Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Let’s celebrate nurses by reining in patient satisfaction

Alex Smith, MD
Physician
May 22, 2015
Share
Tweet
Share

shutterstock_246953212

Let’s take a moment to consider what makes a terrific nurse.

First, by way of gathering information, let’s consider the health care industry’s present views on excellence in nursing.  Let’s think about how this conception of excellence in nursing aligns with our own perspectives.

In a recent Atlantic article, titled “The Problem with Satisfied Patients,” Alexandra Robbins writes about the economic incentive hospitals face to improve patient satisfaction scores.  This is a high stakes issue for hospitals, as their bottom line in terms of Medicare dollars is now tied to patient satisfaction scores.  Most of these scores, derived from a patient survey called HCAHPS, rely on ratings of nurses.

For example: “During this hospital stay, after you pressed the call button, how often did you get help as soon as you wanted it?”

This sounds reasonable on the surface, but then look deeper to see what sorts of issues patients were concerned about when they rated nursing care poorly on this section.  Again, from the Atlantic:

  • “My roommate was dying all night and his breathing was very noisy.”
  • “The hospital doesn’t have Splenda.” A nurse at the New Jersey hospital lacking Splenda said, “This somehow became the fault of the nurse and ended up being placed in her personnel file.”
  • An Oregon critical-care nurse had to argue with a patient who believed he was being mistreated because he didn’t get enough pastrami on his sandwich. (He had recently had quadruple-bypass surgery).

What, exactly, do these comments have in common with high-quality medical care?  Nothing.  Zero.  Zilch.  And yet hospitals are hiring “customer relations” experts to train hospital staff, and nurses, in particular, in how to become more Disney.

Now think of the terrific nurses in your lives.  Are they terrific because they act like Disney concierge services to patients?  Now certainly that wouldn’t exclude them from being terrific, but those are not the qualities that come to my mind when I think of terrific nurses.  I think of: strong, compassionate, “real,” able to confront challenging patients in a way that I could never do as a physician, resourceful, creative, and watchful for errors or early signs of distress.  Note that “finds Splenda and extra pastrami” do not appear on this list.

This whole patient satisfaction thing has gotten out of hand.  It’s a tremendous amount of money being spent on the wrong thing.  Of course, treating patients with respect and dignity is important.  That’s not the same thing as satisfaction, however.  Patient satisfaction thing places the emphasis on making patients happy, not healthy, feeling pampered, not prepared for the worst.

It’s the same thing in doctoring, by the way.  A recent article in JAMA oncology by Kimberson Tanco examined patient perception of physician compassion after more vs. less optimistic messages about prognosis.  Unsurprisingly, patients were more satisfied with scenarios in which they saw doctors give more optimistic messages to a patient with advanced cancer than lest optimistic.  Duh.  Wrong question!  Of course, it seems better to hear, “You don’t need a rectal today.”  (When you actually do.) Or your care mechanic says, “There is nothing wrong with your car.”  (When the brakes are about to give.)

How about asking patients, “Did you get the information you needed to make the decisions you needed to make?”  Or, asking the bereaved spouse after the patient died, “Did you feel prepared when he started to get really sick toward the end?”

But back to nurses.  We’ll give the last word to two nurses.  First, Amy Bozeman, who is quoted in the Atlantic article decrying the focus on patients as customers:

“Now we are told as nurses that our patients are customers, and that we need to provide excellent service so they will maintain loyalty to our hospitals,” Bozeman wrote. “The patient is NOT always right. They just don’t have the knowledge and training.”

Second, a nurse named Kim from San Francisco, quoted in the Atlantic from her blog Emergiblog:

ADVERTISEMENT

A hospital that switched its meal service to microwaved meals, food-service administrators openly attributed low patient scores to nurses’ failure to present and describe the food adequately. It is both noteworthy and unsurprising that the hospital’s response was to tell the nurses to “make the food sound better” rather than to actually make the food better.

Let’s celebrate nurses for excellence in nursing, and call for a stop to this customer satisfaction nonsense.

Alex Smith is an internal medicine physician who blogs at GeriPal.

Image credit: Shutterstock.com

Prev

This is how I know you're a medical student

May 22, 2015 Kevin 6
…
Next

How to win patients and vaccinate people

May 22, 2015 Kevin 1
…

Tagged as: Hospital-Based Medicine, Nursing

Post navigation

< Previous Post
This is how I know you're a medical student
Next Post >
How to win patients and vaccinate people

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Alex Smith, MD

  • Do you know what your staff is saying about palliative care?

    Alex Smith, MD
  • We are morally scarring our future physicians

    Alex Smith, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Handshakes transmit germs: What are doctors to do?

    Alex Smith, MD

More in Physician

  • 5 years later: Doctors reveal the untold truths of COVID-19

    Arthur Lazarus, MD, MBA
  • The hidden cost of health care: burnout, disillusionment, and systemic betrayal

    Nivedita U. Jerath, MD
  • Why this doctor hid her story for a decade

    Diane W. Shannon, MD, MPH
  • When errors of nature are treated as medical negligence

    Howard Smith, MD
  • The hidden chains holding doctors back

    Neil Baum, MD
  • 9 proven ways to gain cooperation in health care without commanding

    Patrick Hudson, MD
  • Most Popular

  • Past Week

    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
    • Why recovery after illness demands dignity, not suspicion

      Trisza Leann Ray, DO | Physician
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • 5 years later: Doctors reveal the untold truths of COVID-19

      Arthur Lazarus, MD, MBA | Physician
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • 5 years later: Doctors reveal the untold truths of COVID-19

      Arthur Lazarus, MD, MBA | Physician
    • The hidden cost of health care: burnout, disillusionment, and systemic betrayal

      Nivedita U. Jerath, MD | Physician
    • What one diagnosis can change: the movement to make dining safer

      Lianne Mandelbaum, PT | Conditions
    • Why this doctor hid her story for a decade

      Diane W. Shannon, MD, MPH | Physician
    • Reimagining Type 2 diabetes care with nutrition for remission [PODCAST]

      The Podcast by KevinMD | Podcast
    • How AI is revolutionizing health care through real-world data

      Sujay Jadhav, MBA | Tech

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 14 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
    • Why recovery after illness demands dignity, not suspicion

      Trisza Leann Ray, DO | Physician
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • 5 years later: Doctors reveal the untold truths of COVID-19

      Arthur Lazarus, MD, MBA | Physician
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • 5 years later: Doctors reveal the untold truths of COVID-19

      Arthur Lazarus, MD, MBA | Physician
    • The hidden cost of health care: burnout, disillusionment, and systemic betrayal

      Nivedita U. Jerath, MD | Physician
    • What one diagnosis can change: the movement to make dining safer

      Lianne Mandelbaum, PT | Conditions
    • Why this doctor hid her story for a decade

      Diane W. Shannon, MD, MPH | Physician
    • Reimagining Type 2 diabetes care with nutrition for remission [PODCAST]

      The Podcast by KevinMD | Podcast
    • How AI is revolutionizing health care through real-world data

      Sujay Jadhav, MBA | Tech

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Let’s celebrate nurses by reining in patient satisfaction
14 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...