Please tell me how this is right?!?!

[L&DRNJenn]

I work for a large univeristy hospital that also has several branches throughout the metroplex. There has been a huge push for patient satisfaction over the past 9 months. Scores are based on surveys completed on discharge and then also a survey mailed to patients at home following discharge. Currently scores are in the low to mid 80's. The goal is greater than 95%. We had a presentation in March on what the expectations were of the staff to insure that patient satisfaction improves and we were expected to sign a form saying that we were committed to just that. The major push was to have the patients be rounded on each hour. The even hours by the nurses and the odd hours by the techs and the purpose of that was to anticipate the patient's needs. We were also to imply with our words, actions and attitude that "we have time". The patients are visited by the supervisors to evaluate how things are going (I'm not sure what all the patients are asked during this time).

On Tuesday we were presentated with a hospital wide program that ranks each staff member as a high, medium or low performer based on carrying out the commitment of improving patient satsfaction. This ranking has nothing to do with patient care, critical thinking and so on. Bad attitudes, gossiping and backstabbing are within consideration to the ranking. The superivsors will meet with each staff member. The order will be high, medium and low in the hope that by talking to the high performers first they will have a positive influence on the rest. The low performers will be given a choice to basically shape up or ship out. My manager says that even some of the most experienced nurses will be faced with that decision.

What do you think of this?

Here's what I think. I think that it is extremely childish and extreme. I can't believe that a group of educated adults put this program together. I feel like it doesn't value nurses and techs and recognize that we are human beings. I also am feeling like I don't even want to work for this healthcare system anymore.

I really enjoy the people that I work with and they types of patients that we have. I even sometimes enjoy the workload :) We as a whole work pretty well together. I'm just dissappointed that we have to go through this and it is an added stress to an already stressful job. I'm further upset that we do not have an advocate.

I'm going to try to let this blow over because I don't see how it is going to effectively work. But the list has already been determined and it is expected that each staff member will be spoken to before January. "Nothing says Happy Holidays more than You Are A Low Performer"

[BabyRN2Be]

for this post i'm going to come from the customer end of it. if someone from management is reading this, i would like to shed a little light on the subject.

here's the big one:

stop calling me with (what i think are) those press-ganey surveys!!!!

i have a doc which i need to see quite often at the moment. after every blessed appointment, a few days later i get a call from a phone survey about the service at the clinic! let me tell you this, it's pretty darn annoying to drop everything that i'm doing to complete your wonderful survey. yes, i know it's all about customer satisfaction and you want to improve ratings. but your rating system is dragging you down because: here's a clue: it's annoying. especially since i get a call about every week. and you know what? the service doesn't change.

here's another clue:

if there's a problem, i will tell you about it. but for now, if you don't hear from me, assume everything is going a-ok from my viewpoint. does this help or is it too much for you to assume that since you don't have a verbal pat on the back from me that i'm not entirely pleased with your service?

for now, i've requested that all surveys to my home phone be stopped. i use it for business, too, and i may miss a client if i spend too much time on the phone with anyone. yes, they can always call my cell but pay-as-you-go plans aren't exactly cheap either.

anyhow, this is getting way too long. but can someone from management understand my side of it?

btw, thanks for letting me vent. this has bothered me for a long time and it's great to get off my chest.

[Tweety, BSN, RN]

So, you are saying making min. wages means it is somehow more justified to render crappy service? I don't bite. ..........

No. You missed the point entirely. I didn't communicate it well. I meant to say I expect anyone making any kind of money to provide customer service, even at McD's. If management at McDs doesn't put up with crappy service from their employees why should nursing? But I would think college educated people, making above minimum wage, working with the public wouldn't have to resort to all this extra training and threats of being fired, etc.

My point in bringing up the money, is that we are getting paid to do certain things, within a job description. I wonder sometimes how some people pick up a paycheck and say "gimme gimme gimme more" and are battleaxe nurses.

I am not going to stop holding the employer accountable for certain things on their end. A paycheck is not enough to keep me there. If I'm to give the best I can be, I need more than a paycheck.

I hated my minimum wage job with a passion and hated my manager and was practically worked to death. But I knew it was part of the job not to take out that stuff on the customers and to provide friendly service with a smile. Sure it would have been easier and more natural had I liked the job and was treated better.

I don't know enough about those programs to make a judgement, as I said way back at the beginning of this thread I'm on the fence. I'm not sure how to address the "customers" who return surveys "the nurses were uncaring". The quality training in orientation doesn't seem to be working.

[Jo Dirt]

secondly, patient satisfaction (or customer satisfaction) while sounding disdainful to a lot of nursing staff is a very real world answer to increasing the number of patients coming to a facility for their health care needs. the retail industry, in particular, has long been aware that offering courteous, friendly customer service increases their sales. healthcare has become a retail item, believe it or not. in some markets (cities) people have a choice of facilities they can be patients in. your hospital has decided they want that business. one of the things they are focusing on that directly affects you nurses is customer satisfaction. there are a number of companies that do customer satisfaction studies for healthcare facilities. i can't think of the names of them, but these surveys can be accessed through your state chapter of the american hospital association. consumers in the know actually look at these reports to chose hospitals they are going to go to! we looked at them when we were looking for a cancer center for my mother's treatment.

third, the thing i know something about is that disciplinary action is probably being built into this program your hospital is undertaking. you may not have been told that, but i smell it. that fact that they had you all sign a form that you were committed to it gives personnel proof that you understood and were made aware that "high performance" was going to be expected. don't be surprised if you are all introduced to some sort of evaluation tool (form) that assesses your level of "performance". you will probably be told about that in your individual meetings with your supervisor. as you said, "the low performers will be given a choice to basically shape up or ship out." i'm going to suggest to you (because i saw this done in one facility i worked) that customers and employees are going to be able to report those who have bad attitudes, promote gossip and chaos, backstab, are snotty and nasty, deliberately sabotage the work of others, refuse to be part of the team effort, etc. your hospital is going to get rid of these employees. first, they are going to give them the opportunity to shape up. this, then, gives the hospital complete legitimacy to fire them it they do not follow these additional performance standards.

we can laugh, sneer and poke all the fun over this we want, but most hospitals that do this are looking to get rid of their lousy, bad attituded employees despite whatever level of training and expertise they have.

we nurses shouldn't think just because we are in the field to help save lives that means we can stomp our feet and stick our noses in the air and we shouldn't care if our patients are satisfied with our method of providing care. it's very true that we are not a maid service or running a holiday inn but i know if i'm a patient i do want to be treated with respect and no, it doesn't hurt to be catered to a little when you are sick. we are dealing with people who are at their worst and who can be touchy and demanding. but (within reason) we do need to see that the patients are satisfied. having been a patient myself about 2 yrs. ago, i have to say i was disapointed with the service (yes, it *is* a service). i'm generally one of the types who doesn't care about being stuck at the end of the hall and forgotten about, but when i stayed overnight in the hospital (i had nasal surgery) i remember calling for help because i was throwing up. i talked to someone over the speaker and they said "okay." no one ever came. sure, i got over it, but it would have been all the same if i had choked to death on my own vomit. i have not yet worked in a hospital, and i do realize patient to staff ratios can be very strained and the work is hard, but from a patient's perspective it seem as though no one cared enough about their job to even come see about me when i called for help.

i did get a survey to fill out but i never sent it in. i can't say i think these are a terribly bad idea, though. in all fields you will have people with bad attitudes and a sense of entitlement that bring everyone else down. better to weed these types out, i say.

[LydiaNN]

We nurses shouldn't think just because we are in the field to help save lives that means we can stomp our feet and stick our noses in the air and we shouldn't care if our patients are satisfied with our method of providing care. It's very true that we are not a maid service or running a Holiday Inn but I know if I'm a patient I do want to be treated with respect and no, it doesn't hurt to be catered to a little when you are sick. We are dealing with people who are at their worst and who can be touchy and demanding. But (within reason) we do need to see that the patients are satisfied. Having been a patient myself about 2 yrs. ago, I have to say I was disapointed with the service (yes, it *is* a service). I'm generally one of the types who doesn't care about being stuck at the end of the hall and forgotten about, but when I stayed overnight in the hospital (I had nasal surgery) I remember calling for help because I was throwing up. I talked to someone over the speaker and they said "okay." No one ever came. Sure, I got over it, but it would have been all the same if I had choked to death on my own vomit. I have not yet worked in a hospital, and I do realize patient to staff ratios can be very strained and the work is hard, but from a patient's perspective it seem as though no one cared enough about their job to even come see about me when I called for help.

I did get a survey to fill out but I never sent it in. I can't say I think these are a terribly bad idea, though. In all fields you will have people with bad attitudes and a sense of entitlement that bring everyone else down. Better to weed these types out, I say.

To me, though, not getting a response to a report that you are vomiting isn't poor customer service, it is poor quality of care, which is completely different. It isn't that I don't believe nurses should treat their patients with respect and empathy; it is that I believe those characteristics are integral to patient care, as opposed to customer service. When I hear the term customer service, I think of things like, when you didn't get what you ordered for dinner, did that the nurse take care of it for you? Ideally, she would, yes. OTOH, if she was responding to a call from a patient who was vomiting after nasal surgery and you had given up and just eaten the pork in the meantime, then I don't think it is fair to penalize her with a low satisfaction score.

[SmilingBluEyes]

To me, though, not getting a response to a report that you are vomiting isn't poor customer service, it is poor quality of care, which is completely different. It isn't that I don't believe nurses should treat their patients with respect and empathy; it is that I believe those characteristics are integral to patient care, as opposed to customer service. When I hear the term customer service, I think of things like, when you didn't get what you ordered for dinner, did that the nurse take care of it for you? Ideally, she would, yes. OTOH, if she was responding to a call from a patient who was vomiting after nasal surgery and you had given up and just eaten the pork in the meantime, then I don't think it is fair to penalize her with a low satisfaction score.

well-said. We are confusing issues here.

[SmilingBluEyes]

I appreciate your clarification, thank you Tweety.

I think Mercy said it so well; we are confusing nursing CARE with customer service. TOO OFTEN nurses are being held universally accountable for issues not under our control .THAT needs to stop.

[SmilingBluEyes]

We nurses shouldn't think just because we are in the field to help save lives that means we can stomp our feet and stick our noses in the air and we shouldn't care if our patients are satisfied with our method of providing care. It's very true that we are not a maid service or running a Holiday Inn but I know if I'm a patient I do want to be treated with respect and no, it doesn't hurt to be catered to a little when you are sick. We are dealing with people who are at their worst and who can be touchy and demanding. But (within reason) we do need to see that the patients are satisfied. Having been a patient myself about 2 yrs. ago, I have to say I was disapointed with the service (yes, it *is* a service). I'm generally one of the types who doesn't care about being stuck at the end of the hall and forgotten about, but when I stayed overnight in the hospital (I had nasal surgery) I remember calling for help because I was throwing up. I talked to someone over the speaker and they said "okay." No one ever came. Sure, I got over it, but it would have been all the same if I had choked to death on my own vomit. I have not yet worked in a hospital, and I do realize patient to staff ratios can be very strained and the work is hard, but from a patient's perspective it seem as though no one cared enough about their job to even come see about me when I called for help.

I did get a survey to fill out but I never sent it in. I can't say I think these are a terribly bad idea, though. In all fields you will have people with bad attitudes and a sense of entitlement that bring everyone else down. Better to weed these types out, I say.

I am sorry but I must have missed it: who said we thought we should stomp our feet and demand our way? I think a reasonable expectation is to hold ALL levels accountable when programs like Studor are put in place. No nurse said here we should not be held accountable for what is our responsibility to render good nursing care. What we are saying is, Studor programs are a disaster in the hands of dysfunctional management/administrators.

And how do you define "catering"? If it's to do our jobs, as nurses, that is not catering, it giving good nursing care. If you are vomiting, it is not "catering" on my part to clean up and give you meds to make it stop.

But, If you think everything under the sun should be our responsiblity (like dietary, housekeeping, unclogging toilets, etc other jobs), get in line. So do, apparently a lot of others. It's wrong and in some places, nurses are stretched WAY too thin as it is.

I have been expected to plunge clogged toilets at times, as we have no around at night to do it----well if I am plunging a toilet, cleaning a room (we have to turn over rooms we triage our patients in), or if I am running down to make up someone's sandwhich at 3 a.m., or making a patient's family coffee, (all considered "good customer service"), it's hard to respond immediately to a patient asking for pain meds or vomiting, know what I mean?

Since you have not worked in a hospital, I am sure a lot of what I am saying sounds like I am justifying your lousy care, but I am not.

No, if you got lousy care, I hope you wrote the CEO/DON to address these issues. Like I have said before, you have recourse, but nothing will change if a clear communication of your needs not being met is not provided to people who can help you....

[nursemaa]

It is so hard to balance the care aspect and the service aspect, particularly when you're dealing with a demanding patient. I think we (and the Studer group) have to accept that there will be times when someone's going to be upset about the service, because we were running around like crazy delivering care.

However, if you can't deliver the service, it only takes a moment to apologize and do what you can to rectify the situation (maybe have someone who's not busy get that cup of coffee or whatever). That's where teamwork comes in. If the patient's nurse is busy, maybe someone else can step in and help.

What I think hospitals are trying to get rid of is the "it's not my patient", "it's not my job" mentality, along with the staff who are just really abrupt or downright rude to people. Both hospitals I've worked in, the administration seems to understand those times when everyone's running around like crazy and the service aspect gets put on the back burner.

[Tweety, BSN, RN]

well-said. We are confusing issues here.

I agree. So if we're a bit confused, imagine what the general public you care for things.

You give awesome quality of care. The patient complains he didn't get his dinner and would like his water picture filled. Nurse says "I don't have time for that right and it's not my job, I'll get to it when I can, you're not my only patient you know. This isn't a hotel or a high class restaurant."

What is the patient going to remember about this nurse? What is she going to put on her survey?

There are ways to respond to and treat patients when you're stretched too thin and stressed.

[Tweety, BSN, RN]

What I think hospitals are trying to get rid of is the "it's not my patient", "it's not my job" mentality, along with the staff who are just really abrupt or downright rude to people.

I read this after I posted above. I agree.

[Agnus]

The problem as I see it is when a company adopts a blueprint for customer service that has been created else where it often does not work simply because they are missing essential insight in the first place.

Customer service and good treatment of employees is not a formula, nor a script that someone else wrote. You either have deep respect for others or you will never achieve what you are after with this manipulative behavior. Employees and customers see through the robotic manipulation that is adopted when perscribing scriped behavior for others. It works in the places where it was started because the behaviors are an outgrowth of human reguard not the otherway around and until companies get the part that the human respect comes first and the words and behavior naturally follow they will continually struggle.

This classification of performser and then talking to each group has failure written alll over it. There is a way to talk to people it is not shape up or get out. The person who came up with that already displays poor people skills himself.

It is true this wont go away. I don't thing anyone is argueing that. That is the favorite line of managers who feel trapped and do not know how to fix a problem. It is a way of saying we just have to take it. Showing again poor people skills. I know I am hitting some nerves here.

People skills are teachable. Like most here have said it starts from the top down. We have management who have received a mandate to implement something they truly do not understand themselves. Managers must learn to use the skills (remember skill takes practice before it is learned) They must truly emulate it toward everyone including the "poor performer" before they can begin to teach others. People skills are best learned in an enviorment where they are consistently practiced.