No-Pass Policy

It turns out all of the nurses on my floor are pretty happy that a patient complained about the care she received. That doesn’t sound right does it? But it’s true. The complaint was one that patients have likely been making for as long as there have been hospitals: the nursing staff didn’t respond quickly enough when the patient rang the call bell.

It was one of those hand-written complaint letters, one that could have easily been dismissed, ignored or blamed on a cranky patient who just didn’t understand the demands placed on the nursing staff. It was likely an isolated case and an innocent oversight by a hard-working staff. After all, hospital floors are busy. Nurses are busy. We try to get it right 100% of the time and make everybody happy, but there’s the adage that says you can’t please all of the people all of time, right? This was just one of those times. Nobody’s perfect. It would have been easy to shrug our shoulders, vow to do better and move on.

Only, our nurse manager didn’t see it that way.

Bad News Travels Fast
The nature of the complaint was important. If the patient was dissatisfied enough to take the time to write a letter, how many people would she tell about her negative experience? How many patients are out there who have similar comments and didn’t tell us about their disappointment with the care they received, but told their friends and family members instead?

We’ve all heard that’s what happens when people have a bad experience: they tell their friends or post a complaint on social media. That’s something none of us wants. We work hard and are proud of the care we deliver. We want our patients to recognize us in a good way.

SEE ALSO: Handout: Addressing Alarm Fatigue

My manager enlisted my help. She told me: “Until we’re on the patient side and push the call bell to see who comes and when they come, we can’t relate to what they are experiencing. We tend to look at from our perspective but experiencing it from the other side is going to be a far better teacher.”

The Waiting Game
She had a plan. I was to become a ‘secret shopper’ of sorts, playing a patient to see how care was delivered from the other side of the bed, so that I could report on my experience to the other nurses on the unit. I went into a vacant room and got into the hospital bed with the nurse manager by my side. Then, I pushed the call bell button. I pushed it once, twice, several times. The nurse manager and I waited. How long would it take for someone to answer?

It was nearly five minutes.

It doesn’t sound long does it? I wasn’t sick or in any kind of need but I found that waiting made me anxious and frustrated. What bothered me most was I could hear people right outside the room having conversations and I actually saw some people pass by. I felt like I was being ignored and that their conversations were more important than my well-being. If I felt like that and there was nothing wrong with me, I could only imagine how much worse the feeling was for people who were in distress and discomfort.

Sympathy for the Patient
The difference of seeing it from another perspective was eye-opening. When you’re working and going about your life, five minutes tends to go very fast. It’s hardly noticeable. But when you’re sitting there waiting, it feels like forever. The waiting builds resentment, anger and raises the question of trust: How can I really be sure you’ll be there if I really need you?

After the bell was finally answered, my manager called all the nurses on the unit into the room and explained what had transpired. I shared my feelings of isolation, trust and frustration. The staff shared a variety of reasons for why they hadn’t responded sooner.

For example, the nurse who was responsible for that room knew the room was vacant. Others said it wasn’t in their district. Other personnel, including dietary and unit clerks, explained that they wouldn’t be able to help with medical issues. But after discussing it, the consensus from everyone on the unit was that everybody could do something, even if it was just checking in and then getting someone who could help the patient.

Answer the Call
As a result, from this one patient letter and a manager who helped us to see what the experience was like from the other side, we implemented a “No-Pass/Answer the Call” policy to the call bells throughout our hospital. It applies to all employees-whether they are a nurse, doctor, administrator or member of dietary staff. If you are within five feet of a room when a call light comes on, you cannot pass the patient room without checking in to see what the issue is.

The response has been amazing. Since September, we haven’t received a complaint letter. Now, the letters are for more positive. One letter from a recent patient read, “The night shift nurse was very kind and she came within a minute after I rang the bell. She was active and ready to help.”

The fact that patients are happier and write letters like that has been quite a morale booster. Our nurse manager’s decision to respond to the letter by conducting an experiment at seeing care from the patient side has been great. Walking in the patient’s shoes may not be a new idea, but for our hospital it has led to an innovative change in policy that has been a real eye-opener and is already improving our patient satisfaction scores. It is a best practice I recommend every hospital implement.

Maria C. Alvarado works at Southside Hospital in Bay Shore, N.Y, part of Northwell Health.

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