We focus a lot on culture as we work with healthcare organizations around the country and, while we know that it “takes a village” to deliver high-quality healthcare, we also know that there is one critical role particularly in hospital care that’s pivotal to the patient experience—nurses.
For a dozen years now, Gallup research has shown that nurses are ranked #1 when it comes to trust among the American public. The most recent survey was released in December and, again, nurses received the most votes for being the “most ethical and honest profession.”
In fact, 82 percent of those responded rated nurses as “very high” or “high” in terms of their honesty and ethical standards—12 percent higher than any other profession. Pharmacists were second, at 70 percent, medical doctors showed up in fourth place with 69 percent of respondents viewing them as “very high” or “high.”
This represents both a significant opportunity and a significant burden for nurses, especially in an environment with publicly reported patient satisfaction. Trust is a very powerful thing and can be easily eroded. And in healthcare, when that trust is breeched it’s very difficult to regain.
The nurse/patient partnership is a powerful relationship and when leveraged, can significantly improve the patient experience. Nurses have a unique role in delivering safe, high quality, and memorable care. But it’s a role that should not be taken for granted, or assumed. Nurses and the organizations they work for have an opportunity to capitalize on the strong sense of trust that patients have for these providers by taking specific, actionable steps to create a strong nurse/patient partnership.
This is a process that requires:
- Defining the desired patient experience
- Examining the role that nurses play in influencing that experience
- Building a culture that supports a positive, memorable patient experience (not everyone has patients, but everyone has customers. If you aren’t serving the patient, you are serving those who serves the patient)
- Creating personal action plans for success supported with ongoing coaching
- Measuring success
Because we know how important nurses are in shaping the patient experience, there has been a plethora of best practice tactics layered on nurses. When these are added to a task list without a strong connection to purpose, nurses will feel overburdened. Whiteboards, hourly rounding, bedside shift reports are among these tactics. While each has merit, many nurses are in tactic overload and fail to see the connection between the task and the nurse/patient partnership. This reduces the practice to a check list. It’s important for nurses to see how each of these tactics adds value in the nurse/patient partnership.
Unfortunately, while we know that nurses can have a significant positive impact on the patient experience and positive patient outcomes, the reverse is also true. Nurses who do not successfully engage with patients to form strong, trusting partnerships, risk eroding the experience, and the relationship. A negative experience with the nursing staff can and does result in a negative evaluation of the entire organization. That’s why it is so important for nurses to see how they affect the patient experience.
Fortunately, nurses can avoid these situations through self-assessment and personal plans specifically designed to achieve their personal and professional goals, the goals of the organizations they work for, and the healthcare needs of their patients. Nurses benefit from seeing through the patients’ eyes and learning how they (patients) judge engagement, empathy, communication, and respect. By providing verbatim responses from patients as part of coaching, nurses are able to make adjustments to their interactions. The following are just a few of the comments patients shared during an ethnographic* assessment on inpatient units.
- “The nurse never looked at me. I was just the ‘thing’ on the end of the IV tubing.” – Once identified in context of engagement the nurse could focus on new behaviors including eye contact, greeting, and touch.
- “I don’t know why they keep asking me my name. It’s like they have to be reminded who I am.” Put in context of communication, the nurse could see the opportunity to manage patient expectations, letting them know that this is a precaution designed to ensure safety. It reminded the nurse to explain to the patient that this would happen in every encounter.
- “People keep writing things on the board and I have no idea what all the numbers are.” This comment reminded the nurse to engage the patient as new information is being placed on the board.
When we teach the Nurse/Patient Partnership course, we ask nurses to review each of the 8 dimensions in the HCAHPS survey and indicate how much influence they feel nurses have over each one. They clearly see how much influence they have over patient satisfaction and loyalty, and are often eager to learn skills and techniques for improvement.
Don’t underestimate the power your nursing staff has on shaping the patient experience. The solution is not to layer tactics onto their work load. Help them to learn and practice skills that reinforce engagement and empathy through the patient’s eyes. By taking a mindful approach to every interaction they have with a patient, or a member of their family, they have the opportunity to become part of their life story. Make it a good one.