Doctors should survey nurses to get direct feedback about the experiences they're providing to both nursing staff and patients.
On my first day as a medical intern, I was working in the intensive care unit in a busy New York City hospital and was informed that one of my patients had very low blood sugar. The next step was clear – the patient needed some dextrose. But I couldn’t recall how it was supplied or exactly how much to give.
At that moment, I remembered something important that was told to me as a medical student: always listen to the nurses. So I sheepishly said, “Sorry to have to ask, but how much dextrose do you usually give?” She politely explained that half of an ampule would probably be sufficient and she also suggested I review the insulin orders that had been changed earlier in the day by one of my colleagues. I remember thinking to myself that this is why you should listen to the nurses: because they know everything.
And It turns out that they do. Particularly when it comes to the quality of care in the hospital.
A study released online recently by the journal Research in Nursing and Health sought to assess the validity of evaluating hospital quality by aggregating hospital nurses' responses to a single item that asks them to report on quality of care. Conducted by The University of Pennsylvania School of Nursing, the study's results showed that nurses’ perceptions regarding quality are basically on the money. A 10% increment in the proportion of nurses reporting excellent quality of care was associated with lower odds of mortality and failure to rescue; greater patient satisfaction; and higher composite process of care scores for acute myocardial infarction, pneumonia, and surgical patients.
According to a story in Science Daily, the study’s lead author, Matthew D. McHugh, a public health policy expert at Penn Nursing said, "For a complete picture of hospital performance, data from nurses is essential. Their assessments of quality are built on more than an isolated encounter or single process -- they are developed over time through a series of interactions and direct observations of care."
The findings of this study may not be news to you, especially if you're a nurse. And when it comes to most quality improvement initiatives, nursing leadership are usually front and center in the effort. But we should take full advantage of our nurses' ability to assess the quality of the experiences they're witnessing others provide. In that single moment of my internship, the nurse learned about my competency, my communication and the sort of experiences I was delivering to patients and staff. Imagine the value of her perceptions after six months of working with me.
If you're a hospital-based physician, survey your nurses and ask them how you're doing. They know.