From nursing to customer service rep

Nurses Activism

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It is apparent to all of us who work in healthcare that a change is needed. Working in a larger hospital for a few years now I have seen the effect that surveys for satisfaction, customer service education for healthcare staff, and scripting have done for our profession.

Let me give you a hint: it's not pretty.

Having worked at a couple hospitals now, both as a student and then as a nurse, I see a disturbing change in the type of care given and then behavior we now see from patients. I work in an urban setting, this definitely impacts the type of patients I see as more often than not, they are frequent fliers from nearby neighborhoods. In school, we are taught advocating, therapeutic communication, etc for patients. Then we get to our job orientation and that is replaced with 'JUST GIVE THEM THE PICKLE!!! LOL'. Followed by staff being given a pickle pin to wear... Really?

We have a botched system that evaluates reimbursement on my ability run around and be yelled at for not bringing in a PRN medication 15 minutes early because your pain is suddenly 10/10 despite the fact you were sleeping 5 minutes ago, or that your ginger ale doesn't have enough ice. Patients now believe too that because they are surveyed on their satisfaction, threatening to leave the hospital they are currently in for another hospital will get them what they're requesting so diligently. My response? Please do.

It's unsettling too that new nurses now, instead of focusing in their training as a new graduate on the important things like how to manage a critically ill patient, they are learning how to time manage drinks and pain meds with a 5-6 patient assignment. The awful thing is multiple times a patient will be decompensating and the new nurse gets pulled out of her own patient's room with that situation to attend to the non urgent needs of another patient. I get some of this is teamwork, but some of this is also the change in attitude of what healthcare is for patients. But it's unacceptable to tell them to wait.

How is it appropriate to evaluate us and our reimbursement on whether the hospital stay was satisfactory? You know what's satisfactory? Getting better and going home. You know what hospitals are for? Healing. Not narcotics galore, free sandwiches, and free tv.

And yet now, we are all mandated to take a class on customer service, smiling, scripting our conversations with the dissatisfied patients and family members threatening to sue for not giving dilaudid to a sedated 20 yo. Please tell me how this will benefit me in our next Code Blue.

Nursing has changed and it is sad. :shy:

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Specializes in ICU.

I have said before and I will say it again. Transfer to a specialty area like OR, PACU, Endo or Cath lab where there are no visitors, the ratios are low, pt comfort is addressed appropriately, the patients are NPO and the food and beverage server duties are minimal to none. No pickles allowed.

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Specializes in PCCN.

Pickles? hahaha!

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Specializes in Dialysis.

I saw that stupid give em the pickle speil 15 years ago. I can't believe its still around!

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Specializes in Critical Care.

There's been stories about the supposedly recent focus on customer service in nursing for at least the last 30 years, it's nothing new. Long ago, I worked for a hotel company that had a "hospitality consulting" division that hospitals contracted to help them provide hotel-like service, that was in the early 90's. The use of Press-Ganey customer satisfaction surveys by hospitals has been around since the 80's. And looking at the historical nursing photos in the halls of my current hospital makes it pretty clear the focus on customer service in nursing has been around a lot longer than that.

I don't really think it's accurate though to lump in surveys that affect reimbursement (HCAHPS) with the more fluffy customer service criteria that many hospitals push. What HCAHPS patients is if nurses did their jobs, and if hospital administrators supported their nurses ability to do their jobs, which is a good thing. What it asks is if discharge teaching was adequate, if nurses explained new medications, etc. All pretty reasonable questions for someone paying the bill to be asking.

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Yeah, tweaking the surveys to make them more "nursing" and less "waitressing" is probably what's needed. I mean, waitressing is honorable and hard work--I've done it--but it shouldn't be the priority on a hospital floor. An acute situation is more important than someone's ginger ale, and the person just has to accept that. If your heart stops beating, your nurse will be right there; if your soda runs out of ice, tough noogies. Sheesh.

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Thanks for posting this. I don't want to write about the details of what is going on in my unit, but it's come down to being a glorified waitress.

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Specializes in Critical Care; Cardiac; Professional Development.
There's been stories about the supposedly recent focus on customer service in nursing for at least the last 30 years, it's nothing new. Long ago, I worked for a hotel company that had a "hospitality consulting" division that hospitals contracted to help them provide hotel-like service, that was in the early 90's. The use of Press-Ganey customer satisfaction surveys by hospitals has been around since the 80's. And looking at the historical nursing photos in the halls of my current hospital makes it pretty clear the focus on customer service in nursing has been around a lot longer than that.

I don't really think it's accurate though to lump in surveys that affect reimbursement (HCAHPS) with the more fluffy customer service criteria that many hospitals push. What HCAHPS patients is if nurses did their jobs, and if hospital administrators supported their nurses ability to do their jobs, which is a good thing. What it asks is if discharge teaching was adequate, if nurses explained new medications, etc. All pretty reasonable questions for someone paying the bill to be asking.

While this is partially true, there are unspoken factors going on. The questions may have to do with nursing care, but the answers frequently have nothing to do with the question that was asked or the floor or service asked about.

If the patient is unhappy, they wish that communicated. If the questions do not match what they are unhappy about, rather than answer the actual question they tailor their answers to reflect their overall unhappiness. Frequently the overall unhappiness is related to things that can, for the purpose of my post, be lumped under"pillow fluffing" or relates to interaction with one department but gets reflected on another. We would get surveys back marked in such a way that it was obvious by the comments the patient was scoring the ED, or PACU or the floor they were on before getting transferred. However, the survey was from our floor and the poor scoring came home to roost on us. If the patient was displeased with cold food or needing extra socks or other care that is nice but not crucial and no question addresses that, they simply score us poorly across the board or on the "would you recommend this hospital" question. The CDC came out yesterday with alarming facts on the number of people in the US addicted to benzos and opiates, yet a big question is about pain control. If one in four Americans abuses prescription drugs, can we conclude one in four of that survey question is skewed?

It isn't working and studies are proving that. The one thing not tried? Throwing more nurses at the problem. Improving ratios. Interestingly, that is the one thing shown to actually impact patient outcomes AND patient satisfaction, which was the original goal of the new Medicare guidelines for reimbursement. It is a failure. A big one.

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I completely agree. Unfortunately it seems where I am more nurses will not be added unless our scores improve. I checked my work email today and I had 4 emails about HCAHPs and how our scores were "less than satisfactory", therefore upon returning to work we will all be focusing on improving those. Frankly we are so short where I am I don't have time to focus on true patient care because I am balancing admissions, discharges, AMAs, and a patient awaiting an ICU bed on a medicine unit.

I know, I know I need to switch specialties but I promised a certain time commitment to this floor when I was hired and I intend to keep it, as it's only a few months but even in the few years since I was hired I cannot believe the amount of change I have seen in the patient population and the focal shift to HCAHPs. It is frustrating.

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