Why aren’t hospitals more attentive to the needs of patients?

In a recent post, Dr. Ashish Jha raises this issue as he relates his own story of coming to an ED with a very painful dislocated shoulder. Unsurprisingly, prompt treatment of his pain was deferred while staff diligently completed registration, sent him for an x-ray, and waited for a physician to see him.

On the bike path where Jha took his initial tumble, people went out of their way to respond to his injury with attention and concern. But as he lay moaning on a gurney in the hospital corridors, waiting for an x-ray and not yet treated for pain, people avoided his eyes and even walked by a little faster.

What gives? Why aren’t people in the hospital more empathetic and attentive? Is this a “wonderful people, bad system” issue?

In reflecting on his experience, Jha remarks that people seem to leave their humanity at the door when they arrive at the hospital for work, and posits that we get desensitized to suffering. He notes that some workers were able to “break out of that trap,” and responded to him more empathetically when he directly solicited their help and attention.

“It is the job of healthcare leaders to create a culture where we retain our humanity despite the constant exposure to patients who are suffering,” writes Jha.

Culture change is necessary but not sufficient

Culture is important. Yet I’ll admit that I’m usually a bit skeptical when I hear of a plan to tackle a problem through culture change. In my own experience, this has consisted of leaders trying to “create culture” by describing to front-line staff what they should be doing, and repeatedly exhorting them to do it. (And maybe giving out gold stars to those who do it.)

This, of course, is never enough. Talking the talk does not mean people start to walk the walk, especially if the walk involves a slog uphill rather than an easier stroll down a path of lesser resistance

If we — whether healthcare leaders or just concerned citizens who want to see healthcare improve — really want healthcare workers to demonstrate more compassion and empathy while on the job, then here is what we need to do:

  1. We should take seriously the task of understanding what might be interfering with this compassion and engagement. This means not only studying workflow, but also the behavioral psychology of individuals as well as groups.
  2. We should then be serious about creating the conditions that would allow regular human beings to reliably produce the desired behaviors.

Why it can be hard to help people in the hospital

What interferes with showing compassion and engagement? In reading Jha’s piece, I reflected on my own hospital days. Here are the obstacles that I remember, and the impact on me.

Difficulty meeting the needs of patients and families. I remember constantly feeling that people needed more from me than I could provide. Sometimes they needed to talk for more time than I felt I had available. Or they needed a service or other form of assistance that I wasn’t sure how to get for them.

Especially frustrating was when patients needed something like pain medication on short notice. I have been that doctor very concerned about a patient’s terrible pain. Unfortunately, I discovered that my power to help was quite limited by hospital logistics and workflow: although I could order pain meds right away, the patient could almost never get it quickly. After all, the pharmacy still had to dispense the medication, and the nurse had to administer it.

If you are a conscientious person who wants to help (which I think most healthcare workers are), it’s very stressful to recognize a person’s need and not be able to address it.

Hence, as a coping mechanism, my guess is that many people working in hospitals adapt by learning to “not see” those needs that they feel they can’t address promptly and properly. (Perhaps we might consider this a form of learned helplessness?)

That ED doc that Jha praises for addressing his shoulder quickly? He sounds like a good guy, but it also helps that he had the skills and ability to do something right then and there.

Frustration with workflows and workplace tools. It’s no secret that hospitals and clinics often present a “high-friction” environment for front-line staff. Back when I worked in the hospital, every day involved coping with inefficient workflows that generated various levels of annoyance. There was redundant paperwork. There were computers requiring multiple sign-ins, or repeated sign-ins. There were tasks that took three steps when they really could’ve been redesigned to take one or two.

Along with the expected hassles, one also had to contend with frequent malfunctions in whatever system you were trying to use. A printer out of paper. A computer that mysteriously can’t be logged into. A shortage of staff in a certain department, such that a routine inquiry ends up taking twice as long as usual.

To be fair to hospitals, designing friction-free workflows for clinical staff poses a huge challenge, given the complexity of the work involved and the diverse needs that hospital administrators need to consider. And the nature of life is such that often things do not work as expected.

Still, it all added up to a fair drain on one’s energy and attention, and made it harder to provide patients and families with attention when they needed help.

Inadequate levels and reserves of energy. Compassionately interfacing with patients takes energy, especially if pain or emotionally intense issues are at hand. If one is worn out by earlier encounters, or by a long workday, it becomes much harder to muster the energy to engage with those who need us.

And of course the energy one can bring on any given day is powerfully influenced by the overall balance of exertion and regeneration that one experiences over weeks and months. Long workdays stacked back-to-back (as experienced by many hospitalists) take their toll. Young children at home, or other significant obligations outside the hospital, can also reduce one’s energy at work.

On the flip side, certain activities help people regenerate and restore their energy. Adequate sleep, exercise, and close relationships with friends and family are sustaining staples that are needed by all. Plus everyone tends to have some favorite soul-nurturing activities that help recharge the batteries.

For physicians in particular, the problem is that residency tends to leave people with little time to recharge. We form our habits as doctors during a time of chronic stress and fatigue.

And even after residency, many physicians end up with chronically intense work-schedules. What effect does this have on their ability to be compassionate and responsive to patients and families?

My own experience has been that when I work long hours, it feels much harder to give people the support they want. I still try to do it but I suspect I do it less well. I also know that when I’m tired I make an extra effort with patients but then have much less patience with other members of the healthcare team. (And then when I come home I’m short-tempered and crabby with husband and kids; not necessarily a problem for hospital and patients but concerning to me.)

Enabling humans to show humanity

Cultural expectations within institutions and groups are powerful. We do take our cues from peers and leaders. But it’s hard to follow the cues when surrounded by pervasive stressors and obstacles. In fact, it can be demoralizing to be told to do something when your leaders don’t seem to be making enough of effort to enable this doing.
As healthcare leaders take on the important task of making hospitals more responsive to the needs of patients and families, I hope they’ll consider the following:

People don’t like being faced with situations that they can’t fix, or that they feel will be a huge time/energy suck to fix.

  • Make it easier for them to do the right thing.
  • Recognize when you are asking them to do something that is a big time/energy suck.
  • Try to give them more time. Realize that they’ll have less energy afterward for efforts that are cognitively or emotionally demanding.
  • Provide communication and empathy training. Without explicit training, people often don’t realize that patients and families appreciate sympathy and attention, even when you can’t solve the exact problem at hand.

Frictions in the workplace add up to material stress and depletion of energy.

  • Reducing these frictions can enable workers to be more responsive to the needs of patients (and colleagues).
  • Adapting to changes in the workplace — such a new computer system or workflow — does create a drain on staff’s energy and attention. Ideally, this is temporary but poorly designed changes often create permanent energy drains.

Be mindful of the overall energy and stress levels of your workers.

  • Workers who are already experiencing chronic stress and fatigue will have difficulty becoming more attentive to patients’ needs.

Now, if you told me that healthcare leaders already know all this, I wouldn’t be surprised. If you’re in a leadership position, it’s really part of your job to learn about managing human capital.

The trouble is that for the leaders of a hospital, addressing the obstacles that I experienced in the hospital feels costly to them. It takes time, energy, and money to reduce workplace frictions. And managers are generally very reluctant to reduce a person’s workload in order to free up cognitive and emotional energy so that the worker can then be more responsive to suffering patients, or even adapt to new technology for that matter.

In principle, these investments in nurturing one’s human capital should pay off down the line: more satisfied patients, less worker absenteeism, better teamwork among colleagues, and possibly even fewer hospital errors and better health outcomes among patients and staff.

Will healthcare leaders find a way to walk their own uphill path, and really make it possible for their front-line staff to do better work? I hope so.

Leslie Kernisan is an internal medicine physician and geriatrician who blogs at GeriTech.  This article originally appeared on The Health Care Blog.

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  • Dr. Drake Ramoray

    I think the answer is much simpler and boils down to two factors.

    1.) Hospitals have consolidated and are now large bureacratic entities, or as they like to refer to themselves Healthcare Systems, that are not terribly different than say trying to get good customer service from your cable company or wireless plan provider. Of course you aren’t ill or in pain (well literally at least) when talking to these examples, but the bureacratic red tape and size and scope of the company delivering a service isn’t terribly different. The employees and increasingly doctors as well now, are just cogs in the coporate healthcare machine, or as I like to think of us…. medical transcriptionists/floor secretaries who happen to see patients on the side (see the article on this site about how interns spend there time).

    2.) At the hospital most people aren’t responsible for paying for the service. The hospitals don’t care about your experience there as a patient because for the most part individuals don’t pay the bills or set the rates (Try a bill to insurance of $18,000 for two series of Rabies vaccinations… the vaccine alone not including the E&M charges or facility fees). The attempts to improve hospital care and satisfaction have resulted in the Press Ganey surverys, just further bureacratizing (is that really a word) the whole process and further pushing healthcare providers into the abyss of corp med.

    Push healthcare providers into an environment of being algorithm following widget making drones and you get just that…. widget making drones.

    I don’t see many articles with patient’s in concierge practices complaining how inattentive, hard to reach, and poor quality of service they get from their physicians. I wonder why that would be the case. /s off.

  • Mengles

    Maybe they should turn to concierge care as you did, Leslie. Not that there is anything wrong with that.

  • FugaziedUp

    This is a well-conceived and well-written post. Bravo, Dr Kernisan. All too often we have to hear about the lack of humanity/compassion shown towards patients. It is a two-way street. Healthcare is delivered by humans…..humans with finite physical, behavioral, and emotional resources, within a system with limited administrative, economical, and supportive resources, which was well-explained by this article. Most HCPs are doing their best within those limitations to provide compassionate yet timely care. Patients would do well to recognize this and it may serve to more reasonably adjust their expectations and, at times, be happy with receiving, not the care that they want, but rather the care that they need…..I think the Rolling Stones said something similar a while back.

  • Tiredoc

    Although I hesitate to join the usual crowd of “No, the real problem is…” No, the real problem is that in a hospital, no one is ever fired for bad customer service.

    There is nothing unique about the working hours or stress level of a hospital or emergency room. Lots of industries have longer hours and higher stress, and certainly higher personal risk than hospital employees. Do you really think the server at your local franchise really wants deliver your food with a smile every day?

    Sorry, I’ve been in hospital management. I haven’t worked in other industries, but I can personally guarantee that I wouldn’t find an industry more concerned with “scope of practice,” otherwise known as “turf” to normal humans, and less concerned with being nice.

    Hospitals charge cash paying patients hundreds of dollars a day for service that would get a hotel’s license yanked inside of a week. They are stacked to the rafters with overpaid nurses and doctors while equally overworked peons actually deliver the services.

    All of this is maintained with licensure, certificate of need, and accreditation that has everything to do with ratcheting up the salaries of the “trained” and nothing to do with anything that smacks of quality control or customer service.

    Hospitals could provide better service at a third the price, and everyone knows it, especially the people that run them. That’s why every spare dollar they have is sent to lobbying firms to make sure their protected position is secure.

    The secret to getting good service in a hospital is to complain while you’re there. A lot. Call the ombudsman. Call the medical director. Call the legal services at the hospital. Believe it or not, call your congressional representative. (Yes, I’ve seen it done. More than once.). Your chances of getting out of a hospital alive are statistically better if the staff is afraid of you. Be the patient whom the staff tells their grandchildren about. The student staff.

    • azmd

      I have to strongly disagree that making yourself the obnoxious patient whom the staff fears (or hates) is a way to obtain better care. Workers who are already stressed by workload or workflow issues have disrupted cortisol levels and are likely not functioning at the top of their cognitive range, since cortisol affects cognitive function adversely.

      Creating a more stressful environment result in the appearance of more cooperative medical workers, but I can promise you that the staff is functioning even less well cognitively under those conditions, and are more likely to make mistakes. It’s just a biological fact, not anything that is under anyone’s control, including the patient’s.

      • Tiredoc

        It depends on your definition of mistake. If you’re talking about actions taken that shouldn’t have been taken, you’re right with some people. Stress motivates some people to make hasty decisions that unless they’re rote decisions are often wrong.

        On the other hand, stress and fear are quite useful in motivating people to do things that are routine and don’t require decision making, just initiative. Most nursing care is of the latter.

        Personally, I try nice first. But if my shoulder was dislocated and the radiology tech was sitting across the room and ignoring me instead of hunting down the E.R. doc for the appropriate order, I’m going with ramping up their stress level. A lot.

        • azmd

          I just don’t know. I have spent quite a bit of time in hospitals and medical settings as a patient and the mother of a patient and have never noticed the kind of attitude you are describing, at least not since I was an intern at an HHC hospital in NYC. Perhaps it’s a regional thing.

          • Tiredoc

            It’s not a regional thing. JCAHO and Medicare use urinary tract infections, bedsores and pain control as surrogate measures of hospital quality for a reason. All three indicate problems exclusive to the nursing side of the hospital equation. If your hospital has those right, it doesn’t tell you much about the quality of the doctors, but it tells you what you need to know about the nurse managers.

          • https://www.facebook.com/arobert6 Alice Robertson

            Considering the NIH had almost beat the infection rates, etc. out of
            many hospital systems recently what you are saying makes sense.

          • guest

            Initially, I agreed with you. However, if you are a patient who is demanding and threatening, the staff won’t like you, but they won’t ignore you either. That said, anytime I or my child was in the hospital I was sugary sweet because I knew how overworked and over-stretched the staff already was.

    • Michael Rack

      “Do you really think the server at your local franchise really wants deliver your food with a smile every day?”

      Agree that working conditions in other industries can be similar or even worse than in hospitals. However, it isn’t a big deal if the typical fast food employee just goes through the motions or phones it in. It is a problem if hospital employees/health care providers act like this.

      Dr. Kernisan is suggesting methods for allowing hospital employees to function at a higher level.

      I agree with many of your criticisms of hospitals, including certificate of need. And while I am not going to argue about what is an appropriate income for doctors, I will point out that many of the doctors in hospitals aren’t being paid anything directly by the hospital (many are not hospital employees). I don’t think nurses are overpaid.

      • Tiredoc

        One of my patients is an offshore drilling rig worker. He worked on the Horizon the shift before it blew. He stated that the Horizon had four engines that they would shut down one at a time periodically for maintenance and restart. He said that before restarting the engine chief was supposed to check with the drilling crew to make sure there was no gas buildup under the rig. He thinks the BP gulf oil spill was caused either by the drilling crew not paying attention or the engine crew not calling. Scores dead, billions of damage, one phone call. Hospitals have nothing compared to that for stress.

        Most doctors seeing patients at fee-for-service hospitals are not paid by the hospital. The administrative doctors that are paid by the hospital, however, are generally overpaid for the work that they do.

        As for the nurses, I think you need to update your impression of what it is they actually do on the floor. 30 years ago, nurses drew blood, put in IVs, transported patients, took off doctors’ orders, cleaned patients, moved patients, turned patients, delivered food to patients, made sure that the food was eaten, mobilized patients to the bathroom, counseled patients and families, gave medications and charted.

        Now, transporters transport patients. Phlebotomists draw blood. The PICC team puts in IVs if the nurse supervisor can’t. The NA’s clean and turn patients. The cafeteria delivers the food. The unit secretary takes off the doctors’ orders. The nutritionists counts calories. The PT mobilizes the patients to the bathroom. The social worker counsels the patient and works on discharge. The pharmacist delivers the medication in nice little pre-determined dose packages. The nurse opens the packages and hands out the medications and charts. And charts. And charts.

        When I left the hospital, nurses were expected to fill out an 8 page form per 8 hour shift. Every time I stopped by the unit, the nurses were either doing mandatory computer training or charting. The ancillary staff was doing everything else. When JCAHO came to review accreditation, they spent most of the time looking at the charts, so it’s not like the hospital I was working at was concentrating on the wrong thing according to JCAHO.

        Most of the quality control fighting that I did at the hospital was with nurses over outright laziness. Nurses don’t want to turn patients. They don’t want to take patients to the bathroom. Getting patients out of bed to go to the bathroom is the single most proven way to reduce inpatient complications. It reduces bedsores, urinary tract infections, pulmonary embolisms, DVTs. It improved muscle function and patients are more likely to go home rather than to a nursing home. It’s not exciting, but it’s true.

        Most of the hospital nurses that I worked with balked at removing foley catheters as a matter of course. Most of them wanted to leave catheters in until the day of discharge. I have one nurse in particular who would only remove it if I personally took her to the room and watched her do it. I would watch her over and over take a call from the unit secretary that a patient needed to go to the bathroom and do nothing. Not chart. Not do training on the computer. Nothing. The only patient that I ever saw her move for was the one who took to turning on his side in bed and urinating on the floor if she didn’t come when he called to go to the bathroom. Nurses like that, of which there are far too many, are always overpaid. Their appropriate salary is $0.

        One final word on actual nursing. There was a trauma center that would send us patients with what we called their “halo.” Every single patient would come with a bedsore on the back of their head and their tailbone. It didn’t matter how old or how long they were in the ICU. Every patient also had a PICC line that was in too long and a simmering bladder infection.

        One day the head nurse at the ICU retired and they hired a new one. The next patient didn’t have a halo, or a fetid PICC, or a bladder infection. Then the next one. Then the next one. I found out that the new head nurse had transferred out of the ICU 2/3 of the nursing staff. For a year we were halo-free. Then the head of the ICU was fired in an administrative coup and we got our halos back. The transferred nurses just had too much seniority to be taking care of ward patients and were transferred back to the ICU.

        An actual nurse is worth their weight in gold. I would be more inclined to pay lazy, overeducated legislatively mandated RNs to stay away from me and my patients. Either that or urinate on the floor to make them come when I call.

        • https://www.facebook.com/arobert6 Alice Robertson

          I appreciate your honesty. Patient advocates recommend a family member being at their side every moment. We did this last operation with around the clock being there for five days, and treated the nurses like gold with gratitude and offers of Starbucks. Our doctor warned the residents to give great care or he would hear about it:) Anything else you would recommend to prevent this type of scary care you outlined?

          • Tiredoc

            The basics of nursing care don’t change. Sedated patients must be turned every 2 hours. Feces should be cleaned immediately. Foley catheters should be taken out as soon as possible. PICC lines for the sole purpose of drawing blood are a bad idea. The patient should be sat up to eat. No bowel movement in 48 hours in a hospital is a problem. Feed as soon as possible. Get the patient out of bed at every opportunity, even if it hurts and they don’t feel like it.

          • https://www.facebook.com/arobert6 Alice Robertson

            Holy cow! I think I will up the schmoozing up the nurse another level:) But, sincerely, this is informative. Thank you!

          • LastoftheZucchiniFlowers

            Read, “My Voice”, by Dr. Itzhak Brook. A respected physician with a cancerous nasopharyngeal tumor, Brook was horribly mistreated by his own colleagues and associates during his travail with oral cancer and laryngectomy. Being ‘on the inside’ is not always a guarantee of better care or even decent care.

          • https://www.facebook.com/arobert6 Alice Robertson

            I think I will read it. Thank you! What so many doctors really believe is that patients can’t handle the truth. And there is some truth to that, but it’s their job to do so there and here. Dr. Jerome Groopman’s book has examples of doctor’s using their clout to get better and in truth I don’t blame them. He, also, has examples of going to, I believe six of the best surgeons he could get recommendations from. Four agreed and he still blew it in his choice. A doctor mess up. It feels like Russian Roulette at times.

          • LastoftheZucchiniFlowers

            Curious – what is the average assignment of RNs on the average 7p-7am shift on your medical/surgical floors and what is the acuity of those patients? Years and years ago the floor nurse could actually render nsg care to multiple patients because charting was not the mishegoss it has become today. That, and ‘team’ nursing was the norm. The horror of hospital nursing is in large part what has led so many good RNs back to school for master’s degrees and certification as NPs. When a nurse can no longer render nursing care for the multiple ‘quality indicators’ looming large over her head – often times the best approach is an upgrade.

          • Tiredoc

            I no longer work for a hospital, having fled to a comfy place where I like nurses, talk to patients and fight with doctors, which is how God ordered the proper medical universe. (Actually, the only thing different is the liking of nurses).

            We had 8 hour shifts. The nurses carried 12-16 patients each. The acuity was low, which justified the high patient load to administration. There really wasn’t enough time for nurses to do anything but chart, give out meds and make sure the ancillaries did what they were supposed to. The core nurses were good. The floaters from other units were the problem.

            If I may speak for all medical directors and nurses everywhere, I have a special place for the call button to be permanently located on whatever functionary came up with that ridiculous “call button within reach” box that has to checked six times daily on every patient in every hospital in the country.

      • Suzi Q 38

        “……..I will point out that many of the doctors in hospitals aren’t being paid anything directly by the hospital (many are not hospital employees)…….”

        How does that work?

        Are the surgeons and anesthesiologists paid by the insurance company alone and NOT the hospital?

        Who pays the other specialists (neurologist, endo, gastro, urologist, etc??? I know that my insurance company is billed, but do they pay them directly or does the hospital?

        I noticed that my gyn/oncologist also worked at another hospital 50 miles away. Not that it matters, but I was just curious. Are they only paid by the insurance companies, or do the teaching hospital that they work for pay them as well?

        • Michael Rack

          When a doctor performs a service in a hospital, insurance pays for those services. Those payments go to the doctor’s employer (to the doctor if he is self-employed, to the group/practice if it employs the doctor, or to the hospital if it employs the doctor). Regarding the specialties you mention, a variety of employment situations can potentially exist.

    • https://www.facebook.com/arobert6 Alice Robertson

      Amazing! You get it! I am gobsmacked! I was going to hit “Like” but felt it was too good a post not to leave you a word “tip”! Ha!

      • Tiredoc

        Thx.

  • azmd

    Great post. Nicely articulated. Two thumbs up. A basic tenet of any kind of management is that your workers will tend to treat your customers the same way you treat the workers. For some reason the healthcare industry has really lost sight of this fact, perhaps because for so long we could count on doctors and nurses to put their patients’ needs before their own. However, we appear to be at the point where the medical workforce has been squeezed to the point where they have very little left to give.

  • guest

    I think the writer Dorothy Parker said it the best. She was in the hospital and her secretary arrived for dictation. She rang the nurses bell and said to her secretary, “Good. Now we won’t be interrupted.”

  • Kaya5255

    I totally agree that one must be the consumer the staff fears. Trust me, when the staff fears you you definately get better care because they are more afraid of having the VP of Clinical Services showing up on the floor if you complain, than you. In over 30 years of hospital administration, I know of only one time as staff member was fired for poor customer service.
    Consumers put up with surly nurses, arrogant physicians and worse. It’s frightening to think that concern over retaliation makes people clam up and put up!
    Customer Service are not words used in healthcare (and that includes medical practices). We’re not customers, we’re “patients” and we will do as we’re told! Wrong!! I pay! I pay for health insurance and I pay the co-pays! I expect service. No, I don’t expect, service, I demand it.

    • Suzi Q 38

      I have found that complaining only works a little.
      It doesn’t change the mistake.
      All I get are excuses as to why it happened, and that is only if I can show the proof.
      One doctor swore that he helped me with a referral to another hospital. He had flatly refused to do so to my face, but was lying and said that he did. I told the Chief Medical officer to “prove it.”
      Sadly, she finally admitted that they were wrong and he did not request a referral for me after all. I had to start all over again without a referral, and this took more time. During that time, my neurological condition declined.
      The powers that be in most teaching hospitals are there to explain away and/or “cover up” the problem/complaint.

      • https://www.facebook.com/arobert6 Alice Robertson

        I have waited four years and given up the right to sue on my daughter’s nineteenth birthday. You know if Frankenstein was rewritten today the doctor’s family may have been spared because the Monster could have used the internet to chase that scoundrel down:)….all this to say my freedom here to name the doctor if I want to….or go to review sites (every single one eventually…haven’t gotten around to that yet:) and warn patients that this guy is a screw-up. It’s odd though because doctors here say not to use those sites…yet elsewhere they are using them themselves. They, too, proclaim fear of the rogue doctor who will do harm to their own family.

        • EmilyAnon

          One enviable perk hospital providers have to vet doctors for themselves or family is that they are witness to quality doctors in their own facilities. Or they can just pick up the phone and call their counterparts in other hospitals. Or probably a better way is to befriend an OR nurse. They are the best witness to a surgeon’s qualities. It may not be foolproof, but their odds of getting good care are better than the average patient gets.

          • https://www.facebook.com/arobert6 Alice Robertson

            It’s a medicinal myriad of must for maladies:)

            Years ago I called the OB nurse’s station and asked for the nurse on duty. When she answered I simply asked her what doctor she would use if she was delivering a baby, and she give me a name of an outstanding doctor who I think had delivered her own children. I don’t know if she would still do that or not nowadays. But midwives or doulas often know the best OB’s. The doctors my OB friend recommended weren’t the ones the gals at the C-section prevention meetings were recommending. And even when a Director recommends a doctor don’t expect the same treatment he or his family will receive from that same doctor. We have “Patient Favorites” around here and the ones I have seen are very good, but very overwhelmed.

            What someone in the higher tier told me was to get ahold of those patient surveys. She said they are taken very seriously. If one arrives at your home take the time to fill it out, and be specific.

          • Suzi Q 38

            They probably would not be allowed to recommend physicians nowadays. On the other hand, I have been told that if I were to need another surgeon again, get the one with more experience. She then named two other surgeons.

          • Suzi Q 38

            One doctor wrote a blog about his mother.
            He was talking about how hard it was for him to get good care. He was from UCSF. He had quite a high position on staff. He had what many would call: “V.I.P. status.”

            I told him that his experience would little resemble ours, those of us without “connections.”
            He would actually be able to choose the best specialists to treat his mother. WE would be given the “junior” physician on staff and in that particular department.
            If she needed surgery, they would give her first choice for the A.M. time. She would not get 4:00 P.M., when the surgeon was tired and had been on his/her feet all day.
            The nurses would know who his mother was, and give her the best of care.

      • Tiredoc

        Too true. Complaining after the fact can’t change a mistake. Complaining early and loudly during the mistake can save your life.

        • Suzi Q 38

          The problem was, I didn’t know a mistake was being made at the time.
          The error came to light much later.

          Thanks for the “tip” anyway.
          I will know for the next time.

    • rbthe4th2

      and the retaliation happens. I’m documenting it … and making sure every last bit of it is in the record.

  • Tiredoc

    It sounds like you have a nurse manager that insists on quality control. It sounds like you understand that nursing is physically, emotionally and intellectually demanding. It also sounds like you’re not the thorn in every nursing staff’s side: the nitwit who can’t stand body fluid of any kind who thought it was a good idea to go into nursing for the money.

    The solution to good nursing care isn’t complicated. The nurse manager needs to have two unchallenged authorities. The manager needs to be able to fire incompetents. The second is the manager needs to be able to protect nurses for things that aren’t their fault. If the nursing unit falls behind in its quality indicators, fire or demote the nurse manager. Just because someone is a good nurse doesn’t make them a good manager.

    I do notice that you didn’t state that what passes for charting these days is useful. In my opinion, nursing is the only field in medicine that has it worse than doctors when it comes to meaningless paperwork that no one ever reads.

  • Michael Wasserman

    Thanks for sharing, you are so right!

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