By Mathew Keller RN, JD
Regulatory and Policy Nursing Specialist
Limousine service, upgraded television sets, nurse/patient “scripts,” gourmet food service, nurse uniform requirements – hospitals all over the U.S. are offering more “customer-centric” patient care in order to increase patient satisfaction scores, which are becoming more and more important for Medicare reimbursements.
These efforts often have unintended consequences.
In the first place, customer-centric interventions rarely (if ever) improve the quality of care patients receive: rather, they merely improve patients’ perceptions of care.
Nurses working in Essentia Health hospitals in Duluth, Superior, Deer River, and Virginia, for example, are seeing a push from administration for nurse uniform requirements. Such uniform policies, which require all nurses to wear the same type and color of scrubs (rather than just requiring scrubs in general, as is currently the case), are undoubtedly intended to improve patient satisfaction scores.
But while Essentia has been working hard at improving patients’ perceptions of the care they receive, it has missed the boat on several common-sense strategies to improve that care altogether.
The most important: nurse staffing. Research shows that improving nurse staffing while controlling for variables (including physicians, LPNs, and nursing assistants) significantly cuts the risk of mortality, lowers the incidence of medication errors and other adverse events, cuts patient readmission rates, reduces nursing-sensitive negative outcomes, and even saves hospitals and insurance companies money — and that’s just the tip of the iceberg.
The evidence, at this point, is indisputable: proper nurse staffing significantly improves the quality of care that patients receive, not merely their perception of it (although it improves that too).
Knowing this, Essentia nurses at St. Mary’s Hospital in Superior, St. Mary’s Medical Center in Duluth, and Miller-Dwan in Duluth, have proposed several common-sense interventions to improve the actual quality of care their patients receive. They have proposed, for example, that charge nurses (as a matter of course) be available to fulfill charge nurse duties and act as a unit resource/first responder to bedside emergencies; in other words, that charge nurses should be charge nurses and not have a full patient load.
Nurses have proposed that when the number of patients in the hospital exceeds the capacity of the nurses to safely care for them, that a small incentive be offered to nurses willing to come in on a day off and plug the gaps.
These are minor interventions, just small steps toward improving nurse staffing. And Essentia needs them: the incidence of unsafe staffing reports filed by Essentia-St. Mary’s Medical Center nurses, for example, jumped from 59 in 2014 to 145 in 2015. Nurses reported specific concerns ranging from “homicidal patient [leaving] without being seen” to “caring for the [patients] as best we could” to “unable to deliver safe, timely patient care as needed.”
Such sentiments are echoed time and time again by Essentia Health nurses in reporting unsafe nurse staffing. As one nurse put it, “I did the best I could and the staff was great, but ultimately it was my responsibility for these patients and I just didn’t feel that I did a good job for them.”
And that’s truly what Essentia nurses want – to do well by their patients. So when they hear from their managers, “Just do the best you can,” in response to staffing concerns… well, “the best you can” just isn’t good enough when it comes to patient care.
Essentia needs to negotiate its nurses’ common-sense approaches to improving nurse staffing. Because if you ever find yourself in the hospital, which nurses would you rather have: ones who all wear the same color scrubs? Or ones who actually have the time to deliver the care that you need?