Nursing Judgment Vs Surveys

[Bailey_lou]

Hello All!

I'm posting this because I genuinely want to hear from nurses regarding the current nursing environment in which we work. I recently have become disheartened by nursing and my role when a manipulative and demanding patient convinced administration that I was not caring for her properly due to trivial requests not done immediately. I work very hard to make my patients happy and healthy. And I care for them all(even the demanding ones). This happens on a daily basis to many nurses, I know. However, I felt that the requests were excessive ( every 3 minutes on the bell for non-health related requests such as sodas or changing clean linens). I really love nursing and enjoy what I do but feel that the survey priority is crippling my nursing judgment. Where I work even nicely and professionally attempting to control a situation using patient education or my nursing judgment is frowned upon. I cannot tell a patient that it will take me 30 minutes to change their already clean bed due to a blood pressure issue for another patient if it makes the patient mad (for example). As a nurse in my facility it is expected that you just get it done somehow or get help. We are always running short, by the way and help is not always available so I MUST use my nursing judgment to prioritize needs. I feel that this is crippling my nursing judgment and our profession in general. We are taught to prioritize according to which patient is most critical and I cannot do that if I have no say in which patient needs me most using my mind and professional judgment as a NURSE. I know this sounds like a rant but this post actually has a purpose lol! Do you feel that your nursing judgment is hamstringed due to the customer survey environment? We are supposed to be a research-based profession but is there any research which addresses this? Medicare/Medicaid payments now hinge upon patient satisfaction based upon research but is there new research showing that this attitude is detrimental to nursing judgment and therefore non-demanding patients' health and care? How would one produce this research and do you feel it would make a difference? I'm just feeling disheartened because it really is a disservice to patients that need more of my attention due to their health! I would love to start the ball rolling on research that looks at this issue. By the way, many facilities talk about how they want to model themselves after the aviation industry to reduce mistakes. But no way would a customer be allowed to yell and demand things from a flight attendant when it would affect the safety of others. You will get kicked off the plane. Let me know what you think and thanks for listening.

[MsBruiser]

I think you need a new job.

[Here.I.Stand, BSN, RN]

I'm not sure how to answer the poll, because where I work nursing judgment is the expectation. They advocate patient and family centered care of course, but abandoning critical needs in favor of waitressing? The ability to critically assess and prioritize, and deliver nursing care is exactly why inpatient units are staffed with licensed nurses, not concierges.

[Bailey_lou]

I think you're right LOL!

[Bailey_lou]

Bump... Any other thoughts from nurses with more experience than me? Particularly on how to handle demanding patients and prioritize nursing duties in a way that administration would respect?

[Leesha]

I think that many of the "non-health" related requests can be delegated to the nursing assistant. Seems like a pretty easy fix to me and certainly not worth getting up in arms about in my opinion. We will all have these patients no matter where we work...they are everywhere!!

[SmilingBluEyes]

Can you please use paragraphs? One long blurb is too hard to read.

[Libby1987]

In my experience, patient satisfaction is largely affected by things that don't take extra time. Such as how you say or explain things, giving them a reasonable schedule and then updating them/communicating timely if any changes need to be made, demonstrating strong knowledge.

A friend just shared a TV issue with her father's current inpatient stay. This is one of the complaints I've heard on this site described as a petty expectation. As she described it, her dad is depressed staring at the wall during during his extended stay. She can only visit in the evenings as she is the primary earner and lives/works an hour from the medical center. The TV has been broken and she says the nurse is working on it. Obviously the TV function is not a nursing task but the nurse is the first line of contact for them. A few days of an 80 something yr old staring at the wall can definitely contribute to depression, the distraction is important as I would think we could all understand. I'm sure this will be marked on the survey and will frustrate the nursing staff.

Most of our patients have legitimate requests and complaints, there are some outliers but they are in the small minority. Nursing is a challenging job but that shouldn't dismiss the validity of reasonable issues from the patients' perspective.