Customer Service at any cost and its effect on burn out and safety??

[PACURN1818]

SO... Things are more different every day than when I started nursing over ten years ago. The advances and technology I can flow with. Some other things not so well. I have worked ICU, LTAC, Med/Surg, Peds, Oncology, Float, and PACU. No matter what the area, this customer service push follows you every where!

I have always understood that the patient is your customer, and you just cant be flat out rude or nasty, however, when did it become routine every day acceptable for the patient, their wife, and their aunts third cousin to be rude, and right out nasty to the nurse?! People more and more feel like they can do or say whatever they want in the hospital. Like basic rules of courtesy do not apply if you are their healthcare professional.

My hospital had a big customer service push with classes a few years ago, which basically was all about how to lie and be fake. This is above and beyond keeping your personal troubles at home, and giving your best to your patients. I currently have two jobs, PACU (because i love it), and LTAC for the money. If there is a problem or any type of complaint no matter where you are, you are done for.

Recently in our PACU a comment card from a patient angry that he was aroused and told to breath was taken seriously and a discussion was had with the management. At what point does this junk stop? At what point does customer satisfaction overpower safety? At what point will someone understand that the impression this junk is giving nurses is that we dont matter, and if someone spits on me I should thank them for it?? HCAPS = Burnout!

I was kicked by an a & o pt last week. I had it, and politely told him i wouldnt go to where he works and kick him, and expected the same level of respect in my work environment. Did not go over well.

HCAPS and the government and the Joint stressing the satisfaction issues simply makes this worse. People making decisions about this stuff arent the ones getting screamed at, insulted, and belittled. Politely educating your patient family member who read how to flush a line on the internet and doesnt know what they are talking about will get you fried. Telling an alert pacu patient they cant scream and curse when there is a 3 yr old in the next bay will get you fried. Telling a family member in the waiting room they cant come to recovery while you are extubating their wife will get you in trouble. Following pplicy will get you in trouble as soon as someone decides to complain they dont like the policy.

Anyways, can you tell I am frustrated? I like patient education, rights, and good customer service, but how ridiculous will this continue to get? I just need to hurry up and hit the Mega Millions. . . .

[TheMoonisMyLantern, ADN, LPN, RN]

You truly have my empathy. This customer service oriented health care model is driving us all crazy. Eventually something has to give, either the hospitals will have their customer service dogma bite them in the butt for sacrificing patient safety and patient care OR nurses will leave the profession in droves and then the patients will really have something to complain about.

I don't know what the solution is, but our health care system is out of control.

[Aly529]

As someone leaving the customer service field after being in there for almost 10 years I can relate. It is out of hand and this is not the place to be "friendly" and rated by a survey.

Polite? Yes.

Curious? Yes.

Caring? Yes.

Efficient? Yes.

Rated by surveys: NO.

[GHGoonette, BSN, RN]

Good grief, an A & O patient kicked you? How old is the patient? You get to expect this from small, poorly raised children (and even some not so poorly raised lol!), and of course adolescents can be moody, miserable nightmares, but if this was an adult patient....

What you can do, if a child or adolescent is raising holy :devil::devil: in pacu, is get the parents to come and deal with it. Even if it's an adult, you can get the wife or husband in to try to talk some sense into their nearest and dearest's head. If management has a problem with that, submit a letter to them, preferably with all pacu staff signatures attached, explaining that uncontrollable patients need to be restrained, other patients in pacu need to be protected, and customer service policies are making it impossible for you to fulfill your duties effectively at the same time as safeguarding yourself from injury. You require feedback from management within x number of days, with an acceptable protocol regarding how you are to proceed in future.

Sometimes it is very difficult to control post-op patients; they may frequently give the impression of being fully awake, but in the meantime they are still in some no-mans land and may do or say things which they later cannot remember, and which bear no resemblance to their normal behavior. Cursing and screaming usually indicates pain, and the sooner you address that, the sooner you shut them up If all else fails, I usually get the anaesthesia provider to deal with his patient.

[Ruby Vee, BSN]

We're sacrificing health care in favor of customer service, and it's going to bite us all in the butt someday. I'm getting tired of being "Reported" because I won't fetch ginger ale for an npo patient (or for their able bodied visitor.) last week, my patient wanted to speak to my boss because I told her that screaming "Help help help" when all she wanted was an ice chip was inappropriate. "I'm right here," I told her. "Two feet away. All you need to do is ask me if you can have an ice chip." she told me she was entitled to yell if she wanted to because she's the customer. Yeah, and what about the other five customers in the room who are trying to sleep?

People aren't used to hearing the word "No" anymore. We're trying so hard to make everyone happy that good patient care is going by the wayside. Mr. Vap doesn't want to do his pulmonary toilet once he's extubated? We're supposed to encourage him to without being "Dictatorial" or "Emphatic" or "Telling me what to do." and if he doesn't want to do it anyway, don't make him. Of course when he gets pneumonia because he didn't do his pulmonary toilet, it's our fault.

Glad I'm going to retire in a few years!

[Kooky Korky, BSN, RN]

ruby vee said:

We're sacrificing health care in favor of customer service, and it's going to bite us all in the butt someday. I'm getting tired of being "Reported" because I won't fetch ginger ale for an npo patient (or for their able bodied visitor.) last week, my patient wanted to speak to my boss because I told her that screaming "Help help help" when all she wanted was an ice chip was inappropriate. "I'm right here," I told her. "Two feet away. All you need to do is ask me if you can have an ice chip." she told me she was entitled to yell if she wanted to because she's the customer. Yeah, and what about the other five customers in the room who are trying to sleep?

People aren't used to hearing the word "No" anymore. We're trying so hard to make everyone happy that good patient care is going by the wayside. Mr. Vap doesn't want to do his pulmonary toilet once he's extubated? We're supposed to encourage him to without being "Dictatorial" or "Emphatic" or "Telling me what to do." and if he doesn't want to do it anyway, don't make him. Of course when he gets pneumonia because he didn't do his pulmonary toilet, it's our fault.

Glad I'm going to retire in a few years!

I guess you can just chart that he refused, that you explained the importance of pulmonary toilette for preventing complications, that he still refused, that he had been medicated for pain and stated his pain was 1/10 but he still refused, that he was a&o x 3 and still refused, that you notified dr. Smith, and let it go at that. What else can you do?

And what do you guys' bosses do when the npo pt c/o about no soda? Do they back you up or not? And what does the yeller say when asked what about the need of the other patients to be free from her yelling? What does your boss say to do about the yeller? Maybe tell her to "Rest now, dear, you don't want to spend your energy yelling when you need it to heal, do you?" "Don't you worry, I'm right here, I'll take good care of you." something similar to comfort and reassure her. I know it's hard to always be nice, but think how you'd feel if you were the more or less helpless patient.

I think a lot of the infantile behavior sick people and their visitors display is based on fear and due to not being in control.

The kick? Call the cops. That is not acceptable. Period.

[deftonez188]

Yes, call the cops for the kick. If patients want to act like clowns, send em to the clown show (jail). I don't beat them up at work, they best not lay a hand on me where I work.

If we called the police more often, people might start to get the point.

[Chin up]

First off, I hear you and I feel you. I absolutely, honestly do. Really. But, the problem is not "customer service." There are a few larger underlying issues, which are causing us to blame, "customer service". Two main ones that come to mind, and I know others could bring up more. Lack of civility, lack of manners and lack of respect. This is an issue in our country. People don't have manners anymore. People are not teaching manners, respect and civility any more. Grown folks who know better, choose not to act decently to others in all spheres of life. Growing up in the sixties, respect to authority, elders, and public servants as well as to your neighbor were stressed. They were not only stressed, but there were consequences when we were rude or disrespectful. Today, this is not considered important. Our "rights" are supreme and "who gives a damn, about yours?" have become a "motto" to many. Sadly, this trend has been growing in the last two decades, with increasing normality. The elderly, the police, woman and even how adults treat young children, are increasingly becoming more hostile. The state of affairs in our country regarding "others first" are dismal and in some areas, nil and void. The second thing that comes to mind is lack of common sense and professionalism. Good managers are hard to find. And when you take into account the first issue," lack of manners and respect", you see this exacerbates lack of common sense. These folks who make policy and the ones implementing policy, are a part of our culture that does not see manners and respect as necessary for democracy to work. They too, just like the rest of the population, do not see, manners and decency as a requirement for making these policy's work. So to get back to what you were saying, yes, people are rude, angry and really can give a rats behind, to how hard you are working. Instead, all they care about is self. They don't care you are a hard working loving mother, trying to feed your family. They only see that they hurt, and you better fix it. This is an example of lack of civility and lack of love for neighbor. People are blinded by, love of self and self entitlement. But then you add in, the manager, who lacks the common sense to see, customer service does not mean being a doormat, or begging to be pushed, kicked and abused. Because these same managers, too lack respect and manners, they see nothing wrong, with said behavior. So they tell you to do it better, missing the whole point. Until we as a nation, get back to civility, respect and manners, these instances will continue in every sphere of our lives. How can a patient, who is lost in self, with no proclivity to decency, be decent to you? And how can management, who too are lost in self, understand and or try to fix a problem they have no idea even exist?

[Bella'sMyBaby]

As long as facilities have Nurses desperate for a job, this nonsense will continue...So glad I'm out of patient care & don't have to deal with patients & their crazy families anymore...And those of you Nurses who do, deserve Halos. ?

[KalipsoRed]

This has been my issue with nursing since I became a nurse. Drives me bonkers! I'm done....I've set my self up enought that if they feel like firing me for doing what needs to be done then so be it.

I think patient surveys are good, I like feed back on my care and really I didn't mind the customer service classes either. I think they helped me dissolve some issues before they started BUT I draw the line at ignorant disrespect and giving good patient care.

I've made people do the things that were good for them and had my manager tell me I could have been nicer to them to get them to do it.....uh, hello, if that were the case the patient would have done what I asked the 1st time I explained why we had to do it now.

One day I'd had it and I went off on a woman who had been cursing me out all day....I don't know why, I've had people say the same things to me before, but for some reason that day I'd had it and I went off on the patient. I didn't curse or be petty back, but I did tell her that she was impatient, a waste of my time, and that I had sicker patients that actually needed my help. I shoved the chart into my Charge RN's hands and told her I wasn't stepping into that room again for any reason. Later I hear my Charge RN trying to do 'patient satisfaction recovery' with this patient and she told the patient that I went off on her because I'm "kinda crazy". Oh yeah that was great, don't let the patient know that she was at least some of the issue AND then indicate to the patient that our hospital hires incompetent, crazy nurses. That sure recovered the patients satisfaction, huh? Eh, I'm done. I've been actively looking for work out of nursing for 2 years and I've only been a nurse for 3! I'm going to massage school and have a part time job serving coffee at a book store. I love caring for people and I think some customer service is really called for in the hospital setting (more along the lines of the education we give and the time it takes for us to answer a call light), but I refuse to be 'nice nurse' when a patient really needs to do something for their health but doesn't because it's 'uncomfortable'. I won't let them do that. I get in trouble for doing the good thing for the patient and the wrong thing for the patient so I might as well make the patient do whats best for them and get b*t*ch*d at about it later.

[CBsMommy]

I've often wondered this too.

Why are some patients allowed to act the way they do? I'm all for "customer service" and will get people (even family members) something to drink, whatever. But when it comes to people who are in their right mind demanding different things and acting like grown babies, when do you say enough is enough?

I had a person who told me to fluff his pillow. He had full use of his hands so I asked him nicely if he could reach it. I don't see that as rude, I see that as helping him to be as independant as he can be. Same with the water glass that he asked me to hand to him that was two inches from his hand. And, guess what, he reached out and grabbed his own glass and took a long drink from it.

I understand that some people are just demanding because it's a way of controlling something. Maybe they don't have control of their bodies or their disease and this is just a way of controlling their environment. HOWEVER, doesn't this cross a psych line somewhere? When people overuse their coping strategies to a harmful degree? For a psych patient, wouldn't we be firm and set rules? Wouldn't we hold them to a behavior contract? Shouldn't the managers come in and set that for them?

[canoehead, BSN, RN]

Managers understand budget considerations. If you are able to argue that the patient's actions will result in an increased length of stay, or increased need for overtime, and low PG scores from patients in the same room, you may be talking their language. But managers like to be right too, so don't expect them to admit that you're making sense.