Which nurse do you want for your Little Johnny?

  1. With today's focus on "patient satisfaction", patient care actually suffers.

    Which nurse do you want for your Little Johnny?

    Healthcare institutions want to be profitable businesses, but few take advantage of their true strengths.

    It's understandable that management tries to reduce costs whenever/wherever possible. Cost reductions generally appear on the bottom line. However, many major costs are fixed and cannot be reduced. So the one area where costs are less rigid is labor costs. Rare indeed is the manager (on any level of any enterprise) that can resist tinkering with labor in the hopes of improving financial performance while looking like a genius to the board of directors.

    These same executives, like anyone else, have a completely different view when considering using the services of some company in their personal lives; damn your costs, I want the best possible service and I want it now! Don't make me wait for my steak for 32 minutes when I expected it in 30 minutes. You should have my AC repaired in less than two hours. What do you mean my flight is delayed because the crew that inspects the plane is short-staffed? That's YOUR problem, not mine.

    Similarly, many people look at student/teacher ratios when deciding on institutions in which to enroll, or to enroll their children. Common sense tells us that it's likely that a teacher with 12 students will be able to provide Little Johnny with more individualized attention than a teacher with 26 students could provide. If Little Johnny is struggling, he can get more help if the teacher isn't overwhelmed. We do not want Little Johnny to struggle. We want him to succeed, so we choose what we believe will give him the greatest chance to do that. By the way, a large part of nursing is educating our patients about the diseases/conditions they have, treatment options, their medications, needed adjustments to lifestyle, etc. Teaching takes a lot of time, attention, and listening if done effectively.

    So... when Little Johnny gets sick and is hospitalized, tell me what you'd prefer- the haggard, exhausted, worried, stressed nurse taking care of him as she/he runs from room-to-room. The one driven by the unrealistic expectation of providing immediate care to everyone at the same time without much thought given to the individual? OR... the nurse that has the time to carefully study Little Johnny's case history, thoroughly assess him, determine which problems are most pressing, devise a plan to address those problems in a timely manner, initiate that plan, and constantly evaluate the effectiveness of it, and updating and adapting the plan as indicated?

    If you'd prefer the second nurse, welcome to the party. She/he is who everyone wants for their Little Johnny. Sadly, that nurse is becoming a relic of the past. Today's nurse is expected to do more, in less time, and with fewer resources than ever before. Under these conditions it becomes more and more difficult to achieve this era's healthcare mantra: patient satisfaction.

    When patients are discharged from hospitals, home health agencies, or other institutions, they are asked to complete a survey. Most people believe (wrongly) that the purpose of completing these surveys is to help improve the care provided by offering critiques and suggestions. Some of these have merit, others do not. But the merits do not matter; if any response is considered negative, it has a negative effect on the institution- and the payment/reimbursement sent to that institution from Medicare and other insurers. Healthcare providers are routinely "dinged" for things like "I didn't get my pain medicine on time" or "I had to wait for 10 minutes to get my ice water". Nevermind that the nurse was in the middle of performing life-saving maneuvers on a patient in cardiac arrest, or checking that the correct medication was ordered and delivered for you, or the nurse's aide was trying to get ice water to all 30 patients on the floor. Circumstances do not matter to the surveyors or insurers.

    The only thing that matters is complete, total patient satisfaction with nothing but glowing praise for every minute spent while admitted. Fail to reach that goal in the silliest way, and your reimbursements go down. Profits go down. When profits go down, cost-cutting efforts are implemented and we've already seen what that leads to- Little Johnny gets the first nurse and his care suffers as a result. So again, patient satisfaction scores go down, profits go down, etc, ad infinitum.

    Where does the downward spiral end? Probably in the decline to third-world levels of the once-finest healthcare system in the world. Can it be turned around before it's too late? I only see one possible answer.

    If you're an investor seeking huge returns, instead of investing in healthcare delivery, invest in healthcare research. Invest in healthcare technology if the medical field is something you cannot resist. Invest in the things that put most of us in the hospital in the first place (none of us are going to give up our vices, ya know). But for the love of God, get the hell out of healthcare delivery and stop trying to run it like a factory. Humans are not machine parts and don't deserve to be treated like they are.

    For those that remain, focus your energy and resources on becoming THE preferred provider in your area. Provide care that does not meet expectations of patients- hit them squarely with "shock and awe" patient care. That kind of care takes truly dedicated clinicians who have the time and resources to achieve excellence. Do that, and the profits will follow.
    Last edit by Joe V on Jun 14
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    14 Comments

  3. by   Have Nurse
    I love this!!! Couldn't have said it better myself!
  4. by   Chisca
    Awaiting to be replaced by a robot.
  5. by   zoidberg
    Quote from Chisca
    Awaiting to be replaced by a robot.
    Hey, being the nurse robot repairman has gotta be easier than floor nursing
  6. by   Daisy4RN
    Unfortunately health care is in a downward spiral and I see no end in sight. So sad and scary.
  7. by   Daisy4RN
    Quote from zoidberg
    Hey, being the nurse robot repairman has gotta be easier than floor nursing
    I will take that job too, lol
  8. by   billswife
    Every word is so true. Sadly, it doesn't always work. In our ICU this weekI had a septic patient, and the Intensivist and I definitely provided "shock and awe" care. The family was wonderful and appreciative. After 13 hours on my feeet with no lunch, assisting in bronching, line insertion, and starting CRRT, at the very end of the shift I receive a 'variance' due to an order I entered at the MD's request to mix sodium bicarbonate drip in NS rather than a dextrose base if possible; if not the usual D5w base was fine. For the life of me, I don't understand how entering his order is a "variance", but I DO know I left work sad and disheartened that this was the ONLY response to my hard work that I received that day. This is why morale is at its lowest point ever, and why new nurses don't want to stay bedside.
  9. by   Daisy4RN
    Quote from billswife
    Every word is so true. Sadly, it doesn't always work. In our ICU this weekI had a septic patient, and the Intensivist and I definitely provided "shock and awe" care. The family was wonderful and appreciative. After 13 hours on my feeet with no lunch, assisting in bronching, line insertion, and starting CRRT, at the very end of the shift I receive a 'variance' due to an order I entered at the MD's request to mix sodium bicarbonate drip in NS rather than a dextrose base if possible; if not the usual D5w base was fine. For the life of me, I don't understand how entering his order is a "variance", but I DO know I left work sad and disheartened that this was the ONLY response to my hard work that I received that day. This is why morale is at its lowest point ever, and why new nurses don't want to stay bedside.
    I couldn't agree more, you literally run your bottom off all day long and get nothing except "well, that wasn't good enough", very disheartening!!
  10. by   Maacanto
    Daisy4RN,
    You're so right. Seems like only mistakes are acknowledge by admin.
  11. by   retiredmednurse
    I loved the article. It is so true and as you stay in the profession, it only gets worse. I shared it on my Facebook page and encourage EVERY one to read it. Help spread the word and share it on your social pages.
  12. by   Elaine M
    So you got dinged for a doctor's order that didn't harm the patient?
  13. by   Kooky Korky
    Stop bemoaning, friends, and start speaking up.

    Talk with legislators, your family and friends, etc. Inform them of the dire
    conditions nurses face on the job and tell them what kind of care they can
    expect if they or their loved ones are admitted.

    Stop waiting for someone else to fix the problem.
  14. by   RobbiRN
    Quote from billswife
    Every word is so true. Sadly, it doesn't always work. In our ICU this weekI had a septic patient, and the Intensivist and I definitely provided "shock and awe" care. The family was wonderful and appreciative. After 13 hours on my feeet with no lunch, assisting in bronching, line insertion, and starting CRRT, at the very end of the shift I receive a 'variance' due to an order I entered at the MD's request to mix sodium bicarbonate drip in NS rather than a dextrose base if possible; if not the usual D5w base was fine. For the life of me, I don't understand how entering his order is a "variance", but I DO know I left work sad and disheartened that this was the ONLY response to my hard work that I received that day. This is why morale is at its lowest point ever, and why new nurses don't want to stay bedside.
    I'm reluctant to detract from the focus of a well-written article with this little detour, but I'm curious if the doc shared his rationale for wanting to use a NS base instead of D5w? God forbid we should ever stray from a protocol even if there're a myriad of great reasons for doing so.
    Last edit by RobbiRN on Jun 15 : Reason: typo

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