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!
NurseManifest 
I love this Peggy! How do people know what “best nursing care” is if they do not even first know what nursing care is? Either we shouldn’t invite analysis on how good our nursing care is, or we should first educate the evaluators as to what our work entails. I prefer the latter.
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Your wonderful work on “the truth ” is making a difference!! We have a long way to go but I think people are getting it. Almost every time I hear pundits talk about the blocking of the Ryan bill they mention – often in this order – hospitals, nurses and doctors opposition!
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I agree that surveys leave a lot to be desired, but what is the alternative? Not seeing any suggestions here, just questions, and no real answers.
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Great point, and thanks for starting this discussion! I am calling for ideas from readers, but here are a few of my own – 1) keep the surveys but use them differently, and combine them with actual interviews to explore the deeper issues reflected on the surveys. 2) start nursing projects to collect stories from nurses about their care, then examine these stories to extract defining characteristics. 3) Share more information with patients about what to expect from the nurses who care for them – particularly for planned hospitalizations – and be sure they know what their nurses are doing to assure safe and compassionate care. 4) work within the system to re-prioritize how patient surveys are used, and be sure that nurses participate in actually analyzing and using the results. 5) Once a few good indicators and outcomes of best nursing care are identified, set up ways to document each and every time these things “happen.” 6) Delete messages implicit in surveys that sustain the “business” purpose of the hospital – for example, asking people if they would return to this hospital is a purely business/profit item. As nurses, we do not want them to return! This is a start — all have pros and cons – but let’s collect some good ideas here and see where it leads!
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Perspective is so important, also. I was hospitalized for essentially the first time in my life (I am not counting childbirth) and was in for 9 days, for an emergency surgery. For the first 3 – 4 days. . I viewed my nurses as angels (and. .yet, there were examples of “missed nursing care”). They were kind, compassionate and, they took care of my pain! As the days wore on and I felt better.. .the nurses didn’t change. . just me. I wanted to walk, but was hooked to an IV and was labeled a “fall risk” (and they didn’t have time. . truly. . I am not criticizing them). The nurses were just as kind and compassionate. ..but now I felt like I was stuck in a place I didn’t want to be. .. so I did not view them as positively. I just wanted to get out of the hospital!
Of course in the end, when I got my survey I rated them all very highly. They were indeed a wonderful group of women and men. . from the new grads to the experienced nurses. Bedside nursing is a hard, and taken-for-granted job. . .and questionnaires can’t identify staffing levels or how hard their CNAs work or if there is a supervisor or resource nurse nearby to help the new grad. .
So I don’t have any answers . . I do think that many of the surveys are not asking the right questions and need more qualitative data!
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Maybe we should evaluate hospitalization as we do education. Establish objectives for the stay, and then evaluate it against those. Client and nurse input, as you’ve mentioned, is essential. We could ask people after discharge, for example, “Can you name at least two ways to keep yourself out of the hospital in the future?” instead of the business questions.
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Hello, where can I find the original article? I have been a Social Worker for 25 years and am now pursuing a Nursing degree. I’m very concerned about the models in place which are purported to be care models when they are clearly business driven. I would truly like to gain better understanding of this debate. Thank you.
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