Secret checks on nurses are untimely and aggressive

16 July, 2009 | By Mark Radcliffe

A Long time ago, when we were ‘a-courting’, I asked my wife what her perfect job would be.

‘Mystery shopper’, she said, quick as a flash.

‘Not astronaut?’ I offered looking as one did in those days for just a hint of compatibility.

‘Not astronaut,’ she said, adding quickly: ‘But shopping would be good because it would give me something to do while
you were away, er, astronauting’. Which turned out to be the nicest thing she has ever said to me. So far.

I asked her what she would shop for and she said - shoes.

‘What sort of shoes?’

‘All shoes,’ she said as if it was a stupid question.

‘But when would you have the chance to wear them?’

She shook her head at my foolishness. ‘Most shoes are not for wearing,’ she sighed. ‘They are for making us feel better.’
Which is by all accounts as close as psychology gets to a truth now. According to The Times recently, two new studies on the psychology of consuming tell us that while spending money leaves us unsatisfied and fails to compensate for not having a richer, fuller life - or being an astronaut - the act of shopping is ‘the heroin of human happiness’. We may know it is shallow and ultimately unfulfilling but so what, it feels good and in my house we have some cupboards full of unworn shoes to prove it.

‘We know the act of shopping is ultimately unfulfilling but so what, it feels good and in my house we have cupboards full of unworn shoes to prove it’

So given the fact that shopping is the all-powerful cultural phenomenon it is, one shouldn’t be surprised to find at least two NHS trusts using mystery shoppers to improve the quality of services they offer.

Now some nurses may be forgiven for feeling that hired patients who are looking for fault cannot possibly place into context the working day nurses face and thus any judgement of their practice is unfair.

But we know, don’t we, that nursing should be able to endure scrutiny, particularly if the scrutiny focuses on the unarguable qualities that should underpin all healthcare interventions - respect, courtesy and good manners.

So why might the idea seem so discomfiting to many nurses? Maybe because it exacerbates a ‘them and us’ culture - the sense that managers exist to check on and ultimately to criticise clinical staff.

Or perhaps because in a climate where staff are feeling under pressure and undervalued, secret checks on their ability to do their job feel untimely and aggressive.

Regardless of how we check on the quality of care, whether it be by ‘mystery shopping’ or just having managers asking patients how things are going, what nurses need to know is that the commitment to best practice is a collective one and that managers are not looking to catch them out but are instead committed to working with them. I wonder, are we sure that all nurses know that?

Readers' comments (15)

Anonymous | 18-Jul-2009 9:10 am
we should be supported, not spied on.
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Jessica Porter | 18-Jul-2009 11:19 am
Hmmm, mystery shoppers, does this mean that we will be paid a bonus if we do well, like out in the rest of the consumer world?! Also, do you not think that nurses have enough work to do without adding fake patients to add to the workload? Nurses are not stupid, we will be able to figure out if a patient is not sick and playing a game, this is unfair to nurses and not treating us as the professionals that we are.
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Anonymous | 18-Jul-2009 4:46 pm
So why shouldn't other hospital employees endure this experimental surveillance technique as well? Hospital staff as a whole should be dedicated to providing the best care possible to the patient--this is why I cannot understand why nurses, and only nurses, are consistently put under the "surveillance microscope", so to speak...
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Anonymous | 18-Jul-2009 6:24 pm
It is getting so that our 'managers', the public, our so called 'union' and everyone else who wants to stick their oar in just assumes that nurses will do wrong and act punitively toward us. It is almost like we are guilty till proven innocent.

We get into this career to help people and heal them, it should be something to be proud of, not something that we have to endure under a stalinist regime where we are watching our back every second!
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Anonymous | 18-Jul-2009 6:27 pm
Beside walls are not cleaned when patients leave ward
Under surfaces are not leaned
Dirty cloths are put back into clean water when items are being washed down
Nurses spend most of the time in the station when not actively performing a duty
Auxiliaries and nurses generally do not consider the keeping clean and fresh side of things to be their remit - they are above it all - inerest in medecines etc

Meanwhile repairs which if not carried out adversely affect recovery and health of patients are not prioritised - if I was ward sister I would carry out half of the repairs myself - nurses don't Go Slow
Nurses are not reporting seemingly unimportant conditions so doctors may be missing on details to make accurate analysis
Nurses are paid more than soldiers and are striking for more money instead of the right to speak up and suggest more practical and economical policies
Ms Nightingale must be spinning
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Anonymous | 18-Jul-2009 6:29 pm
Trouble is you won't find a secret shopper in a dementia ward
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Catherine Ahrens | 18-Jul-2009 9:20 pm
I don't understand the commenter at 6.27pm. Is this a "mystery shopper" report? I don't recognise any of the comments as being relevant to the ward I work on.

It is this kind of sloppy smearing without a scrap of evidence that makes nurses feel so under siege.

The problem with this kind of "mystery patient" approach is that patient rarely get to see the whole story of what the staff are doing. If one patient on a ward is seriously ill they will inevitably monopolise a lot of staff time. Other patients may feel that they haven't been given the same time, but it may be that they simply aren't as ill. If the mystery patient just knows that their nurse is spending lots of time in the other bay, then they give a bad report but without all the relevant facts.
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Anonymous | 18-Jul-2009 9:34 pm
With regard to the comment about being a ward sister and carrying out repairs yourself - you have obviously never been there. I am a ward sister and I work exceptionally hard as do the nursing staff on my ward. Maybe you should try doing the job for a day and you may find that you have no time to sit around making sweeping generalisations, or repeating parrot fashion some of ther tripe you read in some sections of the press.
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John Harrison | 18-Jul-2009 10:13 pm
I'm really not sure how the use of mystery shopper helps. Patients/service users already have a number of recourses to complain or praise the care they have received. And are regularly contacted by the trusts in my area anyway to find out their views on the care they received whilst as an inpatient or outpatient (or even as a GP appointment). In the event of them being unable to do so relatives in my experience are also more than capable of voicing concerns and will do so.

I have to agree with comments above that this appears more to do with spying on staff than any appropriate quality measures. Are any other professional groups being targetted by this sort of aggressive monitoring? What is it they are measuring. I agree with the comments above that the job is not always visible to an onlooker who is not in possession of the facts about competing issues for their time that a nurse may have at any one point of their shift.

It is interesting that the Trust who are proposing this are mental health trusts; or as a psychiatric nurse am i just paranoid?

It would be better if the trust management teams got their own house in order first and actually asked the front line staff what support they need to provide high quality care before underhandedly assessing the staff with bogus patients. If they are recruiting real service users to do the mystery shopper role then questions should be asked, particularly in mental health trusts what the motivation is behind the service users agreement to undertake that role. It might not be PC but some survice users do have an axe to grind particularly in mental health.

One final point. I work with service users every day who are psychotic, depressed and acutely unwell. It should be upsetting to staff and patients alike that somebody will be "mystery shopping" attempting to mimic those types of illness. In fact I persoinally find it ethically and morally reprehensible that trust would employ people to do that. Or have I just got the wrong end of the stick?!
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rebecca churchill | 18-Jul-2009 10:32 pm
Lets think about this for a moment - a'mystery shopper' masquerades as a patient so that they can report on nursing care. All this without the consent of other patients and relatives? Surely not - wouldn't that be like filming really appalling care on a ward without getting consent first, resulting in dismissal and absolutely nothing being done anyway? Or am I missing something?
One rule for 'them' and one rule for a caring, competent nurse?
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Anonymous | 18-Jul-2009 11:34 pm
As a qualified nurse and not a secret shopper I was amazed and disgusted by nursing attitudes and care towards my critically ill and dying mother last year. They did not exhibit any of the qualities of nursing I would display in a similar situation. As a concerned family we were treat like a real pain in the bum, we were not listened to and the care we witnessed generally on the ward was substandard or blatantly obtuse at times. Terminal cleans were laughable and the response thus far to my complaint negligable. I am wondering what happened to 'care' in healthcare??
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Anonymous | 19-Jul-2009 9:31 pm
How can anyone be a mystery shopper on a ward without being sussed out? For a kick off they would not be on any medication apart from maybe paracetamol. Also how would they pretend to be a patent without having tests done etc?
A hired patient would be too concerned in getting better without filling in forms and observing their surroundings
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Anonymous | 20-Jul-2009 5:50 am
Thank you. I work in a critical care unit. Some of my patient load are a down graded status and waiting on a bed on another unit, or to be discharged in the next day or two while the others need much more of my time. I wonder if public has an opportunity to consider what a nurse does. I am happy to get coffee, fluff a patients pillow, bring extra tissues, snacks, family members linen to stay the night by their loved one, but it does not come before assisting my other patients life threatening needs. I admit patients, I help in codes, I speak with doctors, pharmacy, lab department, etc. I am swamped all the time and yet I absolutely am in my career out of the fulfillment of making a difference. Nurses are not wealthy and we earn every bit of what we make. I am not a waitress, I am here to make a difference in the health and well being of my patients. Due to hospital cut backs I usually am the ACP and nurse. So my message is to please be understanding and patient. I am here to help but can not be everything to everyone and everywhere all at once. I last had my 30 minute lunch break during my 13 hour shift 08/2008 so no, I do not sit at the nurses station relaxing. As for the mystery shoppers, gosh, where in the budget does that come from?
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Sandy Woodbridge | 20-Jul-2009 9:37 am
if we are doing our job to the best of our abilities at all times. Why are we worried abiut the mystery shopper?

If we have nothing to hide we would not fear being looked at by mystery shoppers.

it about the quality of the service being given. We must get away from thinking that people are out to get us. there is always room for improvements , however we sometimes needs others to tell how we can imrovie. bring on the mystery shopper,.
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Anonymous | 23-Jul-2009 9:32 pm
As a Manager I know the staff amonst my District Nurses who are under performing just by the feedback I receive from their colleagues, patients and the number of complaints over a year.

What I need is not a secret shopper but support from HR and training either to re train the staff or start performance manageing them so that they can be made to improve and work to an appropriate standard or to fire them.
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