When a Nurse’s Pay Hangs on a Patient’s Opinion

In many industries, salaries are in some way linked to customer satisfaction. Never has that been the case in nursing. Until now.

With government mandates and financial incentives for health care providers increasingly linked to satisfaction scores, hospitals are giving patient opinions a great deal of attention.

But as the focus shifts from an emphasis on the quality of care a patient receives to the importance of the customer experience, hospitals are, in turn, putting an entirely new set of pressures on their hard-working providers. With both prestige and financial outcomes on the line, they are standing on the backs of staff in an attempt to tackle one of the strongest indicators of patient satisfaction: nursing care.

Merit increases have become directly tied to patient survey results for those in scrubs and clogs — and hospitals are sold on the practice.

It’s no secret that satisfaction scores now determine what hospitals receive in reimbursements from Medicare. The system has become a “pay-for-performance” model, with incentives for hospitals and other health care providers to improve their delivery of care. Since 35 to 55 percent of hospitals’ revenue are now Medicare dollars, according to the Washington Business Journal, they need to be paying attention.

But at what cost? Hospitals aren’t just looking for positive responses; they want excellent ones. Which has led many of them to script nurses, enlist patient liaisons and decorate everything with the word “excellent.”

And what leads customers to rate their care as an “excellent” experience? Only a small percentage of patients are feeling excellent about anything when they’re hospital bound — and it’s next to impossible to know “excellent” when you’re breathing off anesthesia.

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Providing quality care isn’t simple, nor is analyzing its outcomes. There’s a menagerie of experiences and individual interpretations of them. Your opinion of the exact same experience may drastically differ from someone else’s, as we all carry individual yardsticks and different boiling points.

After relaying to a patient that his surgery will be delayed by a number of hours, the person may respond, “Thank you for telling me,” while a neighbor, when told, “We’re out of chocolate milk,” freak outs. It’s all relative.

Holding the entire class hostage to recess because of a few bad eggs has never been a widely popular practice. So why are professional nurses, who are in the business of providing life-saving care, being treated this way?

Related: The Winners and Losers in Health Care

“My merit increase and pay structure should be based on my individual performance,” said a nurse from Arizona with 15 years of experience, who asked to remain anonymous. “Patient opinions and surveys are an important component for future health care practice, but should not be a collective means for my personal pay increase.”

Pointing the finger at nurses may be the easiest route to take, but factors such as workload amount dictate the quality of care any health care worker is able to provide. Not surprisingly, patient-nurse ratios are highly associated with positive consumer-satisfaction scores.

Reaching benchmarks for raises may be a new reality, but what hasn’t changed is nurses’ commitment to their patients or to their heartfelt delivery of care.

Patient outcomes have always mattered.

Jewels Doskicz is an Arizona-based registered nurse with 20 years of experience. She’s a passionate patient advocate and health consultant.