The Hotel Phenomenon

Since when did flat screen TVs, overstuffed arm chairs, a multi-page food menu, and an almost concierge service become a major focus in modern day hospitals? Patient satisfaction IS a must, but I feel as if priorities are off considering there often isn’t enough equipment, OR HANDS, to go around. Which is most important?

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The Hotel Phenomenon

It's 0700 and the night shift is scrambling to give report as us day-shifters struggle in with our coffee breath and slightly askew hair. Part of the way through the patient history of the terrible triad (coronary artery disease, diabetes, COPD...) I hear through the grapevine that not one, but BOTH of our CNAs have called out. My ears perk up like a hunting dog and I scramble. I interrupt my own report in order to find the best-working COW (computer on wheels) and a fully functioning dynamap. Of which I sadly realized was nowhere to be found. It makes for a terrible time post cardiac cath if all the MP-5s are claimed and there are no dynamaps equipped with all of the appropriate fixings (temperature, blood pressure, oxygen monitor). Needless to say, I felt as though I was drowning before the day had truly started. As report finished and we had rounded in each room, I could see the gleaming flat screen TV, the arm-chair full of overstuffed pillows, toiletries strewn about the room, and our 6-page menu stuck to the floor in some sort of goo. The manual blood pressure cuff on the wall was either falling off, missing parts, or not there at all and the thermometers on the walls wouldn't turn on. We were operating at a 5 to 1 flex ratio with patients post cardiac procedures, on a multitude of drips, BiPAPs buzzing, and rapid responses flooding in.

Where did this money come from?!

I am no expert in funds when it comes to profit and not for profit hospitals. My father always corrects me on the rant of "where did this money come from?!" "Where did THAT money come from?!" (He would tell me that it's from a different allocated fund). To be completely honest, I am sure that it does. What I would like to know is when did flat-screen TVs with more than just local cable and overstuffed armchairs become more important than an extra doppler on the unit? Or maybe an extra staff member?

A Shift In Healthcare

There has been a shift in healthcare in the last couple of decades (even the last hundreds of years). I sit and talk with my grandmother often who was a nurse when they sterilized the baby bottles in the NICU and had steel bedpans for the adults. Then, thermometers were made of glass (eek! mercury) and there were visiting hours. She explains the vast differences between the times on many accounts, and seems perplexed with "the way things are going".

In truth, there are many things that we are doing right. What I think is a good reminder to patients and their families is that we are at work to help heal and to help give comfort. Sometimes this means that you are going to miss your 2100 showing of "Blue Bloods" (though I do love a good mustache)! It's not that we don't want people to feel safe, comforted with mutual trust but we ALL do want to do a great job. Personally, I want to have the opportunity to catch your sepsis before your blood pressure tanks and your organs start to shut down. Is that so much to ask?

I know that nurses have difficulty allocating their time with the increased pressure from patient flow coordinators to "treat and get them out" or to address multiple social concerns and battles between family members. It's not for lack of trying. As a floor nurse, I get more calls about a TV not working, anger at not being able to have a diet with salt, frustration that someone forgot their iPhone cord and their phone is dead, or that the internet is terribly patchy and they can't watch Netflix. Like I said before, how do we fix the idea that hospitals are not hotels but rather places of healing that warrant a focused approach on labs, tests, assessment, addressing a plan of care, holistic approaches to care and outpatient follow up? Where is the line drawn?

In the past year I've had patients elope for cigarettes who've had NSTEMIs, invited friends to visit at the bedside to give heroin or cocaine IV through a PICC line (by barring the door, mind you), and get in a full-on yelling match with nurses because we sent a patient for an ultrasound and they missed "The Price is Right".

It is a difficult line for each one of us to walk. Communication is always key, but sometimes words can fail. I've explained on multiple accounts why we do the things we do, and how our number ONE priority is patient care and prevention. At times that trumps an extra lounger in your room, or me refusing you to have take-out when you are going for an EGD in the morning.

Do Patient Satisfaction Scores Improve?

Always in the back of my mind, I want to know when (if it hasn't already happened) will our interventions of prioritizing register in our patient satisfaction scores? Is there a differentiation between patients being dissatisfied with their stay due to things in the hospital's control, or rather that they didn't get to maintain their normal routines that warranted a hospital stay that likened a Hilton experience?

I don't write any of these things to accuse patients in any way or to declare that our duties as nurses do not include ADLs and kindness in our daily care. But the chatter continues between nursing professionals of the staffing shortages, equipment issues, and the stress of meeting expectations that seem to be near impossible to fulfill.

Where do we go from here? Where is the line? What is our place?

Should the nurses get surveys concerning how their hospital allocates funds and writes up scopes of practice? Should there be a public service announcement video for each patient and their family upon arrival notifying them of the hospital's roles in patient care and what their satisfaction surveys really mean for healthcare?

I know that this article is loaded with multiple issues, it is difficult to stay on task when one thing reflects another. But with all that said, the issues facing us today ARE focused on money, are reflected by patient satisfaction surveys and are loaded with resources dwindling and the expectations rising. So, my friends, what do we do next?

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Jacqueline.Damm

About Jacqueline.Damm

Molded and formed by a drive to live up to her own expectations, Jacquie ultimately thrives on creativity. Dreams, testing her limits, and traveling all fuel the fire, thus leading to adventures of the past and yet to be: http://misadventuresofanurse.blogspot.com/

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Specializes in SICU, trauma, neuro.

For me, this is honestly not a difficult issue because I don't spend time on nonsense. Something like the example of missing the show for a diagnostic test...oh heck no. I keep my voice calm, but that would have gotten a firm, "I understand enjoying a show, but in the hospital your illness/injury is the priority. It is impossible to take a TV show into account when sceduling tests." And then discuss it NO further.

Complaints addressed to me about the food or the TV, will be responded to with the phone number to the kitchen or buildings & grounds. The food is not my job. It's just not.

Shouting or aggression from visitors get addressed with security. My charge nurses and managers support our need for a safe working environment.

I can honestly say that I don't give the survey a single thought when care planning. I am a good nurse, make the best clinical decisions I can, am kind and empathetic with people, and I make them as comfortable as possible.

I can't fix stupid. Yelling about missing a game show is stupid.

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I think that nurses, understandably, see things through their own lens.

I have a unique perspective seeing patients come home.

Exhausted by lack of sleep, going days with interrupted sleep on top of illness with someone already fragile and/or chronically ill significantly affects healing and attitudes.

Coming home in a poor state of hygiene, it's evident not a lot of personal care is provided in acute care even when things like skin are already compromised. 3 mos in LTC and one of the first things needed is podiatry care for nails curling under but not til I can get a social worker on transportation.

Weight loss due to disease, infection, post op.

Exhausted family members who wanted to be at patient's side but now have to provide 24 hr care.

Quiet halls with ample staff would be fantastic if that could ever happen but the little things like individual dietary options and a comfortable place for family member to sit all day helps.

As far as unreasonable demands, in this society where I bet even a nurse has reacted to an imperfect latte (my daughter works at a coffee house, all walks of life have meltdowns over their custom drink not meeting expectations) I can see why people become unreasonable where the stress is higher than the drive thru. We are not ever going to go back to being satisfied with the 50's hospital environment. People just don't shut off their customer service expectations because they're inside hospital walls.

Personally I'd use things such as cable TV and Internet access as a beneficial distraction. Imagine the Starbucks generation sitting in a stark room with nothing which they're become accustomed to distract themselves and having communications cut off.

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Flat screen tv are the norm now because we have changed from analog to digital tv and cable.

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Specializes in SICU, trauma, neuro.
Libby1987 said:
Personally I'd use things such as cable TV and Internet access as a beneficial distraction. Imagine the Starbucks generation sitting in a stark room with nothing which they're become accustomed to distract themselves and having communications cut off.

Oh, for sure! And to be clear, if gadgets aren't working, I do contact the people who are able to help. I don't consider a fully functioning room an unreasonable expectation. ;)

In fact recently the issue was the phone jack; the pt didn't have his cell phone on him. He'd had an alcohol-related mishap and he was very worried about losing his job. He wanted to call his boss. So anyway, I spent a fair amount of time on the phone w/ our tech people, and saying "Yes, this pt needs a working phone. No, it cannot wait until Monday." (This was a Friday afternoon.)

Things like that, I have no issue advocating for.

A couple examples of where I've drawn the line were pt asking for toiletries for her overnight guest (policy is that we can't furnish that for guests--it's for pt's only. Guests can purchase it from the gift shop.)

Pt yelling "Yo, ***** get me some coffee." I don't respond to "*****." :bored:

If that pt wrote on his survey "Nurse ignored my request for coffee," that's the kind of thing I don't give a second thought to.

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Specializes in Critical Care.

The unit manager is responsible for ordering equipment and I think it is a common trend in many places to keep the budget down by refusing to order needed supplies. When the budget is kept down the manager gets a bonus. Corporate healthcare at its finest!

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.
Here.I.Stand said:
For me, this is honestly not a difficult issue because I don't spend time on nonsense. Something like the example of missing the show for a diagnostic test...oh heck no. I keep my voice calm, but that would have gotten a firm, "I understand enjoying a show, but in the hospital your illness/injury is the priority. It is impossible to take a TV show into account when sceduling tests." And then discuss it NO further.

Complaints addressed to me about the food or the TV, will be responded to with the phone number to the kitchen or buildings & grounds. The food is not my job. It's just not.

Shouting or aggression from visitors get addressed with security. My charge nurses and managers support our need for a safe working environment.

I can honestly say that I don't give the survey a single thought when care planning. I am a good nurse, make the best clinical decisions I can, am kind and empathetic with people, and I make them as comfortable as possible.

I can't fix stupid. Yelling about missing a game show is stupid.

Thank you thank you thank you. The situation is just going to get stupider and stupider until we all take a united stand. We need to educate the public (and our administrators!) about what a hospital is actually for.

In the meantime, Here I Stand, thank you for being the voice of reason in our increasingly ridiculous health care system.

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Specializes in SICU, trauma, neuro.

Aww, thanks TriciaJ!

Hey, if I'm the voice of reason and you agree, that would make you also the voice of reason :up:

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Libby1987 said:
I think that nurses, understandably, see things through their own lens.

I have a unique perspective seeing patients come home.

Exhausted by lack of sleep, going days with interrupted sleep on top of illness with someone already fragile and/or chronically ill significantly affects healing and attitudes.

Coming home in a poor state of hygiene, it's evident not a lot of personal care is provided in acute care even when things like skin are already compromised. 3 mos in LTC and one of the first things needed is podiatry care for nails curling under but not til I can get a social worker on transportation.

Weight loss due to disease, infection, post op.

Exhausted family members who wanted to be at patient's side but now have to provide 24 hr care.

Quiet halls with ample staff would be fantastic if that could ever happen but the little things like individual dietary options and a comfortable place for family member to sit all day helps.

As far as unreasonable demands, in this society where I bet even a nurse has reacted to an imperfect latte (my daughter works at a coffee house, all walks of life have meltdowns over their custom drink not meeting expectations) I can see why people become unreasonable where the stress is higher than the drive thru. We are not ever going to go back to being satisfied with the 50's hospital environment. People just don't shut off their customer service expectations because they're inside hospital walls.

Personally I'd use things such as cable TV and Internet access as a beneficial distraction. Imagine the Starbucks generation sitting in a stark room with nothing which they're become accustomed to distract themselves and having communications cut off.

I'd be delighted if the patient's family members were to get some sleep, but frankly, the patient's room is not the place for that. If they're in the room, they're there to support the patient. If they want to sleep, there are other places they can do that. Perhaps their home (tonight we have two family members spending the night because "it's too far to drive home." I could drop them off on may way home from work -- they both live closer than I do), or even a real hotel. When it comes to caring for the patient versus letting the family member sleep, the patient trumps the family member's rest every time.

Your daughter may have meltdowns to contend with at Starbuck's, but her job is ultimately less stressful than ours and her service is less important than ours. Nurses, under constant pressure to do more with less and score those stellar Press-Gainey's while dealing with persons in an advanced stage of crazy are bound to need to vent now and again. Perhaps you can see why people become unreasonable where the stress is higher than the drivethough, but perhaps you can also see why nurses would become more stressed dealing with valid patient care concerns when someone throws a fit because they can't get HBO on the flat screen TV.

Perhaps you didn't mean it that way, but your post came across as unsympathetic to the hospital and LTC nurses who are forced to spend more and more time on "customer service" and less and less time on actual patient care.

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Specializes in Med/Surg, Academics.

I'm beginning to think that all departments have a role in customer service and patient safety, and I really wish the PTB would reinforce this expectation. Let me give you a few examples.

Would it it be so difficult for housekeeping to have in their checklist after cleaning a room to test that everything is functioning and report nonfunctioning items to the appropriate department? That doesn't mean they will catch the exact moment the TV goes on the fritz, but at least the TV will be working when a new patient rolls in.

Where I work, housekeeping is responsible for sharps containers. I have days where I empty multiple sharps containers in my rooms, some of which have sharps sitting on top of the swinging thingy that dumps them into the box. On Monday, I worked a room where, at the end of shift, I took out a full sharps container and endorsed the need for a new one to the oncoming nurse. Yesterday, I admitted a person to that same room, and guess what? There was no sharps container on the wall! That room went through multiple nurses, multiple patients, and multiple cleanings, and no one bothered. Can you believe that crap?

Another of my rooms was out of gel. As soon as I noticed it, I called housekeeping and left a message. A couple hours later it was still empty so I delegated follow up to the US. A couple hours later it was still empty, and I informed the housekeepers on the floor. At the end of shift, it was still empty, so I endorsed it to the oncoming nurse. I am so sick of that ********.

I rounded on on a patient who just had a serial blood draw to see how he was doing. He said he asked the phleb to hand him his urinal, but she said she was too busy and walked out. To smooth things over, I told him that she couldn't for infection control purposes (not sure if that's true or not), and he asked why she didn't bother telling me of his request. I wondered the same thing, but I kept my mouth shut.

Sorry...this turned into a vent.

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Ruby Vee said:
I'd be delighted if the patient's family members were to get some sleep, but frankly, the patient's room is not the place for that. If they're in the room, they're there to support the patient. If they want to sleep, there are other places they can do that. Perhaps their home (tonight we have two family members spending the night because "it's too far to drive home." I could drop them off on may way home from work -- they both live closer than I do), or even a real hotel. When it comes to caring for the patient versus letting the family member sleep, the patient trumps the family member's rest every time.

Your daughter may have meltdowns to contend with at Starbuck's, but her job is ultimately less stressful than ours and her service is less important than ours. Nurses, under constant pressure to do more with less and score those stellar Press-Gainey's while dealing with persons in an advanced stage of crazy are bound to need to vent now and again. Perhaps you can see why people become unreasonable where the stress is higher than the drivethough, but perhaps you can also see why nurses would become more stressed dealing with valid patient care concerns when someone throws a fit because they can't get HBO on the flat screen TV.

Perhaps you didn't mean it that way, but your post came across as unsympathetic to the hospital and LTC nurses who are forced to spend more and more time on "customer service" and less and less time on actual patient care.

I'm saying there is more than one perspective than the nurse's.

Not all rest by family members takes place during the night. My dad was confused and weak as hell as he was dying, I stayed with him all day and I see the elderly spouses wiped out with their loved one's illness but not wanting to leave their loved one alone in the hospital all day. I'm not at all unsympathetic to nurses but I'm also sympathetic to patients and their families, I can be sympathetic to both.

As far as the nurses' service being more important than a baristas, by that logic a Dr's service is more important than a nurse's and they actually do deserve more reverence than us. I call BS on that but that's where your logic is pointing. My point however was that people can and do lose their **** over the most insignificant things.

Question, if no family member or patient ever interfered with your time, is the staffing adequate to provide quality comprehensive care? Getting rid of the hotel phenomenon would be a game changer?

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I think dudette10, BSN, RN has a good point. Instead of saying that we should stop providing these things for the patients, maybe hospitals should stop letting all of the responsibility fall on the nurses. Nurses are wonderful and all, but they are not omnipotent.

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