Patient satisfaction or patient dissatisfaction

[Brian]

Press-Gainey and other satisfaction surveys drives the consumer choices for healthcare to some extent. Our patients are more savvy than they once were and many now have choices in the hospital that they use as well as choice among providers. What is your hospital, clinic or organization doing to improve your scores? What do you think of these efforts?

[dudette10, MSN, RN]

I was a recent pt @ my own facility and have several questions. PICC should have been inserted w/in 48 h of admission as receiving IV vanco 1 gm q 12 as well as 4 boluses of K w/ lidocaine and IV K 40 meq in bag for hypokalemia 2.7. I asked the hospitalist but he insisted on waiting until ID saw me. PICC finally placed day of d/c 5 days later!!! How do you advocate for quicker implementation of PICC? Additionally bed broke during PICC placement resulting in a traumatic insertion. I had venospasm in my arm for 48 h. I just happen to have been a PICC nurse in past and am presently certified in case management. This is a magnet level hospital. What else can I do to make my complaints heard. Called quality, my insurer, spoke w/ the head hospitalist. All to no avail. Please share your thougths.

Did ID not see you for five days after the consult was placed? What was their rationale for not giving you a PICC? Why did you need a PICC? Did you have extravasation of the vanc or K-rider through your peripheral line in those four days?

Receiving vanc and k-riders is not an absolute indication for getting a PICC. As a PICC nurse in the past, you should know this. Hmmmm.

You did not receive a "bolus" of K, btw.

You also state you spoke with all these people "to no avail." What exactly do you want that you feel you are not getting?

[dudette10, MSN, RN]

"The customer is always right" was the rule in retail. "Treat the pt as a guest" seems to be the rule in healthcare. I don't think hotel acomodations are available in health care, and I don't think sick people really want someone who treats them like a pansy either!! How many positions have been justified by this hotel mentality?? When there is a problem if I cannot fix it I refer it on to "guest services." Or I make recommendtions to management so the problem will not reoccur. We are all pawns in the game of healthcare!!

I had a patient (who I actually liked, btw) complain to me about the care he received in his residential facility. He said my hospital was like a Hilton, and his facility was like a Super 8. Mind you, he had chronic diseases, and he needed a scooter chair for mobility, but was quite independent otherwise. I told him it had to do with how many people each caregiver has, and that in his facility, his room is cleaned, meds are brought to him, and food is provided. I ended with, "What other services would one need in their own home? You are not going to get, and should not expect to receive, 24/7 personal services in your home when you are as independent as you are."

[Karou]

My hospital does inpatient satisfaction surveys weekly that they post for staff to see. They also do a survey after the patient discharges. Any staff with positive mentions get acknowledged. This is factored in when employee of the month is awarded. So they are constantly telling us how we are "performing" as a unit and giving "positive recognition".

If a patient has a complaint then the supervisor visits them to discuss it and patient advocate gets involved. I am lucky because my manager is actually very supportive of our staff and will stand behind us (when reasonable).

One thing we constantly rate low on is noise level. They recently implemented those noise traffic lights at the nurses station. We also rank low on room size but that can't be fixed. It is interesting to me how vastly those scores can range weekly. We might be 90% positive one week and 1% the next on the same topic. Oh well. You can't satisfy everyone. Some patients requests/complaints are just plain unreasonable.

[Tenebrae, BSN, RN]

As nurses we keep in mind who the patient is- I give skilled nursing care, not customer service.

There is a trend in retail to make everyone a guest, and as a guest you should follow the rules of the house... In healthcare its making patients and their families "customers", as a customer the expectation is that you are always right.

These trends are disturbing... metrics drive crazy behavior that does not equal good care

Not to mention too many people take 'the customer is always right" as a carte blanche pass to act like a knob

Hated that attitude when I was working in retail to supplement my nursing studies, couldn't handle it if I had to deal with that now

Customer/patient "I don't want to move at all after my hip operation"

Nurse "Ma'am, if you do not mobilise following your operation it may increase your recovery time, cause more pain, put you at risk of blood clots"

Customer/patient "I dont care, I want to see your manager now!"

[SoaringOwl]

I hate the waitress mentality we're teaching the patients and their families to have. My last hospital expected nurses and aides to make coffee for the patients and their families. I was dumbfounded when a patient's family member asked me for a cup of coffee on my first day. I told him where the cafeteria was, and that he can get coffee there. He said, "Don't you guys make coffee?" I was immediately corrected by a passing CNA, who made the man coffee at the nurse's station. So from then on I made coffee, and of course there's never enough milk or cream or sugar, and I always had to go get more. And my favorite is when they'd chuck it out, saying it's lousy. Well, I didn't go to barista school so $(%* you!

Thankfully, my new hospital doesn't expect us to make coffee. I hope they don't get any ideas...

[SoaringOwl]

Some patients requests/complaints are just plain unreasonable.

Like the patient I recently had who wanted a free ambulance to the hospital 65 miles away, simply because he didn't like our terrible, no good, very bad hospital. Sorry, it doesn't work like that pal! You can drive yourself, but no free ambulance! He threw such a hissy fit I almost called security. We won't get good scores from that guy. It feels like the majority of people these days are unreasonble.

[scaredsilly, BSN, RN]

I had a patient that slammed us on the satisfaction survey because no one would wheel her outside and across the street to smoke. She ranted and raved the whole time she was here, and just couldn't understand why we were so cruel.

[TeeKay12]

My hospital requires rounding on the patients every hour from 0600 to 2300, every 2 hours during the night. Most patients are annoyed by it. We're supposed to ask them about "Pain, Position, and Potty". I refuse to ask a patient if they need to "potty". I WILL ask if they need assistance to the restroom.

I frequently remind my patients they checked into a hospital, not a hotel. I say it jokingly and they laugh, while getting the message. This is completely not what we're told, we're not supposed to remind them we're not here to kiss their behinds. I'm not. I'm there to give skilled nursing care. I do enjoy my patients, so being nice and kind is natural.

We get 'dinged' for patients reentering the system within 30 days, but we can't just look at them and say "Look, you have COPD, CHF, DM, and CKF. You're 500 pounds and have chronic cellulitis. You're lucky the leg is still on your body. Maybe you should stop eating 2 pizzas for lunch and smoking and drinking a case of Mountain Dew daily. Try walking around a little. And TAKE your meds as prescribed."

I had a patient yell at me once because I reminded him he was on the ADA diet and the fast food his (petite) wife brought wasn't on that diet, especially in the amounts she brought. "I AM NOT FAT! You people keep trying to tell me I'm fat, but I'm not." Well, sorry buddy. You're 675 pounds, every time you're here we have to get the extra large bari bed and place it in the biggest room we have, you stink because there isn't a shower to fit you so you've had nothing but bed baths for years, and every night I'm afraid you are going to roll over onto your (5 year old and tiny) son and kill him because he sleeps in the bari bed with you. That's what I wanted to say. What I had to say was "No-one said you're fat. We just want to help you learn what diet is best to manage your diabetes."

[mydogscute]

Vanc should be given in a central line. It has a pH of around 3...too acidic for a peripheral line.