Patient Satisfaction STAB. Right in the back.

Let’s say you have been working for a company for 13 years.

You have six years in your current position.  You are working a high acuity cardiothoracic stepdown unit. You are in charge every night with a full assignment, start 90% of the lines on the floor, and precept almost every new employee. You work short every single night, 5:1 ratio or worse, on patients who are post op day 1-2 CABG’s, valves, MAZE procedures, and other complicated chest surgeries.  Sometimes when the ICU needs a bed, you get a post op day ZERO.hpg-home1

These people are SICK.  They are on sternal precautions, and most are quite obese so you are deadlifting 200-350 lbs constantly.  There is absolutely no lift equipment in this giant, state of the art teaching hospital that will help you.  You do not have enough nurses to help each other, and support staff is simply not even budgeted for.  At all.

Sounds dreamy so far.

Like most major teaching hospitals, you have a combination of charity care, normal middle-aged folks, elders, big money VIP’s, and …..people who do not ‘adapt to the hospital environment well’. 🙂 You have a relatively new manager who is trying to slog her way to the top of this leaning tower of unsafe staffing, low morale, and bad patient satisfaction scores.  As a matter of fact, your floor has terrible scores.

You recently gave your thirty day notice because yhospital-food1ou got a new job in an outpatient, day shift environment. Even though you have loved your job, the changes are a little overwhelming….especially since the floor cannot keep a decent manager.  The environment is no better for management, and they are constantly pressured to do more with less.  

Does any of this sound familiar?

You took report from the day shift nurse, who told you to remember to give the ambien to a specific patient at bedtime.  This patient’s family is slightly intense, but Mom has had a long, complicated hospital course.  It is well known that they complain loudly about essentially every staff member they come in contact with. It happens.

When you go to give the patient’s meds at bedtime, you see that no ambien is ordered, despite the day nurse saying she took care of it.  It happens.  You bite back some pretty awful words and page the doc.  You give the patient her other medications and apologize profusely about the oversight.  You promise to get the ambien as soon as humanly possible.

CvHer daughter arrives at the desk and makes a giant scene.  You explain what happened, again. You are completely honest about it, apologize, and stay classy.  When she asks to speak to the charge nurse, you are forced to admit that you are in charge. She stomps back to the room.

Twenty-two minutes later (and still a few minutes before it was actually DUE) you get the order.  You are in the middle of cleaning up a gigantic CODE BROWN and ask another nurse to quickly give the patient her medication.  Naturally, you want the patient to get a good night’s rest.  The medication is given promptly.  The patient seems to like you now, and you navigate getting a new IV on her because it is expired, while getting her labs so she doesn’t have to endure several sticks.  GREAT JOB!

And then you are called to Human Resources within a few days.  email-fired

You are told that the patient’s family had a problem with your ‘perceived attitude’.  You have had exactly ZERO patient complaints in 13 years.  It was the patient’s word against yours.The patient who complains about everything and everyone.  And your current manager is trying to make a name for herself, because your unit is only a stepping stone for her.  HR was really confused about what your manager was trying to accomplish with this meeting.   She states that she wants you terminated, for a single patient complaint, about a missing medication the day shift assured you was ordered.  

You cut her out of the conversation and speak to HR, offer to resign since you already have a job, and verify that you are eligible for rehire.

This is how completely insane nursing has become. You have received multiple commendations from every manager who has run this unit.  You have won hospital awards. You have literally never had a patient complaint before.  Ever.


The manager has been under pressure to raise your unit’s satisfaction scores.  

So now she can say she ‘got rid of’ you, the troublemaker.  And how your unit will be better with less bad attitudes.

And get a new, higher paying, high powered leadership position.  Which is actually what happened.  

This is the story of a good friend of mine. I have some advice for you:

  • If your hospital organization takes a patient’s word over your word when your record speaks to the complete opposite, resign.
  • If your boss is only interested in ‘just in time’ charting, and not whether you put your hands on a patient or not, resign.
  • If your floor cannot keep a manager for longer than six months, resign
  • If your staffing grid actually calls for unsafe, ridiculous staffing, resign
  • If your boss seems to think it is ok to climb over the backs of her fellow nurses to get promoted, resign

And if you have any self respect left, please write your legislators about why reimbursement should not be based on patient satisfaction, and why it should be based on outcomes.









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Author Janie Garner

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Join the discussion 4 Comments

  • Janie, this blog entry hit me where it hurts. I put up with all of your “bullet points” above because I loved my job and wanted to stay. I was eventually fired, after nearly ten years with that company (as staff and full-time agency), and with the same type of accolades that you mentioned. And yes, they finally fired me after an absolutely ludicrous patient complaint ( I worked in acute psych and detox.)

    Our unit, too, could not keep a nurse manager. We went through four managers in less than two years. I never applied for that position.

    Janie is right. If you are facing those bullet point issues, RESIGN and take your dignity with you. It took me two years and a lawsuit against my prior employer before I finally began to regain my dignity.

    I am now retired. However, I fight every single day on behalf of nurses and our profession, and I cannot foresee a day when I will ever stop doing so.

    Listen and learn, my fellow nurses.

  • Annie says:

    Good post and comment above. YES-we must stand up with class and dignity and fight like the pros we are!

  • J. R.N. says:

    You know what Janie? That’s exactly what I did. Two years ago. And I’m 100% happier because of it.

  • J.C. wildman says:

    Jani, you just described exactly and in fine detail what happened to me, the ratio was much worse some times it was 9:1 without an assistant I had to start and restart 100% of the IV’s ng tube and correct meds error the new grads and the inexperienced were making, like having a Cardizem drip going at 200 cc/hr and wondered why her pt. Didn’t have bp , or the new nurse from overseas that gave a pt with CP a whole bottle of NTG and told me he stopped complaining , so she thinks she save his life of course he was dead when I went down to check him and why did she not get an ekg or put him on O2. , not being acls trained she was clueless anD we had a new nurse manager every year or two just like you said, had oNE dynamic for 6 nurses or usually 4 nurses because we always were working short , then to tip the hat I got a two instead of a four on my evaluation because my manager said I didn’t advocate for the hospital enough ,WHAT !!!! I WORK 7P-7A FOR 23 YEARS I LEFT THE NEXT DAY. I now work in a cardiology office no weekends , no call, all the holidays, lunch is free everyday, but 3/4 pay but I don’t miss it at all . Jani there thousands of who are a the top of our game , i’ve been voted nurse of the year two times but what did it matter , thank you for your story and thank you for your professional service , be as happy as you can be and carry on. J.C wildman Lpn 2 ACLS certified, I V certified , Divinity Echo certified, EMT . 34 years in the business 9 more to go

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