Issue link: https://nnumagazine.uberflip.com/i/197820
CE2_Oct REV 11/6/10 1:38 PM Page 19 patients," after he was given a project to improve patient satisfaction while employed at Holy Cross Hospital. He made a determination that "nurses needed certain requirements to do their jobs properly," according to one article. For his first performance improvement and customer satisfaction project, Studer turned to the consultants at Press Ganey. According to the Press Ganey website, "Press Ganey questionnaires are the healthcare industry's method of choice for collecting patient, employee, and physician perspectives." The Studer Group currently markets and sells manuals, scripts, books, and interactive video training courses on the subject of influencing customer satisfaction. The Studer Group's latest book, The Nurse Leader Handbook: The Art and Science of Nurse Leadership (2010) reads like a Carnegie text on "how to win friends and influence people." Most, if not all, direct-care nurses would be hard pressed to glean any "art and science" of nursing from its pages. The ego hook for nurse managers comes in the introduction with a flattering sales pitch for his program presented in the book's forward: "As a nurse leader, you know the ultimate goal is to make sure that every patient has a great experience." (Emphasis added) Direct-care nurses know that acute-care hospitals are not vacation destinations where patients go for an "E-ticket" ride to Fantasyland and a thrill-seeking experience! Patients needing medical care in hospitals are at risk of significant complications or death. Patients require sufficient numbers of registered nurses with substantial scientific knowledge, experience, and sophisticated technical skills to meet their needs and to prevent complications of their illness or injury. Patients require RNs to provide, monitor, assess, document, and evaluate the safe, therapeutic, effective administration of care and the patient's response to treatment. In terms of "evidence-based science", the Studer Group book and method appears to fall short. In the introduction he writes, "We know what is in here works. Studer Group doesn't publish anything on theory, based on hypothesis, or based on thought (as in "We think this is true"). The book is basically the result of being out in the field, watching these tools being implemented, and observing and documenting the outcomes." Instead of scientific research to test a hypothesis, and controlling for variables using unbiased research observers for data collection, analysis, and interpretation, the book apparently presents self-fulfilling and biased opinion surveys and perceptions as "research" rather than empirical evidence. This research omits a critical IOM recommendation: taking into account organizational variables. Current research on scripting, rounding, and patient satisfaction schemes employs the most simplistic design; holding everything else constant, change one variable and then see what happens. This may be appropriate in a lab setting where everything else can be held constant. The problem is "holding everything else constant" in the real world of applying the nursing process and providing the art and science of nursing care to patients who are uniquely different. It is impossible because the patient's characteristics, work and practice environments, organizational financial priorities, and emphasis on technology are constantly changing. The most desired outcome for the Studer Group is not helping the patient achieve his or her optimal level of health and wellness. The goal is apparently about reducing the number of times patients use their call lights. The major problem with patient call lights is that they constitute a significant (according to Studer's proponents) O C TO B E R 2 0 1 0 source of interruptions in workflow, which leads to a high rate of medical errors. Indeed, frequent interruptions of nurses are, according to the Institute of Medicine (2003) study, a contributing factor in errors, but patient call lights are not identified or documented as the most significant source of errors attributable to interruptions. Low nurseto-patient ratios and worker fatigue due to forced overtime and lack of rest and nourishment breaks are, however, highly correlated with an increased risk of patient complications according to several published research studies. The apparent goal of the Studer scheme is to single out nurses, routinize their communications with patients, and provide unscrupulous employers a means for selectively evaluating (through surveillance) employees' compliance and competence in implementing the employer's behavior standards with regards to rounding and customer satisfaction schemes. Such surveillance is an example of the use of technology in restructuring initiatives that override the independent professional judgment of RNs and restrict their RN duty and right to advocate. Rounding and scripting is skill degrading and it is purposely designed to maintain a healthcare industry driven by private interest and to assert paternalistic dominance and control of RN autonomy and ability to individualize the nursing care plan based on the individual healthcare needs of the patient. Managers are instructed to observe and monitor individual nurses, follow up with patients to validate performance expectations, and, as necessary, have "Critical Conversations" with "HighMiddleLow Performers" (sic) and reward their success or punish their failure in using the "Key Words at Key Times (AIDET *sm)" scripts and "Service Recovery" tasks. Such tasks might include writing an "I'm sorry" note, and/or giving gift certificates for a free meal, free parking, or a massage if the patient or family member is upset and complains that there's been a perceived delay in staff responsiveness. Management surveillance, discipline and punishment of directcare nursing staff for failure to fully comply with the additional burden of the hospital's imposition of these customer service initiatives and schemes may be construed as a form of harassment which is incongruent with promoting a culture of respect for the nursing process and the intellectual knowledge work of nursing. CNA/NNOC/NNU nurses who've been mandated by their employers to attend the Studer Group's A.I.D.E.T training have reported that they feel disrespected, insulted, and annoyed at the suggestion that their interactions with patients and families should be scripted. They report the "rounding for outcomes" initiative interferes with their ability to plan, prioritize, and individualize their patients' care, in accordance with the nursing process. Many nurses are reporting they are being subjected to intimidating, offensive scrutiny and disciplined for not following "the script" or completing the additional survey paperwork in a "timely" manner. According to the Institute for Safe Medication Practices (ISMP), intimidating and disruptive behavior on the part of management can interfere with nursing care and undermine the culture of safety, leading to increased medication errors. According to The Joint Commission for the Accreditation of Healthcare Organizations (JCAHO), the presence of "intimidating and disruptive behaviors" in an organization erodes professional behavior and creates an unhealthy and/or hostile work environment that can lead to a reduction in patient safety. End of Part 1 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 N AT I O N A L N U R S E 19