Hostage situation

CBlover, BSN, RN · Oct 9, 2015

I agree. They're constantly hounding us to keep satisfaction scores up when some pts are impossible to please. It's taken a lot of the fun out of my job personally thanks to all the added paperwork and what-not they've added to our daily duties just to aid in bringing up scores. It's burnt me out almost completely. I've gotten to the point I'm wishing I could get out of the hospital altogether.

FolksBtrippin, BSN, RN · Oct 9, 2015

I wouldn't call this a hostage situation; I dislike hyperbole when discussing pertinent social issues. Another thing that bothers me about your post is that you claim to have multiple Munchausen patients when that disorder is very rare. Are you sure about that?

I agree that patient outcomes should trump patient satisfaction when it comes to judging the quality of a hospital. But patient satisfaction is still important, and patients are vulnerable to abuse and maltreatment in the hospital and other settings, something needs to be in place to protect them.

Drug addiction is a complex social problem that requires more than medical intervention and the disease model doesn't work. Is there evidence to suggest that placing a higher value on patient satisfaction contributes to drug abuse? I don't think so, but if you found some let me know.

Jensmom7, BSN, RN · Oct 9, 2015

The affordable health care act has brought a lot of changes into our profession. Some good, some.. still questionable.
I'm kind of wondering about the rating system. If a patient rates a hospital as one that delivers poor service, then they get less compensation. That could lead to doctors prescribing narcotics to addicts just to keep them satisfied, so that they get rated well and receive their compensation.
I have seen this personally on my hospital floor. Munchhausen patient's admitted for abdominal pain that have been through multiple tests with no definite cause. I kind of feel like our MD's are held hostage to the ACA. We have an opioid addiction problem in the USA as well, I kind of feel that the ratings based compensation is only helping to exacerbate the problem.

You bring up some interesting health care dilemmas, unfortunately your premise is based on misinformation.

The ACA has nothing to do with satisfaction surveys/scores. It provides for Medicaid insurance coverage for adults (and also the dependent child portion).

Part of the narcotic addiction problem you speak of has been exacerbated by the "you have the right to have all your pain needs fully addressed" portion of the Patient Bill of Rights. It has been abused by both patients and providers.

HouTx, BSN, MSN, EdD · Oct 9, 2015

Actually, there is emerging research on this area - relationship between 'patient satisfaction' and clinical care. And (not surprisingly) the results are supporting what many of us - including OP - are already suspecting. Thus far, high satisfaction appears to be associated with more 'unnecessary' care. Oh My Gosh!!! said no one, ever.

ClaraRedheart, BSN, RN · Oct 9, 2015

I wouldn't call this a hostage situation; I dislike hyperbole when discussing pertinent social issues. Another thing that bothers me about your post is that you claim to have multiple Munchausen patients when that disorder is very rare. Are you sure about that?

i never claimed to have multiple munchausens patients. I've had one very early on in my nursing career and one fairly recently.

I've also had many patients who have developed an opioid dependency for a legitimate reason who still seem to have a dependency and require massive amounts of the medication upon every hospitalization. I do not mind doling out the medication. If the doctor orders it, I

do my job. Every now and then I do feel a bit guilty for exacerbating a problem, however.

Emergent, RN · Oct 9, 2015

Hopefully the pendulum will swing back to a reasonable middle. This all came about because of rude, surly health care workers.

I know, when I am paying through the nose for health care, or anything, I want courtesy, not a snarky Nurse Ratchet telling me off.

Unfortunately, a disproportionate part of our patient populations are rude, demanding, disrespectful people who want to be queen or king for a day. Not sure what the answer is.

MunoRN, RN · Oct 9, 2015

The "rating system" your referring, HCAHPS, comes from Value Based Purchasing, which was part of the HiTECH act, not the ACA, and predates the ACA by quite a bit. My hospital started using HCAHPS in 2006, the ACA was passed in 2009.

There is no specific score a hospital must hit to not get penalized, they only need to not be significantly worse than everyone else. HCAHPS are basically a set of questions asking patients if staff were doing their jobs, and it seems pretty reasonable that a payer would want to ask if what they're paying for is actually being done.

heron, ASN, RN · Oct 9, 2015

I wonder if people are getting hcahps confused with Press-Ganey scoring.

FolksBtrippin, BSN, RN · Oct 11, 2015

i never claimed to have multiple munchausens patients. I've had one very early on in my nursing career and one fairly recently.
I've also had many patients who have developed an opioid dependency for a legitimate reason who still seem to have a dependency and require massive amounts of the medication upon every hospitalization. I do not mind doling out the medication. If the doctor orders it, I
do my job. Every now and then I do feel a bit guilty for exacerbating a problem, however.

In your original post you stated, "I have seen this multiple times on my floor. Munchausens patients with abdominal pain..."

In reference to you feeling guilty about exacerbating a drug problem when doling out prescribed meds: stop. You are not exacerbating a drug problem when you give a patient his meds in the hospital. Your idea about that is false.

If you feel that drug addiction is a problem for a particular patient, talk to that patient about it. Assess how the patient feels about his drug use, whether friends and family have expressed concern to the patient about drug use, whether drug use has interfered with work.

jadelpn, LPN, EMT-B · Oct 11, 2015

i never claimed to have multiple munchausens patients. I've had one very early on in my nursing career and one fairly recently.
I've also had many patients who have developed an opioid dependency for a legitimate reason who still seem to have a dependency and require massive amounts of the medication upon every hospitalization. I do not mind doling out the medication. If the doctor orders it, I
do my job. Every now and then I do feel a bit guilty for exacerbating a problem, however.

What problem? I feel more of a "problem" is sending patients home with medications that cost an arm and a leg. I feel more of a "problem" that there's little to no outside referrals that I can set up a patient for regarding chronic pain, mental illness, or substance issues.

In my PERSONAL life, I am a huge advocate for choices. And for support of services who help people to function as humans.

As a nurse, I advocate for whatever is available to help the patient. I can not (nor should anyone) take on the role of "I feel so guilty".....guilt is a personal emotion.

CryssyD · Oct 12, 2015

So many problems with healthcare, so little time! My personal take is that the ACA has nothing to do with hospital satisfaction scores, which don't actually affect compensation--nor should they, as they are completely subjective ratings from patients who are 1) biased, 2) personally involved and thus incapable of being objective, and 3) unqualified to accurately assess medical or nursing care in any meaningful way as relates to outcome or medical quality. Measurable outcomes do matter, though, and we need to keep working on better ways to assess, track, and learn from them.

The ACA, like most complex legislation, is in need of constant review and revision as necessary. However, although there are still lots of things to work on, I don't think adding to addiction problems in the interest of getting happy patients is one of them:)