Patient Satisfaction: A New Priority

[AnnoyedNurse]

So I just want to rant really quick about my disgust with reimbursement based on patient satisfaction scores. Obviously, as a bedside RN i could care less about whether or not we get reimbursed. My priority is the care I provide my patient- their safety, wellbeing , and comfort. However, after three years of nursing, my sanity is starting to become more of a priority.

Family members are the most rude, ungrateful, and disrespectful members of the healthcare team. Not only are they stupid, but they think they know what is best for the patient, yell, cuss, pay no mind to established rules, will silence my monitor alarms, will disconnect the patient from their IV's, etc. Bottom line: family members are truly getting in the way and all because of patient satisfaction, physicians and nursing management make us deal with it instead of supporting us in setting boundaries.

Have any any of your hospitals (I'm in a Neuro ICU) moved more towards letting the families do whatever they want? I'm truly sick of it and have applied to many non-patient care areas. I don't want to interact with rude people anymore- and that includes our ungrateful patients.

[Daisy4RN]

I agree with you that patients and families are out of control and admin does nothing about it (for what ever reason). This leaves the bedside nurse to deal with families with no back up what-so-ever. I have experienced those type of attitudes also, family thinking you are there to cater to them, not following hospital rules/policies (no matter how politely you ask), basically doing whatever they want because they know they can get away with it. Any staff who does not see this as a problem is probably not a bedside RN. The RN is made responsible because we are there for 12hrs. Other ancillary staff (lab, RT etc) come and perform their task and leave, I have even had then tell me, room 120 wants water etc, really?? . This trend of patient satisfaction hurts patient care because all patients will suffer when nurses are running around attempting to please patients/families with trivial matters instead of using that time for nursing tasks/critical thinking etc.. It hurts the nurse also because we are placed in a no win situation, some families wont be happy no matter what you do, but you still end up being held responsible. This is exactly why nurses are leaving the bedside. The ultimate hyper-stress of being held accountable for things that are out of your control!

[Ruby Vee, BSN]

I agree with you that patients and families are out of control and admin does nothing about it (for what ever reason). This leaves the bedside nurse to deal with families with no back up what-so-ever. I have experienced those type of attitudes also, family thinking you are there to cater to them, not following hospital rules/policies (no matter how politely you ask), basically doing whatever they want because they know they can get away with it. Any staff who does not see this as a problem is probably not a bedside RN. The RN is made responsible because we are there for 12hrs. Other ancillary staff (lab, RT etc) come and perform their task and leave, I have even had then tell me, room 120 wants water etc, really?? . This trend of patient satisfaction hurts patient care because all patients will suffer when nurses are running around attempting to please patients/families with trivial matters instead of using that time for nursing tasks/critical thinking etc.. It hurts the nurse also because we are placed in a no win situation, some families wont be happy no matter what you do, but you still end up being held responsible. This is exactly why nurses are leaving the bedside. The ultimate hyper-stress of being held accountable for things that are out of your control!

I have to laugh, because you are absolutely right. Any staff who doesn't see the spirally time suck that families can become (and all to often DO become) is probably not at the bedside. OR at the front desk where they hang out to complain about not getting their 12 sodas with just the proper amount of ice and the guest trays that they "are supposed to get" every single meal.

[Buyer beware, BSN]

Patient satisfaction "new?"

This is how it works: poor clientele's family unruly, surly, dangerous and threatening, they get escourted out.

Rich clientele's family all of the above and my husband, brother, son, daughter's a lawyer and a doctor with a donors plaque hanging in the lobby the nurse gets escourted out, looses job and is banned from all hospitals within the system.

God bless America.

[LMtally43]

I agree that patient satisfaction surveys had become a nightmare for nurses. It goes to a point that the nurse is required to be a maid to patients and families. The worst part of this new " requirement" is that it undermines the nurse job when she needs to meet every single ridiculous wish like bringing juice and crackers when the nurse is busy caring for for 4-5 patients at a time. And you can't complain to your charge nurse, you will not be backed up by management. Hospital administrators are more concerned about money matters than in providing quality nursing care to patients. This need to be addressed and the only way to do it is getting the voice out there.

[AnnoyedNurse]

Hey all! I'm the original poster of this thread. Each time I read one of the rude comments judging me for my dissatisfaction with the ridiculous survey first mentality that has overtaken our hospital systems, my heart broke a little more. For those of you who haven't had my experience, I think you are very lucky.

Unfortunately, my experience has been different. For those who have judged and made nasty comments about my "social" skills, nursing isn't my first career and I'm not some 21 year old who "just doesn't get it'." I am a 30 year old Army Medic, who was a very successful salesperson in a lucrative industry. I became a nurse because I wanted to help people. I wanted to work in critical care because I wanted to help the most vulnerable people and provide them a chance at making it another day.

For those who have criticised me in saying that families are entirely in the way for our unstable patients in the ICU, then quite frankly, you haven't worked in an ICU before.

I do love my patients and their families, -!: yes, the majority of my family members are very grateful and are not rude. However, the amount of negative family members is still so high- even when they aren't my patients. It really gets on my nerves when people just don't listen. Rules are there for a reason. People are always trying to crack the doors open, sneak people in the ICUs, disobey the two person at a time rule, no food in drinks in the room, please don't wake up the patient (there is a reason why we sedate them). There are maybe 20% of nurses who enforce these rules and 80% who don't out of fear of being reported to management for being a bad nurse.

I do enforce the the rules in a nice way. I do educate my patients. I go above and beyond. I try my best to treat them in the same way that the ICU nurses treated myself and my family, but maybe we were raised better by our parents and we had an unconditional respect for the health care staff. Even when I was upset about something, I spoke to them with respect and tried to understand.

With that said, everyone is entitled to their own opinion. I can say with confidence that I'm a great nurse- my coworkers know it and so do my patients. But unfortunately, discontent I have with entitled patients, has driven such a disconnect between me and what was once my passion. So yes, I will be another statistic. I have accepted a job offer in Sales and will be starting in two weeks and I have made arrangements to start investing in real estate again. I am going to live my life for ME again, because quite frankly, as nurses, we're living life for others.

[brownbook]

It sounds horrible. What do your co-workers think? It just seem that if it is as awful as you say your co-workers would feel the same as you?

Can't you and your co-workers bring up the problems at a staff meeting? Can't there be a security guard outside the unit doors enforcing the rules, checking in visitors?

A key pad entry on the door, visitors have to wait outside the door and are escorted inside?

Locked psychiatric units have a lot of security measures, maybe they would have some ideas? Many, most, ICU type units must have found ways to deal with this?

I admit I am away from acute care bedside hospital nursing, but when I visited my daughter 12 years ago in a plain old post partum unit there was a security guard at a desk at the entrance and we had to sign in, (I forget if he had to call the nurses station or just had a list of allowed family?).

Don't curse the darkness, light a candle.

[AnnoyedNurse]

Great point! So in theory, we are a locked unit. But families are allowed entrance without even asking the nurse. They also piggy back themselves behind other visitors. & yes, many of my coworkers have the same thoughts. We've talked about it plenty. The unfortunate thing is, we work for a very prestigious "institute" where people from all over the country come for many times scheduled neurological surgery and therefore, the physicians have more power than in most hospitals and choose patient satisfaction as their priority as that is how they get paid. So unfortunately there isn't much to be done. For example, I had a wife of a man who wouldn't allow me to do Neuro checks on her husband, wouldn't allow me to turn her husband, infuse the IV fluids except antibiotics, or provide any other nurse care. She was dictating care through and through. After bringing this to the attention to the surgeon, he refused to talk to her about the importance of nursing care and back me up and instead said, "just document it." In my opinion, that's a cop out. And this is only one example of how doctors refuse to help nurses when we run into issues with our patients.

[brownbook]

Not being able to take care of the patient, no turning, no neuro checks, no IV fluids, is causing harm to the patient!

I just hope maybe that particular patient had very little hope, no chance of recovering, so the doctor didn't think basic nursing care would make a difference? But the family couldn't accept that?

Of course in that case they should be a DNR? It sounds just horrible to work there as a nurse! Your hands are tied!

[AnnoyedNurse]

I don't think you've ever worked in an environment where something like silencing the alarm can lead to a patient death or disconnecting an IV doesn't just affect the fluid intake but rather hemodynamic stability. I agree that many family members have a wealth of knowledge on the patients care at home, but when they are critically ill, vented, on multiple pressors, anything more than giving comfort and holding hands of the patient is causing harm. Hence why they are in the hospital. Critical care nurses aren't "everyday run of the mill nurses." We are experts and yes, we also do this everyday. We are the professionals. If they want to refuse care, that's up to them, and I will gladly respect that, but unless that's cleared by the doctor already, you cannot touch my monitor or other equipment. I'll politely educate once or twice but after that, they're being escorted out.

[Here.I.Stand, BSN, RN]

For example, I had a wife of a man who wouldn't allow me to do Neuro checks on her husband, wouldn't allow me to turn her husband, infuse the IV fluids except antibiotics, or provide any other nurse care

Oh heck no...she doesn't have the option to refuse that stuff. A while back I had a pt sign out AMA after receiving tPa because she refused the post tPa neuro checks/VS, refused to stay in bed, refused to be on the monitor, and insisted that she would be going outside to smoke. The nursing supervisor on duty even said we can't accommodate that; it would jeoparize our stroke program.

Post surgical neuro changes when they happen, happen FAST. That man could be swelling or bleeding or developing hyrocephalus, and without those neuro checks nobody will know...if nobody knows, his brain could be irreparably damaged. Personally I would rather face that wife than face a malpractice suit, when the patient was harmed due to my not performing my assessments as per the prudent standard of care.

I'd think that possibility would occur to the physician as well.

[AnnoyedNurse]

I just wanted to provide an update as the OP of this thread. I did not start the sales position and instead took another job in an ICU on the east coast and am LOVING it. Of course the rude family members still exist, but our manager is really strict about the rules and gives us the backing to do what we can to provide the best and safest patient care possible. I'm happy to report that all I needed was a job change and not necessarily a career change! I'm even enrolling in a masters program and couldn't be happier. Thanks everyone for all your input and various opinions on the matter!

[FLgirlRN1977]

While poorly expressed, everyone take a deep breath for a moment. We constantly remind others how patients and families can say/act rudely or inappropriately when under stress. This nurse is human and no different than our patients and families. The blanket statements about families being stupid sounds more like a vent from a tired and frustrated stressed nurse. Furthermore, there's a very valid point here. The more the "anything goes as long as you and your family members are happy" attitude is creating the perfect environment for families to act out poorly in. In the 18years I've been in practice behaviors have escalated exponentially. This is part of the reason we're facing an epidemic of workplace violence in our hospitals. We have created a culture within hospitals where many families actually feel justified (and proud) over assaults on staff. We recently had an incident with a disgruntled family member bringing a loaded gun in (this is L&D and Mom and baby were healthy and not in any medical danger. He was simply disgruntled and entitled and if the snap of the finger was not met with his bidding, he was angry.) There's little to no support from physicians and administrators are apologizing to visitors if their inappropriate behaviors are called out by the nurse and they complain. We had the issue of them contemplating letting the visitor come back if he was released from jail to keep the family happy. That should have never have been an option. This is what the "satisfaction" culture is breeding. And it usually starts out with the refusal of a turkey sandwich or a particular pain med the family members demand for their loved one.