By Carrie Mortrud, RN
In wanting to understand what drives people, Abraham Maslow studied motivational systems that he believed stimulated people. He argued they were unrelated to rewards but rather, when one need is fulfilled, a person seeks to fulfill the next one and so on.
We can’t be confident, respect others, and desire to be a unique individual if we are struggling to breathe, are malnourished or fearing for our safety. I think this is the same for patients and nurses alike.
As this article from Quartz points out, hospitals are trying to raise their patient satisfaction scores (and their reimbursement dollars) by copying tactics of five-star hotels. Manhattan’s famous Ritz-Carlton, for example, gives each employee a $2,000 allowance per guest to ensure his or her satisfaction. So, look for more cookies on pillows than nurses on duty. However, the article also says patients spend the most time with nurses. After all, a patient wouldn’t be an “in-patient” if she didn’t need 24 hour nursing care for a period of time.
“Happier nurses will effortlessly pass their satisfaction along to patients—no spa required.”
Therefore, investing in making sure the nurses are happy is critical to patient care, and by happy, nurses don’t mean pizza, chocolates or Diet Cokes. We almost always mean ENOUGH of the properly trained nurses in our unit when we need it. Rather than the Ritz-Carlton’s 2k allowance, what if hospitals gave nurses two extra hours for each patient to do whatever nursing care it is that patient needs to make their hospital stay exceptional? That could be time to sit on the bed with the patient and talk about his fears of being diagnosed with lung cancer or teaching a 55 year-old woman who had a heart attack how to care for her incision after she is discharged. Or re-instruct the couple as first time parents how to safely bathe their new baby. According to Maslow, patients need to be cared for (fed, clothed), then made safe (treated, medicated), then feel a connection (heard, cared about) before they can respond to cookies and piano music from the lobby.
I could apply Maslow’s Hierarchy of needs to nurses as well. If I have to fight with the nursing supervisor on why I think we need to actually get a nursing assistant to fill the 1:1 need for the confused patient and why the assignment I had yesterday was unsafe and I was unable to give quality care, I am less likely to perform in the top motivational brackets and worry about my patients satisfaction of care when I am literally trying to keep one from crawling out of bed and crashing to the floor because he is unsteady.
I do believe our surroundings have an impact on everything we do. From learning in schools to efficiency at work and of course healing in a hospital. However the idea that a hospital environment should mirror that of a swanky hotel is ridiculous. A vacation destination is a place where I am going for rest and relaxation, to escape my everyday life, to have someone pamper me. A destination medical center is a place I am trusting my health care to, to deliver my baby, to operate on my father’s heart to treat my mother’s cancer, to fix my sister’s broken arm. I do understand that a healing environment can be critical to a patient’s healing. Still, I would argue that creating that healing environment should be addressed or built AFTER a safe environment is created, specifically a safe nursing environment. That safe nursing environment includes but is not limited to, the right number of nurses with the right training.
I think this whole idea of creating hospitals to resemble hotels is why patients don’t understand what good, quality, safe care looks like. The hospitals are too busy and, frankly, good at creating a diversion or sleight of hand so that patients don’t actually learn or understand what safe quality care looks like. It isn’t a waterfall in the entry way or a personal chef or room service or warm towels. It’s getting your medications at the time they are scheduled to be given. It’s getting a boost in bed or a reposition every 2 hours because you are unable to boost yourself. It’s getting your questions answered about discharge to your satisfaction. That is what quality care is. Let’s work together to get that first. Work together to get our first and second level needs met, the air and physical safety first and THEN we can worry about self-actualization and waterfalls and pianos.