and what not to come for. No one can vomit or have diarrhea without rushing to the ER. No one can have lady partsl discharge without rushing to the ER. No one can be in the first trimester of pregnancy and have some normal stretching pain, without rushing to the ER. No one's kid can have a fever without rushing to the ER. No one on medicaid can have anything wrong with them without rushing to the ER. If only we could say heck with EMTALA, get out of this ER.....but we can't and on top of having to let them come in, we have to see that they are happy when they leave!
I get so tired of working twelve hours and running for that whole twelve hours, working three of them back to back and be expected to "put on a happy face" for every single one of those patients that come in, even when they are the hundredth patient I have seen in three days and I am flat out beat to death. I guess I am just not a good nurse, but I can't keep the weariness from showing on my face and in my manner. I still do my job well, but please don't ask me to be chatty Kathy and chipper after 36 hours. I'll do my best but I'm human.
It seems like these days all the powers that be are worried about is whether we made our patients "happy" and woe to the nurse that didn't. It doesn't matter that that nurse may be the best damn nurse in the whole hospital, if she has a bad moment and gets one complaint from some
unhappy "customer" then her butt is in a wringer over it. Maybe that is one reason why there is such a nursing shortage these days. Who cares if you get multiple compliments from patients and families every day; onne complaint brings you down with the boss.
Sorry for this to be so long, just had to vent. I'd hate to think I am already burnt out with my job, but sometimes I wonder. Maybe I just need to double my prozac! :chuckle
We all know that the truly torqued patients take a sick, morbid, twisted pleasure from filling out those surveys! And when you work in a small unilt or facility -- one or two of those less than stellar results can drop your numbers rather quickly!!! Patients who have great expeiences will often jot a thank you note, but most patients just don't think to fill out the survey -- unless they are mad about something. The squeeky wheel gets the oil! It is frustrating -- so we try not to let the numbers influence us too much -- the goals are a great idea and so we try to focous on those and do our best -- knowing full well that no matter how hard we try, there will always be SOMEONE who will be unhappy with us.
I like to tell the powers that be to take their Press Gainey's and shove them where the sun don't shine! :angryfire
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.
We have a much smaller volume of patients in our ED but whenever someone REALLY complains (not for minor things) but for excessively long wait times, or anything else they feel is an injustice to them we offer an attonment package to smooth things over. Depending on the complains we offer things from a free meal in the cafeteria to free items in the hospital gift shop. Our goal here is not to bribe the patient but to acknowledge their complaint. They will be less likely to go out in public and say so-and-so hospital made me wait for 4 hrs while some people just walked in-I'll never go there again. Chances are they will return if they feel their complaint was acknowledged and see some form of immediate action.
We have a much smaller volume of patients in our ED but whenever someone REALLY complains (not for minor things) but for excessively long wait times, or anything else they feel is an injustice to them we offer an attonment package to smooth things over. Depending on the complains we offer things from a free meal in the cafeteria to free items in the hospital gift shop. Our goal here is not to bribe the patient but to acknowledge their complaint. They will be less likely to go out in public and say so-and-so hospital made me wait for 4 hrs while some people just walked in-I'll never go there again. Chances are they will return if they feel their complaint was acknowledged and see some form of immediate action.
Sounds like an airline :chuckle .....here's a ticket to anywhere in the USA, one way, sorry for the delay.
It makes me so mad when I get called in the "principal's office" because some moron had some stupid complaint. I would love to know out of the 85plus patients we see every day, how many actually fill out and return those surveys, then how many of those returned surveys contain complaints, then break that down further to the number of survey's from patients who have legitimate complaints. I wonder what the numbers would reflect then? Especially when your numbers are being brought down by the inadequate parking, wait time to be seen, doctor attitude. Rarely do I see surveys that actually have nurse complaints on them, but we're still the ones that get responsibility for trying to bring the numbers up.
If I get three complaints in a 6 month period, I'm supposed to be upset about that?! Does it not count that I took care of at least a hundred people during that 6 month period, had umpteen compliments from patients and families themselves and worked myself to a frazzle almost every shift? Like someone else said, when patients are happy they rarely fill out and return surveys. Plus the fact that we never hear from surveys of patients that end up getting admitted; we only have like one question on the inpatient surveys.
I suggested once that we put our own little comment cards in each room and then have a box for them to be deposited, one at the elevator going to the inpatient units, and one in the waiting room. People thought it was a good idea but that was as far as it went. I used to be on the satisfaction committee but now that committee is composed of people that went to the Studer Conference. What a joke. I haven't seen any of these people that went do jack#$%$ about employee satisfaction that hasn't already been done. At least I was trying things, but now I am over it. I wanted to put up a bulletin board with pics from the employees with a theme for the month. Got no response from anyone, not even the "Studer" crowd. Maybe I wasn't trying hard enough to improve employee satisfaction, but it was a heck of a lot more that those people are doing. Sorry, to go off on a tangent, hit myself in a sore spot.
Anyway, I am so with you wishing we could tell these people that this is an emergency room, and their minor stupid problem isn't an emergency. Course, I'm told that it shouldn't matter why they are in our ER, they're there and we should be thrilled about it. Yeah, right. When the charge nurse tells you that certain patients can sit in the waiting room until hell freezes over before they go back......
I agree, someone needs to educate people on what to come to the ER for and what not to come for. No one can vomit or have diarrhea without rushing to the ER. No one can have lady partsl discharge without rushing to the ER. No one can be in the first trimester of pregnancy and have some normal stretching pain, without rushing to the ER. No one's kid can have a fever without rushing to the ER. No one on medicaid can have anything wrong with them without rushing to the ER. If only we could say heck with EMTALA, get out of this ER.....but we can't and on top of having to let them come in, we have to see that they are happy when they leave!
I get so tired of working twelve hours and running for that whole twelve hours, working three of them back to back and be expected to "put on a happy face" for every single one of those patients that come in, even when they are the hundredth patient I have seen in three days and I am flat out beat to death. I guess I am just not a good nurse, but I can't keep the weariness from showing on my face and in my manner. I still do my job well, but please don't ask me to be chatty Kathy and chipper after 36 hours. I'll do my best but I'm human.
It seems like these days all the powers that be are worried about is whether we made our patients "happy" and woe to the nurse that didn't. It doesn't matter that that nurse may be the best damn nurse in the whole hospital, if she has a bad moment and gets one complaint from some
unhappy "customer" then her butt is in a wringer over it. Maybe that is one reason why there is such a nursing shortage these days. Who cares if you get multiple compliments from patients and families every day; onne complaint brings you down with the boss.
Sorry for this to be so long, just had to vent. I'd hate to think I am already burnt out with my job, but sometimes I wonder. Maybe I just need to double my prozac! :chuckle
Thanks for letting me vent!
Pam :)
I had 3 complaints against me in 1.5 years. I was just terminated yesterday after the last one. A lady with a toothache on Christmas Eve that had to wait over 2 hours and got mad because I took an Emergent pt seriously while the toothache was in the same triage room wanting to know where on the list she was. I was told that it didn't matter how good a nurse I was, or what my co-workers thought of me, that the patient's PERCEPTION is the only thing that counts. :angryfire I do have the right to appeal and I will do so, but I don't know that it will do me any good. I wrote the post on Ow She Bit Me about being assaulted because I used a 12cc syringe instead of a 3cc syringe while drawing blood during an IV start on a non compliant diabetic with atrocious veins. I was suspended for 5 days (60 hours) for that one and was told one more complaint and you are terminated. Sure enough, one more complaint and I have been terminated. I wouldn't care as I am angry that this nurse manager obviously will not back her staff, but I love the shift I work, my ANM, and my co-workers. I have enjoyed working here more than any other place I have ever been. I am 55 years old and starting over gets harder and harder. I have been searching the net trying to find answers, support, anything that will help.
W-spirit...this may be the time for you to take some time off, when was the last time you had a vacation?, you need to rethink the options that you are facing...you may want to work another 8-10 years..maybe something beside er would be good for you...these people are usually in the worst possible mood and they are going to be difficult to handle
think about the different options you have...working in something like day surgery, working in an insurance co or lawyers office...home health...ltc...i thin you have a lot of choices...maybe it is time to put er behind you
thin again about the r&r sometimes you are so stressed yourself that you really can't handle someone who is being unreasonable
canoehead, BSN, RN
6,909 Posts
"Look, you can have fast care or quality care, not both. Everyone gets to choose which they want when they go back- I'll put you down for fast."