Customer Violence

after all, the customer is always right.

A good nurse has always been , one who displays good clinical skills , good people skills ( which is an amalgum of good customer service and the ability to de-escalate a misunderstanding ) , but as Virgo mentioned the hospital it is NOT a place where the customer is always right . Sometimes their condition dictates that things are done to the patient at inconvenient times and can be downright challenging to even a saintly disposition .
Personally given the choice of being admitted to a) a hospital with an excellent clinical reputation , or b)one with a sumptious lobby , Haute cuisine menu , wifi and rooms with panoramic views , I would always choose a) .Patients / customers should be educated so that they will demand that hospitals primarily promote excellence in clinical skills .

I've been a patient; I've even been intubated in an ICU. I've had tubes in everything but my ears and eyeballs. I've been in pain, and I've been morally afraid I was about to die (and almost did). I never threw urine or fecal, I never cussed out someone who was trying to help me, I never hit, kicked, bit or slapped someone because I was having a bad day.

No. But the customer is always the customer... upon whose patronage your business depends upon in order to keep you employed.

Like it or not, patients are customers... and yes, patients, too.

I am working with a focus group on a policy to address customer violence. Our nurses have encountered covert acts of violence from family members which have increased over the past few months. Our organization prides itself in customer service but we need to be supportive off our staff and excellent patient care by implementing a zero-tolerance policy for violence. Does anyone have a policy (that you would be willing to share) that addresses customer violence. Thank you in advance.

When threatened with a lawsuit I generally respond that "yes, you may hire an attorney and sue both me and the hospital...that is why I write down everything that you say in a threatening manner". The first time I said something of this nature I was a young RN in a Peds ICU. The "uncle" of the child responded something to the effect that I should becareful walking to my car at night (I worked 3-11). I asked him in a clear and loud voice if he was physically threatening me...a number of people heard me...he, of course, denied it...but you can bet that I documented every word. I also notified security (why the heck are they not armed?) and never walked alone to my car until well after that child was gone from our unit. By the by...I have a CCW and have been known to carry when visiting patients in the greater Detroit area. I recently had a fellow approach me as I was walking back to my car (by company policy I was wearing all white, obviously a nurse in a VERY bad neighborhood)...I kept walking...put my hand to the small of my back...and said very loudly..."DO NOT SPEAK TO ME...DO NOT APPROACH ME...YOU DO NOT WANT TO MESS WITH ME". I was not kidding, and apparently he believed that I was not kidding as he turned around and went the other way. You can bet that my heart was pounding just about out of my chest, but I was prepared to shoot that idiot if he tried anything.

I too encompass the attributes that you have described in your post however....you must remember that profit is the bottom line in healthcare nowadays.
My facility was known in the community to take in clients that no one else would take. LTC care facilities take in a diverse population never before seen in the history of SNFs (skilled nursing facilities). IMO, a nursing home is not the place for residents with serious psych disorders, violent felonies, etc. To keep beds filled, management has exposed workers to actual and potentcial violent encounters. I have seen my share in all my decades of nursing. When a patient went "postal", picked up a chair and busted out all of the windows in the dayroom, threw all the furniture out of the window(had anyone been under that window they would have been seriously injured or killed), he was led out in cuffs and never returned. You see he had damaged "property". I have seen documented charting on incidents "dissapear from charts", and statements changed regarding incidents.
Like the majority of nurses on this board I Love nursing, but the dirty side of it has left many of us

I've been a patient; I've even been intubated in an ICU. I've had tubes in everything but my ears and eyeballs. I've been in pain, and I've been morally afraid I was about to die (and almost did). I never threw urine or fecal, I never cussed out someone who was trying to help me, I never hit, kicked, bit or slapped someone because I was having a bad day.

I did, however used to manage a store belonging to a major retail chain. There we had customers. And if the customer acted like some of the patients I have seen, they got an escort to the curb by the county; if they took services or things and did not pay for them, they went to jail for theft. If you hit, bit, kicked or slapped my employees, you were arrested for assault. Period. And my incident reports were detailed enough and accompanied by video tape and no one was ever given a gift certificate and invited to return. And our "unit" was one of the highest grossing stores in Atlanta. My employees knew one thing -- I would do everything I could to keep them safe, and the first thing I did was remove a potential or actual source of violence.

At my hospital, one third of our patients do not pay, aren't on medicare/medicaid, and have no insurance. We eat everything they cost us -- time/material/payroll. They are classed as "non-recoverables" by management. We cannot turn these people away by law, but my hospital is running in the red, we have had no raises this year, they've stopped paying into the retirement plan, and openings as nurses leave aren't being replaced with nurses but with "customer care associates" who float into the rooms asking the patients what they can do to make things better (but can't do anything clinically). We can't find COWs that work, we're down to 2 functioning VS machines for the whole floor, we have ONE pulse ox for 30 patients, but we just spent 5,000 on bushes for the main entrance of the hospital. We spent an hour trying to find dressings for TLCs, only to be told we were out. Now, we can buy azaleas, but can't get the sterile dressings we need for patient care, or the equipment we need to provide nursing care?

And, yes, I am going to find another place to work as soon as I graduate. The inmates are running the asylum.

If it's physical violence, the hospital needs to have a zero tolerance policy. If a nurse reports being hit, her supervisor MUST let her press charges, in my opinion.

If it's more like verbal abuse, I'd suggest educating the nurses. Verbal abuse is hard to stop. And even good people say nasty things sometimes in periods of stress. Let's say the hospital wants to improve things. Could they bring in someone to coach the nurses on dealing with verbal abuse? They should also make it more clear to their nurses when it's ok to just walk out of the room when a family member starts cussing them out or when it's ok not to pamper someone's nasty demands. If nurses felt 100% secure in not being penalized for doing their job, they would not get flustered when Mrs Smith threatens to file a report if his meds are 5 minutes late.

Just my 2 cents worth.