The current feature on the AJN blog “Off the Charts” is a post titled “The Limitations of Rating Nursing Care by Customer Surveys.” Since I have, for many long years, decried the practice of basing the evaluation of nursing care on patient satisfaction surveys, I jumped at the opportunity to read this post! Of course we need and want to know how patients perceive the care we provide, but how we obtain this information, and what we do with this, is a key factor. Since this approach derives fundamentally from the corporate business model, and is now practiced in the context of this model, the substance, use and outcomes of this practice are deeply flawed when examined from a NurseManifest perspective. The example the author, Juliana Paradisi gives as an example of her best safe and compassionate nursing care involves a woman in extreme distress who “fired” her as her nurse – a situation in which she could not break through the barriers inherent in the patient’s distress, but provided a level of care that was exemplary.
Even though the overarching business model that governs healthcare now is probably not going to go away soon (Ha!) – we can raise awareness of the limitations that this imposes on our practice, select specific actions to take to place these practices into context, and work to achieve whatever changes we can make. We can start with addressing the question: “What is best nursing care” from the perspective of the values in the Nursing Manifesto. There is no single answer to this question – but there are insights to be gained by thinking, talking and writing the ideas that arise from it. Once we have expressed our ideas, we can examine new and better ways to document our care, and continue to address the limitations of the existing practices that fail to document and support our best practices.
We welcome your ideas here – and stories about the times you provided what you think is the best nursing care!