Issue link: https://nnumagazine.uberflip.com/i/117874
Theresa Brown, RN, in a March 14 New York Times commentary aptly headlined ���Hospitals Aren���t Hotels,��� and echoed by William Sullivan, MD in a March 20 article in Emergency Physicians Monthly titled, ���Dying for Satisfaction.��� Nurses don���t need these high-priced consultants or CMS or the ACA to determine how to improve quality at the bedside. Studies have long documented that safe RN staffing, especially mandated RN-to-patient ratios, and other measures that reinforce professional nursing judgment and the application of an RN���s clinical expertise and experience have far greater impact on positive patient outcomes. Indeed, nurses increasingly see that the patient satisfaction scam, and the scripting and rounding that accompanies it, are closely associated with hospital industry restructuring aimed at deskilling, displacement of RNs, and automating RN interactions with patients. They interfere with nursing care, undermine the culture of safety, can lead to Do you feel good about your highly skilled profession when the nursing process is subjugated to the Disneydesigned perception of care? If your patient is smiling when he dies (even though he would not have died if the hospital had safe RN staffing ratios), do the consultants and CEO believe that you have done a good job? (Assuming they can get someone else to fill out the satisfaction survey, to the CEO���s satisfaction.) NNU recently uncovered some sample survey questions that did not make the final cut in the consultant manual, ���How to Win Friends (in the CMS reimbursement office) and Influence People (patients deceived by the phony appearance of care).��� 1. A diabetic patient asks for a piece of chocolate cake. Which is the correct answer? a) Politely say ���no.��� Explain it���s not in his best interest and that it could cause him significant harm, such as sending him into diabetic shock. Remember, however, that with this answer, you are taking the risk that he might feel unhappy or ���dissatisfied��� with you and the hospital, thereby risking a negative patient satisfaction response from him later. b) Give him the piece of chocolate cake, thereby decreasing the risk of a negative patient satisfaction survey response from the patient when he checks out of our state-of-the-art five-star quasi-hotel (remember, never tell him he���s in a hospital), and then hope and pray he doesn���t go into shock or worse. 2. Your case manager has asked you to discharge a bulimic patient two days early. You: a) Do 15-minute bedside education and refer her to a dietician, therapist, and support group. b) Give her a gift certificate for a huge box of See���s candies and refer her to a dentist. 3. Your post-op knee replacement patient is crying and doesn���t want to walk because it hurts. You say: a) ���Sit up and dangle your feet twinkle toes. I���ll be with you every step of the way.��� b) ���Let���s do it tomorrow when you feel better. Linda will be here then. She���s a great nurse with 10 years of experience. Everyone loves Linda.��� 10 N AT I O N A L N U R S E increased medical errors, and subject RNs to intimidation, offensive scrutiny, and discipline from managers for not following the consultant���s script and doing enough to artificially inflate patient scores. It���s a safe bet that when Disney executives themselves are in the hospital, they���d rather have safe nursing care than a potted plant at the bedside. RoseAnn DeMoro is executive director of National Nurses United. 4. Your proud mother-to-be lost her baby unexpectedly. Do you: a) Sit down with her and the family and just be there. b) Say, ���Can you reach the ice water? I washed my hands so you know they���re clean. What���s your birth date? Please confirm your allergies. I���ll be back in one hour to ask you the same questions.��� 5. A��teenage patient who is terrified as she is dying from terminal cancer and is also blind asks you to sing��to her and hold her hand so she can get to sleep at night. Do you tell her? a) ���Yes, of course,��� or, b) ���Sorry, that it is not in the script, but will you please ask your parents to give us a good recommendation for the excellent care you received at our Magnet medical center in the survey the hospital sends them after you expire?��� RN bonus questions 1. The hospital CEO discovers an extra million dollars in his budget.�� He will spend it on: a) Increasing RN salaries and benefits. b) Hiring more nurses��� aides so that patients will get more attention. c) Upgrading old and outdated equipment at the bedside. d) Hiring a consultant to tell him how to improve patient satisfaction. e) His bonus 2. You���ve had an incredibly difficult, but very rewarding day. You saved a patient���s life by noticing a change in a critical lab value.��You helped a patient and family discuss end-oflife care.��You mentored a new graduate nurse through challenges of her own.��But at the end of the day, you were behind on your charting and stayed a half hour after your shift to finish up.�� Which response is more likely: a) Your manager thanks you for a job well done b) Your manager disciplines you for excess overtime and ���poor time management.��� Do you have a suggestion for the stupidest scripting question of all time? Tell it to us at www.nationalnursesunited.org/silly or you can post the question on NNU���s Facebook page at www.facebook.com/nationalnurses. If you win, you���ll receive a prize. Deadline to enter is May 31, 2012. W W W. N A T I O N A L N U R S E S U N I T E D . O R G MARCH 2012