Nurses hold unique positions as educators and advocates for patients who have been prescribed oral cancer therapies. Patient adherence to treatment protocols can be directly related to education and follow up care initiated at the nursing level.
For our April post please read Oral Chemotherapy: Not Just an Ordinary Pill. Please also read the highlighted links that are embedded in the article.
Questions
- Describe some of the advantages and disadvantages of being prescribed oral chemo or targeted therapies.
- What barriers exist that may interfere with patient adherence to oral therapies?
Discussion Question
Patient satisfactions scores are reported every day in Daily Connections. Our numbers are always very high, but I never feel the they totally reflect the blood, sweat, and tears that go into caring for a patient. At MRMC I think all of our nurses deserve top box ratings! Please read The Limitations of Rating Nursing Care by Customer Surveys, and share what you think. Could you design a better system to evaluate nursing care?
Please send your answers to melissa.luebbe@ctca-hope.com. This is the fifth of six posts for Journal Club 2016-17.
Patient satisfactions scores are reported every day in Daily Connections. Our numbers are always very high, but I never feel the they totally reflect the blood, sweat, and tears that go into caring for a patient. At MRMC I think all of our nurses deserve top box ratings! Please read The Limitations of Rating Nursing Care by Customer Surveys, and share what you think. Could you design a better system to evaluate nursing care?
Please send your answers to melissa.luebbe@ctca-hope.com. This is the fifth of six posts for Journal Club 2016-17.
I think her comparison of nursing satisfaction surveys to ratings of a poster is very valid. It is so subjective, and sometimes no matter what you do you will never please a patient. The only recommendation I would have would be very specific surveys based on the patient's reason for admission/diagnosis and based on the floor that patient was on as opposed to a general satisfaction survey. Maybe that would point out a specific issues that may be occurring with care for that particular diagnosis, or how care is on a specific floor that could be better pinpointed to work towards improvement.
ReplyDeleteHi Angela,
DeleteYou are very right. The surveys are very subjective. Your idea of adding the patient's diagnosis upon admission is a good idea and it could even be added to the satisfaction survey and maybe relate the questions to it if applicable. It could help for them to be able to offer suggestions toward improvement on the unit they were staying but to also mention positive aspects. On our floor we have started to discuss the post discharge surveys upon a patients actual discharge process. However, this is an area where we could be more informative, especially before the craziness of actually going over medications and discharge instructions.
Thanks for sharing!
This comment has been removed by the author.
ReplyDeleteI think that nursing satisfaction surveys are definitely one view of nursing care. I like the toaster review example used in the article! It shows that multiple reviews can be opposite of another and yet, they can both bring valid points and information to the potential toaster buyer. I do not have a suggestion for a better way to evaluate nursing. I do suggest that surveys be one part of a nursing satisfaction evaluation and to use the results as a tool to help improve processes, nursing care, and patient outcomes.
ReplyDeleteThe nurses at CTCA really do deserve top box ratings. I see the hard work everyday. We work with patients who often live on an emotional roller coaster. They are anxious when they need scans, with every ache and pain, they are in denial or think they have new sites of cancer everywhere. Most complete the satisfaction survey if they had a bad experience or if their experience also resulted in a positive outcome such as a surgery removing all of their cancer. I am not sure how to design a better system to evaluate nursing care but maybe mini surveys on a daily basis while admitted so we have a clue of what their concerns are and what we can change and then mail the main survey post discharge.
ReplyDeleteHi Patricia,
DeleteI like your idea of mini surveys to keep track of days when good things happen. Sometimes in the midst of all the craziness they endure throughout their cancer journey, a positive memory can help. This can help document the good and the bad and help us to improve our care as well.
Thanks for sharing!
Hi Patricia,
DeleteI also love the the mini survey idea. That would be a more focused way to pinpoint things we may need to improve to increase satisfaction. It is unfortunate that we do get surveys that tend to reflex a two opposite ends of the spectrum instead of more surveys from patient's that fall somewhere in between (extremely bad versus very good if as you said we were able to surgically remove all the cancer).
Patricia,
DeleteThe mini survey idea is great! Although, for my patients in stem cell they'd probably get sick of having them every day. However, even twice a week could be helpful! Doing some type of mini survey during a hospital admission would definitely help us correct complaints/concerns/issues in a more real time way which could then boost our big survey results. Maybe a patient would pause to consider a negative answer because they would remember us not only surveying them while inpatient but working to find a solution to their concerns.
Patricia,
DeleteI like the mini survey idea while still inpatient, as you can find out concerns and address them prior to the patient's discharge and hopefully rectify the situation, allowing for a better overall survey later on.
Brenda
Good idea! Problems or negative "perceptions" can be possibly changed in real time.
DeleteI agree with everyone above and their responses! Sometimes you just cannot win with a patient and it could be entirely unrelated to you as a nurse and person. Sometimes they just have a bad day or get bad news, or are upset about something happening at home. I find that sometimes in these situations, the second time you care for or see this patient that may "fire" you or dislike you they often change their minds. I think that on occasion, patients are discharged and not on the best notes, leaving them to give nursing poor marks on surveys. This is not always indicative of the nursing care that was given. We just want to be safe, compassionate, understanding, and ethical. Sometimes not so positive outcomes yield these poor marks. I also cannot think of a better way to evaluate nursing, but I agree with ideas like surveys each day while at the hospital either outpatient or inpatient. This could almost be like a treatment journal to help them document what happened during the day and how they felt about it. That way they could really review their feelings and see where they were directed. This could help them better answer their surveys post discharge and really evaluate their nursing care a little bit better.
ReplyDeleteyou are correct , Stephanie sometimes the patients just had a bad day and then we end up with a bad review. all we can do is too understand them because they are going thru a lot
DeleteI agree Stephanie- sometimes you simply cannot win or please everyone- no matter what you do. It is still important to still provide the best care possible and just carry on. Documenting the care we do provide in our charting is important as well to show a record as to the care we do provide.
DeleteSurveys, surveys, surveys...When I have my appointments at a Northwestern which is now Lake Forest...I automatically have a survey in my email the next day. These can be annoying but they will send like 3 in a row until you answer them. I now just answer them and am honest. It looks at that visit and maybe this is more fair than to look at a 3 month time period. Nursing is reflected in these surveys.I feel these better reflect the day to day. Over the long haul I feel this will better reflect the actual care and not just a "bad" or a "good" day.
ReplyDeleteI agree Pat-I get surveys from them too. I am honest with my comments but feel I allow alot more latitude than the average non-medical person does because I know what it is really like working in healthcare today. It is nice to be able to give excellent feedback when a particular clinician exceeds my expectations:-)
Deletethis survey are subjective , just like the toaster story . there is no happy medium. I see how we work hard as nurses. i agree with Patricia with the mini survey. I know how important survey because it helps improve our service so we can help our patient better and hope that satisfaction rate will be satisfactory
ReplyDeleteI agree to everyone's comments. It is hard to please anybody and especially in healthcare because they are here and don't have a choice. Patients are scared, anxious. We need to provide safe and compassionate care to all our patient.
ReplyDeleteI do agree that CTCA at MRMC nurses should have a top box ratings.Every patient I cared for sang all praises & wonders if we go to a certain school for good behaviors. " I have not meet an employee who dos not adhere to Mother Standard of Care". Everyone here are so caring, knowledgeable, and very nice. They verbally say these to me, so I don't know the format of our survey,maybe as all you guys pointed out the questions might not be specific enough to reflect nursing care.I'm also a big proponent of ongoing survey like a mini survey. It is conducted while the patient is still in our facility, we can address & solve problems right away. And it will be more specific not generalized conception.
ReplyDeleteImelda,
DeleteIt's funny you say patients ask if we go to a "certain school for good behaviors". I had a patient ask me this same thing the other day. "You all are so nice" he said. "Does the hospital make you act like that, do you get special training?" I did mention the "mother standard of care" and how it is included in our mission, vision, and values. It's nice that at least "some" patients recognize this.
I like the idea of the patient completing the survey BEFORE leaving the facility. I think we would get more responses and everything is still foremost in their minds.
DeleteImelda,
DeleteThat is funny about the "school for good behaviors " comment. It just goes to show you that we are upholding the Mother Standard of Care and treat not only our patients, but each other in the highest regard. Great job everyone for doing what you do each and every day!
Brenda
Generally speaking I think it hard and even unfair to evaluate nursing care with surveys. It is similar to the waitress that is poorly tipped over bad, cold, late, incorrect food for example when it is the kitchen's issue and not hers but unfortunately she is there on the front line, seen by the customer. As nurses we are at the mercy of how well our computers are working, if medications/supplies are available, if tests/consults are scheduled properly, if the correct meal is delivered/if at all, if the room is acceptable, etc etc. Because the nurse is one of the few consistently visible to the pt, poor perceptions may be automatically attributed to the nurse. Also, another thing is that nurses are portrayed so far from reality on TV series' and movies, it's no wonder that people's expectations are not realistic and therefore experiences perceived as sub-par.
ReplyDeleteJulie, I love the analogy you used. It's a great perspective of how askew a customers perspective can get. As a former waitress, I recall a patron who returned his steak 4 times before he was finally satisfied. During all my years here at CTCA, I've observed that we continue do what ever it takes, beyond what other facilities/health care professionals will do. Jumping through the numerous hoops to find out what will help our patients best during one of the worst times in their lives. Seeing it through their eyes helps to change our perspective, which is something that our whole team does the best :)!
DeleteAwesome way to put it Julie. I always try to remember if it is a problem with the food it is not usually the fault of the waitress. So much of what we do as nurses is totally out of our control!
DeleteExcellent analogy Julie H
DeleteIt’s usually not in the culmination of day to day experiences that our patients/families rate their nursing care. I find that it is in those extreme moments, good or bad, that leave lasting impressions and where our most complete surveys come from. What would the ideal nursing care survey look like?? Did you get your medications on time? Did you get instructions that you understood and could follow? Did your nurse listen to your concerns? What did the nurse do with that information? The list of questions could go on and on. It would be extremely difficult to have one survey that would cover all areas in nursing and even harder when it comes to the evaluating it based upon the patient/family perception. The one question that would be a good start is: Do you feel that the nurse was your advocate?
ReplyDeleteWell said-great post:-)
DeleteGreat response Deb. So very true. So much of what we do is behind the scenes & our success is limited by technology problems, scheduling issues, etc.
DeleteThanks for your response Debbie! I find it very thoughtful. I agree that patients should be asked about specific nursing behaviors. Sometimes it helps them to reflect upon the role nurses have in their care. We are not always there to make them happy, but to keep them safe.
DeleteThere are situations when patient survey's are relevant to impact clinical practice and there are times when they are not. Statistics from surveys do not always directly translate into being influential for change in nursing practice. Evaluating the amount of patient's surveyed, the questions asked along with many other variables can drastically change the outcomes/statistics measured. I've noticed that with our survey's here, often times the caregiver fills out the survey on the patient's behalf - which can also result in flawed data. I don't have a great answer for how to survey nursing care. I do agree that continued research on current practice and evolving new evidence based practices will ultimately provide safer, higher quality nursing care. This in my opinion, should result in patient satisfaction.
ReplyDeleteI really liked the part where the author writes about being fired by her patient. When I think some of the most difficult patients we have dealt with, those are some of the people we bend over backwards for, given even more compassionate care, and tried to make their experience as good as possible. However, these are often the patients who aren't going to respond positively to those efforts. So, while your care may have been great, the patient may have received all the care, attention, education, and support that was possible to receive- and they will still send in a survey that makes us sound like some kind of torture hospital. While I understand that these surveys do have value, it's hard to be judged on your nursing practice by a piece of paper or email that can only include so many questions/options. With the flexibility afforded by email/computers these days, maybe a survey could be made that would tailor more to a patient's responses, such as if the patient is giving low scores on pain management, the survey could ask more in depth questions that could get the person to think more about the experience. Of course, that could also get really complicated and some people may say that is manipulation of people's answers, but aren't all surveys that way? :-)
ReplyDeleteI havent really recieved feedback from a patient survery that would change the way I practice. I do know that, as a nurse who has worked at this hospital for many years, the level of personal attention that we were once able to give a patient has been altered, and as a result, our patients seem to be less satisified as they once were. Even though they are still given excellent care, things have changed, due to changing roles and staffing. Nurses seem to carry a heavy burden in regard to patient satisfaction but we also have the honor of positively impacting our patient in their cancer fight. I think Katrina's idea to further investigate a patients survery responses is good idea. A survery response could have been made on a day that a patient was more tired than usual or in more pain, thus impacting overall results.
ReplyDeleteHmmm....simpler wording couldn't hurt. I think some surveys are just plain difficult to understand, and the patient may inadvertently fill it out opposite of what they really mean, due to strange wording. Also - a free text area. Let them say what they want to say. I feel that MIGHT give a clearer picture. But I agree with the author of the article - you can do your very best, and some patients don't have the capacity to see that. Another good reason to build each other up as professionals, day by day. We need to remind ourselves of the excellent care we DO provide. Go us!
ReplyDeleteJenifer, I agree with you I often find that patients do not understand the questions and answer them incorrectly. A free text box would be a great idea.
DeleteThe survey questions are so generalized, they paint the nurse experience with a broad brush. I like the idea of writing specifics of the nurse care on the survey. I also like getting feedback in the middle of treatments rather than several months later, but the patients may not have the energy & motivation for multiple surveys. We all get thank you's & positive feedback, even if not reflected on a survey. It means more to me when I get a hug or a heartfelt thank you.
ReplyDeleteI don't think HCAPs and patient satisfaction scores truly reflect the care we provide as nurses at CTCA. Like the saying "you tell one person for every good experience you have but you tell ten people for every negative experience you have"- I feel that more people are likely to only complete the HCAPs if they are dissatisfied with their care. Its disappointing that our reimbursement is based on them, and that we only get credit for the scores if patients answer "always". I think there needs be a different way to measure patient satisfaction, what- I am not sure.
ReplyDeleteI agree with many bloggers that HCAPS surveys are unfair. I think especially related to pain. In a cancer hospital especially, the patient's pain is not always going to be controlled. I do think we advocate for and try our best to alleviate the patients' pain as best we can and as far as our given capacities will give us. I for one cannot stand to see people in constant pain and will call 1000 times if needed to the practitioner until the pain is under control, or at least manageable. The patient does not always see the behind the scenes actions we take as nurses to advocate for them. This in turn leaves a sour taste for nursing care and therefore lower scores on patient surveys. I think a good idea is to have a working knowledge of exactly the questions the patients will be surveyed about and incorporate feedback as much as possible while the patient is still in the hospital. It's hard to find a balance though of making the patient feel like you actually care and making them feel like you are just working for good survey responses.
ReplyDeleteI do not have a better system to evaluate nursing care. I understand the corporate "need" to have surveys as a source of feedback. I think sometimes people feel over surveyed. Sadly I do not feel that our surveys are an accurate reflection regarding the quality of nursing care provided at CTCA. Often the questions are too vague to be valuable feedback. It is sad how few surveys are returned. The majority of patients do not respond. Some people NEVER score high thinking that there is always room for improvement. So we end up with people that were really satisfied or very unhappy because it was too much bother for the rest to fill out. Which is why I like the suggestion mentioned by others of having the survey completed before leaving the facility. Bottom line, while we can try and improve based on feedback, I think we need to take the survey results with a grain of salt and look at all aspects ie percentage that reply, quality of questions, individual interpretation, etc.
ReplyDeleteDebbie, I agree with you that the survey results are not accurate not to mention we really dont know if it is the patient or family member filling them out. Like the toaster they are either happy or not.
DeleteI feel like our patients at CTCA are probably survey overloaded. They get so many different surveys that I wonder if they start taking them less seriously. I also agree that wording of the surveys can be confusing. I think having a free text box would be best for them. It may be harder for the one doing the statistics on the surveys but I bet we would get a better picture of the care that they believe that they received.
ReplyDeleteTina, I agree that at times our patients are overloaded by surveys here at CTCA. Having a clearer picture of the patients perceived care would definitely provide the specifics, especially when the wording is vague.
DeleteWhen it comes to Surveys and CTCA patients are overloaded with them. The newest survey being the Press Gany survey which compares many different areas of each patients experience to outside cancer centers and gives us an overall score based on those results. I don't know for fact that a survey related to just nursing is ever truly done. I have found like the toaster patients will either like/not like you and remember your name based on the interaction. If they loved the stay however they usually rate the whole experience and not just the nursing piece. I think if there were specific questions related only to nursing we would get a better idea of the job we do.
ReplyDeleteI agree with you Pam. Patients are very much over loaded with surveys. We even call the patient once they are discharged from the hospital to find out how their stay was here. Most patient's have a hard time remembering who the nurse was who provided them excellent care. I believe it would be somewhat hard to create a survey rating nursing with honest answers.
DeletePam,
ReplyDeleteYou make an excellent point regarding the overload of surveys. It wouldn't be surprising to learn that patients simply check random boxes just to get the task done. This can significantly impact our scores, and not always in a positive manner? Perhaps a survey only targeting the nursing piece will give us a better picture of how well we are doing and identify areas of improvement.
Jess
our patients are so over surveyed! We should do a survey to ask how they feel about surveys! Keeping this in mind like others have said I really believe that the nurses who work here are amazing! We work with such a unique set of patients. When they do well they love everyone and have top box results. I like the idea of our ipad surveys- quick and done on the spot. Short daily survey- maybe 3 questions at the end of a shift rather then a long one they get a week or two later may be more accurate.
ReplyDeleteGreat idea Jessica to have a short daily survey or at the end of a shift. That would also give the patient a chance to give feedback quickly so any issues could be addressed.
DeleteBecause healthcare encompasses various disciplines, it is a challenge to design an accurate tool to specific evaluate nursing practice. While I do not have a better method to create such tool, a different route could be to honor the great care that is rendered and recognize the nurse that has gone above and beyond to provide excellent care via and award or nomination. Like some have already mentioned, our patients at CTCA are constantly surveyed thus, encouraging them to share their personal story about nursing care is different and something that many have already demonstrated interest in.
ReplyDeleteJessica Mendez
I agree Jessica, it is hard to think of a way to create a tool that would really capture the nursing practice. Creating a feedback option to tell a story might reveal more than a questionnaire. Great idea!
DeleteWe have so many dedicated, thoughtful and caring employees at this hospital, where a survey rating system does not do any of us justice. I think each survey has is pros and cons and its hard to really find a flawless system. I do think that most people do not want to take the time to rate something, because at the end of the day its just another thing they have to do. I do think there should be a better way of rating our staff. I do like the stakeholder to stakeholder recognization because in a way you are rating your fellow staff members and showing them what a great job they are doing.
ReplyDeleteI agree with these ladies that another survey method may not be the answer, however, finding a way to capture patients experiences and views of there nursing care in some other way than survey questions with 1-10 would better reflect teh care nurses at MRMC give. Maybe giving them the opportunity to just share they're personal experience would be the best reflection of nursing care given here.
ReplyDeleteI agree with many of the others that patients are simply over-surveyed, and I believe that it is very difficult to truly assess quality of healthcare delivery via patient survey. There are times that attempting to satisfy a patient's wishes would not be acting in their best interests, such as providing their requested medications or procedures if we know that they could cause harm.
ReplyDeleteI know that it is important to assess patient's perception of our care, but their satisfaction is not always directly related to quality of care. I agree with some of the others who suggested seeking more personalized accounts of how patients felt affected by their care providers, rather than a simple graduated level of how much they agree or disagree with several statements. It is hard to take personal stories and turn them into nice data charts, but by listening to patient's personal statements, we may be able to reflect more on how we are perceived and possibly may provide feedback to patients about our role in providing safe care.
The toaster example is a very accurate comparison to how patients see view the care they received from nurses and other medical professionals. One patient may love you and the next not feel your care was up to their standards. I also feel that our patients are over-surveyed. Constantly being surveyed is not the best way to determine the effectiveness of nursing or medical care. I believe that we can find a way to have them rate their care and make it more personalized and more focused on their visits, rather than just giving them a number scale and generic questions. It is evident that many of the patients and care givers are grateful for the care they receive at MRMC, we just need to find the best why they can express both their gratitude along with their frustrations.
ReplyDeleteI tend to share the same sentiment on many of the issues about surveys others have posted surveys can definitely and dramatically impact results, and also the reported data and the way the information is tabulated can be unfair and misrepresent all the efforts a team has poured into when caring for a patient. I work in a small unit and our manager shares with all of us very frequently information on the hospital’s survey results on pain control/satisfaction for example and sometimes if we get 4 surveys back and 3 out 4 surveys gave our unit a 10 out of 10 and one comes back at 7 out 10 that drops our scores to only a 75 % satisfaction rate! Is that fair? I do not think so (personally). Like many of you have mentioned we cannot please every single patient 100% all the time- we definitely try our best as a hospital, but expectations are so subjective that makes it quite challenging sometimes. A patient can have the best, smooth, successful stay in the hospital and the day of discharge even if one single thing did not go right- that one specific experience will be remembered and it may be reflected on the survey- this is just one more reason why surveys can be unfair. My suggestion may be somewhat unrealistic but daily feedback from patients or family members may give us a better result. Even if there are some “not so good days” if all data is averaged out that may reflect a more accurate opinion.
ReplyDeleteHortensia A.
Is it sad that a patient will remember only the "bad" part of their hospital stay? It could be the discharge or the pain immediately after they arrived to room after surgery, or a cold entree served at dinner - not one of these this things could have anything do to with the excellent nursing care the patient received. The patient could have also be having a very difficult time accepting the new dx, the patient & family could be very angry.
DeleteAs several people have mentioned prior to me, CTCA passes out several surveys to the point that I, too, wonder if the patients are over surveyed and just willy nilly fill them out or wait until that one prominent negative event happens to cause a stir. In my opinion, I feel as though, it is those negative events that are what are discussed more than the positive interactions that occur or sharing appreciation for the time commitment that went into clarifying a situation. I know we do positive things not necessarily for recognition but it saddens me when everything can go right, but as soon as one negative thing happens it can completely alter that patient’s interpretation of their experience.
ReplyDeleteElizabeth,I agree.patients are over surveyed and it is often that negative survey that takes precedence or priority. I think we need to evaluate them overall and gain knowledge how we can best deliver competent and compassionate care. I also think you cannot make everyone happy. That is not how life goes but we learn as we go. Nancy c
DeleteI agree that patients and society as a whole are being "over surveyed". I feel patients have so much on their plate and can be frustrated with another task. I think the patients who are really motivated to complete a survey are those who have an amazing experience or those who have the worst experience imagined. I don't know what the solution is for surveys, But what I know and witness every day is nurses going above and beyond and doing the best they can for patients.
DeleteTrue, satisfaction surveys have some good and bad outcomes based on how questions are being phrased, worded, framed, etc. Not only that, the questions are more generalized especially those National surveys that patients received since it has to compare to national benchmark to rate the organization's standing. However, the mechanics of obtaining surveys can be modified and tweaked to conform to the goals we want to achieve for better or optimal care possible. I agree that the results of the surveys are being investigated as the foundation as to where we need to improve with processes that can benefit most optimal patient care outcomes. No doubt, everyone here demonstrates the Mother Standard of care and all should receive top ratings possible.
ReplyDeleteI feel patients sometimes patient’s answer the questions based on either a really good or bad experience that may or may not directly be influenced by the nurse. I do not think there is a specific survey related to nursing and then at that, which part of the nursing staff is being referred to. With CTCA now incorporating Medical Assistants and LPNs along with the RNs, patients may have a bad experience with one nurse over another. There is no clear depiction. I also feel many patients just do not understand the questions that are being asked in the survey. Simple wording needs to be provided. There have been times, patients complete the surveys and then I would review their responses with them, and the most common response was “oh I didn’t mean that” or “I guess I read the question wrong”.
ReplyDeleteAs far as surveys go I agree with many of the earlier comments stating how hard it is to articulate the entire experience the patient has with his/her nurse. We treat patients in such stressful and difficult times, it is not surprising surveys are not completed correctly or in haste.
ReplyDeleteI do like the idea of mini surveys and utilizing the I pad to make it quick and easy for patients. I think a free text box would help since again I feel many times the patient or care giver misinterprets the survey questions. That being said, I think the surveys are here to stay and we just need to continue doing the best job we can every day.
I agree and think that nursing satisfaction surveys are definitely one view of nursing care. Its hard to come up with a specific tool to evaluate nursing care, but.....how about keeping it simple and easy to understand. I also like the idea of the free text box. Nursing needs to be praised more due to all we do!! GO NURSES!!
ReplyDeleteI totally agree that these Patient Satisfaction Survey Scores do not reflect the total care we give to each and every patient we have here at CTCA. As what some say it's unfair, generalized, confusing and complicated and patient tends to remember the bad experience rather than the good ones, and because of this; it will greatly affect the way they answer these surveys.Even worst, some of these patients who gets a pleasant experience tend not to fill up the survey because of their busy schedules and they just don't have the time. So , no matter what our survey scores will be; lets embrace our vision, mission & values and deliver the mother standards of care to everyone because that's who we are and that makes us different from other organizations.
ReplyDeleteFinally, as to the question of better design to evaluate nursing care... I have no clue as of this time !!! but I will PM everyone when I got one.
Well said Alex.. "lets embrace our vision, mission & values and deliver the mother standards of care to everyone because that's who we are and that makes us different from other organizations."
DeletePeople have asked me what I do for a living, and sometimes I answer tongue in cheek "I make people do things they don't want to do for their own good." Sometimes I have to teach someone to do a self injection so they can go home or wake them for turning or vitals in the middle of the night or encourage them to take one more walk. I have to often say no to someone who wants three PRN medications at the same time that could interact in a negative way or tell them for the 5th time that the NG tube has to stay in another day and I can not give them something to eat or drink. As much as we all love our jobs and enjoy our patients and hope they enjoy our care; the truth is the hospital will always be a place most people want to leave and not come back to. Patients can also have faulty memories on names of staff, days that certain things happened..etc. I've had patients even misunderstand who was in their room doing what task. Ie: that rude young doctor just came in my room, emptied my foley and didn't give me my results. Ooops, that was the PCT, not the doctor. I think it would be fair that patient's are rounded on by USL or CRL at the end of every shift and the care they recieved on just that shift noted. It may also help then at the end of their stay to do an experience summary, reminding them of that vigilant RN they had the first day out of surgery who kept their pain under control but never had assigned to them again, or the PCT whose care they raved about on day 3.
ReplyDeleteI give my best 100% of the time, every day. Many patients see that, while others may not. I constantly hear how we are so much better than this hospital or that hospital. While I feel patient satisfaction surveys have their place, I feel that they do not accurately reflect the care that we give here. The surveys that I receive in the mail I toss in the garbage as I seriously have no time to fill those things out. The person who has a bad experience will more than likely make sure they take the time to fill it out which can alter the satisfaction scores tremendously. A system should be advised where they take into consideration the number of surveys sent out in relation to the number that are returned, and some sort of formula devised that could take in the consideration of the percentage of "bad" surveys calculated amongst all the surveys sent out but not returned.
ReplyDeleteThe survey also needs to be clear and concise, and not too long or people will not take the time to fill it out.
Thanks,
Brenda Chiappetta
I agree Brenda. Most times it is the disgruntled or unhappy customer that will fill out the survey.
DeleteThe patient satisfaction surveys are subjective. Peoples perception of excellent care varies. A simple question such as "did the nurse answer your call light promptly" can bring about several different responses. What may be prompt to me may not be prompt to someone else. There needs to be an objective system that is developed to rate the quality care that is given. Questions need to be posed that have a concrete yes/no answer that would be answered the same by most patients if they were in the same situation. For example, "did the nurse answer your call light within 5 minutes". Also, have the surveys go out to the patients when they are discharged, not weeks later.
ReplyDeleteGreat comment Barbara. Perception is huge! If the patient is having a bad day, they can respond totally different. If the nurse is at work because she cannot call in sick and doesn't smile as much or sound perky enough, that can make a difference in the survey.
DeleteGood point that a survey should have objective questions. And yes, they should go out to the patients soon after discharge while their experience is still fresh in their minds.
DeleteI'm sure if I were rated, I would be like the toaster. Mostly 5's with some 1-4 thrown in there. Is that a true reflection of my nursing? No. It is the perception based on that particular interaction. Sometimes no matter how professional, how caring, how knowledgeable you are, if you don't tell them what they want to hear, it will not end well. I think surveys are very important. They are a tool to be used to seek areas of improvement across the board. If there is an area of consistent "needs improvement" it can be addressed. Without surveys, we wouldn't have this knowledge. having received several surveys from various businesses I find the short, sweet, to the point is answered more accurately. I appreciate having a text box to add specifics following each question, if needed. I would be interested to see how scores changed based on the number of questions being asked.
ReplyDeleteWe are telling our patients specifically what we are surveying and what response we are attempting to achieve.
DeleteElisa- you are so right!!! I feel the exact same way
DeleteIt is hard to develop a survey that will always devise a positive, honest outlook of nursing care. You could devise a survey with finite number scales for each answer, no subjective answers. It does help to smile at a patient and attempt to spend more time with a patient than you may have time for and this may elicit positive answers, but of course not always.
ReplyDeleteI found it very interesting to read through the comments. I think generally we agree the patients are over surveyed, the responses are subjective. Patients love to report the negative and the nurses are told about those comments where we never hear all the positives our patients say about us, which I am sure outweigh the negatives. We are an amazing staff that work with a difficult clientele, that despite the sadness and heartbreak, we pour out our love and they love us right back. I am not a big survey person and don't really think they portray the true picture. I don't have a good answer for what is better.
ReplyDeleteI agree either the patients love you or they hate you. With the ratings there is really no in between. Most patients rave about the care they receive here, but I do think the patients are over surveyed. The satisfaction surveys are a bit warped, and I think it would be hard to develop an honest survey to rate nursing care here. Care givers often fill out the surveys for the patient.
ReplyDeleteFor me, there is really no accurate and transparent way of gauging patient satisfaction as this can vary all the time. Like what the article says, no matter what you do even if you give your best already at it, people may still find faults in what you do especially if they are very ill, depressed, and given a very bad news. Often times, displacement of feelings by the patients to their caregivers always becomes a problem. I, in my practice,has already experienced this and sometimes it happens when you least expect it. Yes it hurts you not as a nurse but as an individual whose only concern is to give the most and the best of what you can, but apparently you can't do anything except to understand and to accept the fact that God knows your intention is not bad for the patient but good. For me, the greatest gauge to measure a nurse's worth is not seen by the numbers, but by the quality of care a nurse has provided that made a difference in the patient's quality of life.
ReplyDeleteThe surveys give a picture of care but not the complete one. Nursing care is hard to measure, so much of what we do is subjective. It seems as if only the negative comments are the only ones we do hear about, never the good stuff. We are an amazing group of nurses who deserve top box scores all the time!
ReplyDeleteLISA HAMMONS
ReplyDeletePerception of care should not be given as much power in the surveys sent to patients. It is important that as nurses we provide the very best care that we can in a caring and compassionate way, however, a nurse can give the very same kind compassionate care to two different patients and those patients may have totally different perceptions of that care. Patient surveys are important to get the insight/opinions that patients can offer, but actual patient outcomes are even more important in my opinion.
I feel the patient satisfaction survey to rate nursing care should not be the only tool used to evaluate nursing care. I feel that often patients and patient’s family members have no idea exactly how much a nurse does. Nurses do not simply answer call lights, give medications, and clean up patients. Nurses do not just follow physician’s orders without their own judgement. Nurses can make their own nursing decisions and often call the doctor and ask for orders based upon their own assessments. Nurses are on the front line and often know more about their patients than the physicians themselves. Nurses do so much more for patients than what they see or know behind the scenes. Yes, patient satisfaction is somewhat important, however this is not the only factor of a good nurse. Nurses must be able to advocate for their patients and I feel this often goes unnoticed. When I am taking care of a patient I use my nursing assessment and judgment to make my decisions. This does not always lead to the highest patient satisfaction scores, but I am more concerned with my patient’s safety and providing them the best nursing care. For example, I was taking care of a patient receiving high doses of pain medication and the patient kept requesting more and more of the medication. The patient did not seem to be in as much pain as they were stating and I also tried giving them alternative pain relief. The patient was insisting on more pain medication even when they could barely open their eyes and had slowed breathing. It was my nursing judgment to withhold the next pain medication dose. My patient’s vital signs, consciousness, and breathing led me to this decision. I was looking out for my patient’s safety. However, this did not make them happy even when I explained why. This patient clearly would not have given good satisfaction scores however, this in no way demonstrated my nursing care abilities. Patients do not always know what is best for them.
ReplyDeleteI feel that patient satisfaction surveys aren't necessarily the best way to evaluate nursing care. Surveys can easily capture patient's perceptions of observable behaviors - things such as did the nurse smile at me, did they answer my call light, did they wash their hands. Surveys can't as easily capture patient's perceptions about nursing judgement and aspects of care that patients may not "see". A survey can be used to have patients tell us if they're satisfied with the experience of their hospitalization/care, not necessarily if the care they received was effective/appropriate/competent or whatever it is we're wanting to measure.Outcomes are important (things like infection rates, re-hospitalization, length of stay) and perhaps a tool that captures that data, along with patient satisfaction and some questions about specific measures like how long did it take to answer my call light, was my pain controlled, did I understand my treatment plan might be one way to evaluate nursing care.
ReplyDeleteValuable data can be gleaned from patient satisfaction surveys especially since they are anonymous, but it heavily depends on the patient's perception. If they are a highly critical or negative person, this is the kind of review you are likely to get. If they are usually positive people, this is what you will get. Useful, but not entirely truthful. Non-medical people can be very uninformed about what nurses have control over and attribute a bad experience to the nurse when it was perhaps the MD's fault for not thoughtfully ordering enough pain medication. As the author wrote, she went above and beyond and everyone from staff to family saw this except the patient. Sometimes we take the brunt of patient anger, because it is safe to take it out on us. Patient satisfaction surveys should be tempered by everyone getting a survey and often as Pat Dillow explained that her hospital does. By sheer number you can weed out high and low outliers as just that - outliers not really reflecting how the majority of our patients feel.
ReplyDeleteI feel that I receive many surveys, I am sure our patients feel the same way. I know after a long day the last thing I want to do I answer a survey. I give our patients & caregivers SO much credit everyday, they have received life changing news and they continue to come daily and do what we ask of them - including fill out our surveys. In every department at MRMC our nurses do such amazing work with patients that are sick, anxious, stressed, tired, and dying.
ReplyDeletePatient satisfactions scores are reported every day in Daily Connections. Our numbers are always very high, but I never feel the they totally reflect the blood, sweat, and tears that go into caring for a patient. At MRMC I think all of our nurses deserve top box ratings! Please read The Limitations of Rating Nursing Care by Customer Surveys, and share what you think. Could you design a better system to evaluate nursing care?
ReplyDeleteI think that this article is pretty accurate. Nurses put in a lot of hard work to make sure all their patient’s needs are met and there are a lot of times we don’t get recognized or acknowledged for the work we do. I personally always do for others as I would want done for myself, even if that means the outcome isn’t what I want at the end. As nurses, we just need to know that we have done everything we can do and that we can’t control our patient’s reactions or feelings in the end. I have noticed in our hospital we don’t have satisfaction surveys in every department or comment cards, so I don’t feel that is fair to all departments because some of us aren’t recognized for the good things they do, good or bad. Hopefully one day they can come up with a better plan.
-Mallory Mukka RN-BSN