Safety vs. Satisfaction - what is really important?

Nurses General Nursing


Specializes in ER, progressive care.

Obviously safety is more important, but now I am learning that isn't the case anymore. It seems like hospitals are focusing more on Press Ganey satisfaction scores and they could all care less about safety. I mean, the "higher ups" would much rather have us overmedicate our patients even if they are somnolent because "it's better for our satisfaction scores.". One higher up actually told a fellow RN this. I had a pt on Klonopin TID, so they had that scheduled along with trazodone and lyrica, and the patient was also requesting their PO Dilaudid. Pt was drowsy, kept drifting off to sleep and was slurring their speech. I definitely didn't feel comfortable giving that all at once, so I told the patient they needed to wake up first - I didn't want them stop breathing. It was for their SAFETY. Te patient wasn't upset with me...I know from my professional nursing judgement I did the right thing but from a management stand point, I'm afraid I did the wrong thing.

Is it like this everywhere else, too?!

Yep. Unfortunately the higher ups don't seem to realize that a dead patient can't be a repeat customer.

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

Since higher scores on the patient satisfaction surveys translate into higher reimbursement rates, the powers that be (a.k.a. management) focus on customer service at the expense of safety.

Therefore, let that type I diabetic patient have two slices of double chocolate cake with his lunch tray per request. Even if he goes into DKA, he'll be more likely to turn in a positive patient satisfaction survey for 'good service.'

Yeah, accompany the frail COPD patient to the parking lot so she can smoke as much as she wants. She'll be one happy camper.

As long as they filled out a positive review before they OD'd on q30 min dilaudid, I think some managers would be fine with it.

@Commuter: You did the right thing, not doubt about it. With a patient who was that "out of it" after having been given multiple pain meds, it would not have been wise to give addition pain medication. As far as upper management is concerned, I realize that these scores are the equivalent of money which the hospital receives. It also determines if the patients will return to the hospital for care. Yes, money is important or hospitals would be closing down from being in the negative. Thankfully, as nurses, we simply deliver care at the bedside: we are not accountants.

The two jobs are different: The "higher management" look at numbers, figures, etc. and nursing strives to deliver exceptional care despite the patient's means (no matter if they are insured or not because it would be unethical to do otherwise). No one can fault you for good, solid nursing judgement. However, if patient harm is caused from a lack of good nursing judgement, you know as well as I do that nurses are held accountable.

Bottomline: I would say to take care of your patients with both you knowledge and gut instinct. Your management cannot fault you for looking out for the best interest of your patients, keeping them safe.

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