Going "Above and Beyond" UGH

[SubSippi]

At my hospital, there has recently been a push for nurses to "go above and beyond" when providing patient care. They send out emails, put up little signs and posters, and will occasionally show up in the unit and ask people how we have gone above and beyond today. It has really rubbed me the wrong way. First, because it's ridiculous to set such an ambiguous standard. But mainly, it's because I think it is probably impossible for a nurse to actually do something that would be considered "above and beyond." Let me explain.

As nurses, we have an incredible amount of responsibility for our patients. We are responsible for providing infinite aspects of bedside care. We are responsible for providing emotional support for both patients and their families. We are responsible for providing education to each patient about his or her medical condition, medications, any necessary procedures, and instructions for after discharge. We are responsible for keeping them both safe and comfortable simultaneously. And, we are responsible for communicating with each patient's specialists, surgeon, nutritionist, respiratory therapist, PT/OT and whoever else, and coordinating care between all of these people. And of course there's more.

These responsibilities are all part of a standard nurse's job description. We are expected to do each and every one of these things for all of our patient's every shift, and if we leave just one of them out, we have fallen short, and can even get written up. This isn't me complaining about being too busy or having too much responsibility. I love my job, and enjoy the patient population I get to work with. But with all the different hats nurses wear, it seems to me like anything I do for my patients, no matter how difficult it is to accomplish, or how much time it takes, is just me doing my job.

Nurses can't go above and beyond when caring for their patients...it's like trying to travel at the speed of light!

Anyway, it's been grating on my nerves. Partly because it's coming from administrators who have either never taken care of patients, or haven't done it in decades. And partly because I'm being asked to meet an unattainable goal. Any thoughts?

If y'all have any "going above and beyond" examples, please share.

[dec2007]

Dear Klone, I am also human, tho I don't always feel treated that way! I tried to go "above and beyond " for my attempted suicide patient( his 6th try) to get him some help until he tried to punch me in the face when I extubated him. All our social worker staff, etc has pretty much written him off as a lost cause. "He'll be back!" they say. "Can't fight the system." Guess so. Verbal/physical abuse? Hey, it's part of your job! Support from above? Ha!

[rnforforty]

When did hospitals (hospital: a place where sick or dying person go to have their basic human and medical needs cared for in a humane manner by specially trained and skilled caregivers) go into competition with the Waldorf-Astoria Hotel Chain?

As a Korean nurse friend was heard to tell a demanding, ready to go home patient, 'Dis NO Holiday Inn!'

And when did a patient become a 'client' or 'customer'? They are PATIENTS, sick and afflicted! A client or customer are there voluntarily, patients don't want to be there at all!

Lord, when did it all go to he**?

[chevygirl1987]

My unit was recently recognized for 3 quarters of the highest staff recognition from patients as well as exceeding the national goal for responsiveness on HCAHPS. In the same meeting, we were told what we would change to achieve good scores in these exact things.

My response- when everything's a priority; nothing's a priority.

[NurseDiane]

I think health caer has been circling the drain for quite a while, and the ACA put the cherry on top. For some reason, insurance companies have caused hospitals to go into "servant mode" instead of caregiver mode. As long as healthcare is treated as a profit-driven industry, this is what you're going to get. Our government put those stupid "satisfaction surveys" into the equation, basing reimbursements on how "satisfied" patients are with the care they received during their stay. So, if a patient that came into the ED in CHF stayed in the ICU, intubated, sedated & on a vent for 2 weeks heads out onto a tele floor awake & alert, able to eat & there's nothing they like on the dinner menu, the hospital will get a poor satisfaction survey. Then the hospital has to explain why the patient was unhappy before they get reimbursed by the insurance company. Never mind that the hospital saved the patient's life---the patient doesn't care about that. They care about what they're going to eat. The whole thing is totally absurd----as I wrote in one of my prior posts, I have heard that now in nursing orientations, the nurses are given a "script" of what the hospital wants the nurses to say to the "clients". As I've said before, if nurses wanted to go into sales or customer service, they wouldn't have incurred tens of thousands of dollars in student loans to get a nursing degree.

What's ironic about it is that the satisfaction rates among nurses are the lowest they've ever been in the history of healthcare. Understaffing issues, poor treatment by management, constant threats of being reported to the nursing boards, excessive charting, etc. etc. etc.---and the hospital expects nurses to act as servers too. The patients are lucky that the nurses even walk into their room to talk to them, forget about being a servant for their other "needs" as well. I wonder what it will be next: Nurses giving haircuts? Nurses giving manicures & pedicures? Nurses giving facials? That would be "customer service", not healthcare. If people want personal services instead of, many times, having their lives saved, they can Google some local places to suit them. Expecting nurses to be customer service specialists is ludicrous.

[dec2007]

Well said, Nurse Diane! This "trend", (if we can call it that), has made me feel that my goals of providing excellence in nursing care are no longer relevant. Mostly I feel now that the final years of my career will be spent providing "customer service" similar to the waitressing days of my youth. Whether or not the public is aware of the reality, when the time comes that a loved one is critically ill, "customer service" won't be what saves their life!

[WKShadowNP, DNP, APRN]

When did hospitals (hospital: a place where sick or dying person go to have their basic human and medical needs cared for in a humane manner by specially trained and skilled caregivers) go into competition with the Waldorf-Astoria Hotel Chain?

As a Korean nurse friend was heard to tell a demanding, ready to go home patient, 'Dis NO Holiday Inn!'

And when did a patient become a 'client' or 'customer'? They are PATIENTS, sick and afflicted! A client or customer are there voluntarily, patients don't want to be there at all!

Lord, when did it all go to he**?

I hear ya. But like it or not, they ARE customers. I think the problem lies in the drive to seek customer satisfaction as if it were a hospitality discipline. I doubt there will be a change anytime soon but we need to educate the public we serve in that what they want may not be what they need.

I wishes were fishes....

[NurseDiane]

I respectfully disagree. Patients ARE NOT customers---customers go to places that they choose, not hospitals for their care. Patients go to the hospitals their doctors practice out of. Patients go to the hospital that is closest for an ambulance to get to. Patients go to tertiary hospitals for advanced diseases like cancer, ALS, autoimmune disorders, etc. AND, patients go to the hospitals that their insurance will pay for. Converting "care" to "customer service" or "upselling" is wrong on every level. If I go to the hospital---and, incidentally I was admitted 2 years ago for a submassive saddle pulmonary embolism----my concern is that I am being medically treated properly. I don't care if the coffee is Starbucks, or that they don't have cocktail hour, or if I get my medication an hour late. (It just so happens that my hospital stay was fantastic & every single person I came into contact with was exemplary & should have gotten a raise---I wrote letters to the CEO of the hospital & chief nursing officer to praise them, right down to the dietary people.) The people that were less-than-hospitable were the residents, and they weren't that bad. I know that residents work their asses off, are often exhausted & so I give them a break. Then again, I wasn't a demanding patient. It would be nice if letters like mine would get all those people raises, but it won't. If places get reduced reimbursements based on poor surveys, then shouldn't they be rewarded for positive ones? Just expecting superior service for payment isn't right. Everyone knows that positive reimbursement works much better than punishment & punitive treatment. I guess not in health care.

[klone, MSN, RN]

Not all healthcare facilities are hospitals, though. People CHOOSE their clinic and/or PCP, which often drives where they go for inpatient care.

[Havin' A Party!, ASN, RN]

After a short while in practice, think we pretty much all realize that the cr_p discussed in this thread ("above and beyond" or "whatever it takes... and more," or any other such phrases) is purely "Management BS of the Day."

And the longer we're out there working our butts off, the more annoying it gets.

Don't let 'em get to ya.

_____________

As an aside though, I believe all patients are customers... because, while the reasons / circumstances may vary, there's always a choice involved for any type of treatment.