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. . . .

[greenfiremajick]

Hate to say it, but when the government dictates how to raise your kids, (or your healthcare for that matter, but that's another rant), whether you're allowed to swat them on the butt when they're being disrespectful towards you or another adult, is at the root of a lot of it.

People are too scared to do a proper job of raising their children and once these kids get through the years of excuses and being let off the hook, or receiving counseling, they suddenly turn 17 or 18 and are thrown in jail, absolutely amazed they're being taken to such a place (which of course, all good tax paying citizens get to pay for, as well). There's an RN in Tucson that was raped in the middle of 2 boys robbing her (aged 16 and 17as she left work). They get to go to the minor's unit at the corrections facility and they will see very little jail time and be allowed to have it removed from their records, once they make it to adulthood. Can you imagine the fear, horror, and just plain embarrassment of being robbed and then raped by 2 violent kids???

And society's dependence upon social programs?? All the welfare moms out there, purposely breeding more, to suck off the teat of the governmental handouts, makes me sick....sick, angry, and sad. I understand some need help, but when the number of average working citizens is far outnumbered by greedy, selfish people that refuse to work?? (Yes, I understand that in today's current economic situations, the government and the economy has made it to where really is no choice for many.....But when the people of a government rely on that government for a majority of their goods, services, etc---when they are not allowed or expected, to be responsible for their own lives and are also required to fall in line like good little sheep, there's no future in it, unless something drastic happens).

Instant gratification and self entitlement is a twisted, greedy, and evil thing. Anyway, I'm getting revved up for a long speech on the soapbox, so I'll step down now. This is all just my opinion, of course.

Chin up said:

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?

[martymoose, BSN, RN]

As wierd as this comment may be- we need another Noah's Ark- the world has gone to Hades. People are evil. not all, but a large percentage.There is no repect anymore. The mgmt only encourages this horse bleep. Which gets around to others that it's ok to be violent and rude. I bet if the op had called police to report assault- i Guarantee that she would be canned- how DARE we accuse our CUSTOMER of such a thing. Why this crap is allowed in nursing makes no sense'

I feel the frustration OP. Mgmt KNOWS how desparate we are to even HAVE a job in this current society. They are just as abusive to us as much as the rude patients. All this patient satisfaction stuff can take a flying leap. These "customers" aren't stupid- they KNOW they will get THEIR way. welcome to burgerking.

[GHGoonette, BSN, RN]

A while back we had a "repeat offender" in PACU. Not rude, just one of those characters who come to hospital and look for things to complain about. This one had already caused two RNs to be disciplined for being "rude" and "not caring". Now, we are very conscious of our duty to our patients, and also very understanding of the confusion and disorientation that they experience post-op.

She was received and roused by my colleague, and when I noticed that my colleague was trying to make her comfortable, I went over to assist. This patient then accused me of not having explained anything to her pre-op, and that I was "not a caring person." Realizing that this was the same person who had caused problems for the previously-mentioned RNs, we immediately called the UM to take over, informing her that under no circumstances were we going to be responsible for a patient who was going to do her best to have us disciplined, regardless of the quality care we gave her.

[Mrs. SnowStormRN, RN]

Imagine my dilemma, us mental health nurses have been getting abused for years, BUT its not unusual to call the cops in my field - which I am grateful for.

[kcmylorn]

This is why we need socialized medicine, regional medicine or national medicine - what ever one wants to label it. If we take the competition out of the Hospital PTB/CEO/ MBA/MONEY MONGERS/BEAN counters hands- "the nauseating cheerleader"we are the best, come to my hospital instead of the one down the street", this crap would cease and desist. People would go to the nearest provider, hospital to their residence or don't go at all. the healthcare professionals would be able to focus on their jobs- healthcare, not selling themselves like a bunch of hookers on the street corner.Which is what we have going on now in our hospitals. Thank You MR CEO. I've said it before, I'll say it again- WE are not Macy's or Walmart and don't ask "Did you find everything alright?" @ the checkout line. Let the CEO come down from his mega millions ivory tower, bend over and take it: and turn the other cheek. Hand him/her the shift report, the out of control patient and the stethascope and say here buddy it's all yours.

And another reason why this heathcare reform( change to a preventative model form an acute model) is going to be very interesting. I am now in a clinic after 30 years of hospital bedside- the level of stupidity and "me want it my way" is unbelievable. This is going to be a tremendous and rocky learning curve for the American public. Stupid is now a fashion statement. We have patients who have pain medication for the right leg and want pain medication for the left.! Nursing has to tell them the same pill for the right works for the left. That's stupid!!

[okchug]

Everyone knows everything! Used to, if the nurse said "do it" you did it! People trusted and respected nurses.....now they treat ya like an idiot or a slave.

I'm all for pt rights & the ability to refuse treatment. BUT if you don't want to take any meds OR do the therapy OR the IS, breathing, walking etc.....then go home and let the internet take care of you. BUT you'll be back with complications & then you'll blame me anyway- can't win.

either we're bullies by pushing people to do what they need to do OR we get bad outcomes because we let the surveys get in the way! don't people (management & patients) realize that the ultimate customer service is a healthy outcome!!!

& trying to give personalized service to 8 "total care" patients.....impossible

[lalalalexi]

What really gets me is how we as nurses are often held accountable for EVERYTHING. Any bad experience or complaint is a nurses fault. My manager leaves press ganeys out for us to read sometimes, and tells us "Be sure to read them. They can help us improve as a floor and see where our weaknesses are". So I go through them. Some of them are complementary, but a lot of them contain what I consider to be trivial complaints (that apparently also seem to ruin their whole hospital stay), or are things that nurses are not responsible for/can't do anything about.

Some of them had vague comments with no basis, like "The nurses all seemed like complete idiots". Or "the nurses had no idea what was going on". That isnt very helpful, IMO. Give us some examples.

And far and away the most complaints are about the food. Like I can do anything about the food...We get a lot of bowel surgeries on our floor and we hear all the time "they didn't let me eat for THREE days!". Well yes, that's the way it works when you have your bowel operated on.

Other complaints "They made we walk a few hours after I just had surgery", "they had to put a tube down my nose and it was AWFUL!" So you want to keep throwing up a liter an hour because you're obstructed? "They woke me up all night" "My room wasn't cleaned one day". And a really great one "I didn't get any extra amenities. I saw other patients had combs, lotion, mouthwash etc and I NEVER got any. This made me very angry". Uh, last I checked all you had to do was ask for those things!

And the question that asks about the skill of the nurse caring for them, most of the time the people comment about IVs. "They had to poke me TWICE to get an IV started". Or "they poked me every morning to draw blood." Or "my IV pump kept beeping". I think it's funny how when asked about technical skills of the nurse all they think about are IVs. Like that's the only technical thing we do. And like I can change the fact that you have small veins, or that the doctor ordered labs for you (because they are actually important) or that your IV pump beeps when the bag is out.

Management is always about Press Ganeys or HCAHPs and how can we improve them. Well after reading the survey results, I usually have no good ideas. After reading this last batch I'm like, so in order to get a good Press Ganey we should basically let the patient do whatever they want...let them eat whenever, avoid any procedure that might be uncomfortable or painful, avoid waking them up during the night and above all else "not be an idiot". Great.

[PACURN1818]

It is SO nice to see that I am not the only one struggling over this. I love the Press ganeys that say things like, "my roommate puked all night" or The nurse wouldnt go down to the lobby and get me a sandwich from McDonalds" Really?!

Its just killer how YOU are somehow responsible for all this crap. I give good care. My fellow nurses do as well, but the comments you see have nothing to do with care, they are basically about how they did not get to do whatever they wanted, or how they didnt like what the MD ordered, and then blame the nurse.

We chart by exception at my facility, but I have stopped doing that and started writing every time I get the vibe that Mr Smith is angry his pillow is plastic to cover myself and illustrate the patients ridiculousness. Sometimes that helps when my manager pulls and reviews the charts.

It is crazy and maddening, makes me want out of nursing, you cant do your job, you cant convince people to do their stuff, and you cant say anything back when getting abused.

Comfort in others experiencing the same thing.

[rngolfer53]

CBsMommy said:

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?

Emphasis added.

I think we do harm as providers when we allow patients/families to regress unchallenged to childhood.

Where is the dignity in acting like a toddler?

Yes, people are stressed (though the level of stress in our society is ludicrously small compared to previous generations and other places in today's world) but that does not give them license to forget they're adults.

It may be ok to let an adult in a department store act like a child, because the mission of the store doesn't include providing healing.

In health care, and especially in nursing, we are supposed to be addressing the entire person. That may not be compatible with "customer service" on the retail store level. Actual "customer service" will include tough love on occasion. That may be the doctor mincing no words when it comes to telling a Pt to stop smoking or lose weight. (I think more docs should drop patients who are chronically non-compliant with such things, but that's a discussion for another day.) A nurse insisting that a post-op follow the evidence-supported activities is good customer service. Yes we have to make sure there is no real reason, such as pain, that accounts for the Pt's reluctance. But once those are ruled out, then it's time to be firm, and insistent to the necessary degree.

I believe it's our responsibility as a profession to make noise until this is recognized in practice as well as theory.

As much as any group, managers are lemmings and typically follow the latest buzz words generated by consultants, who have their own lemmings-in-chief. Following the herd lessens your chances of getting eaten. We all have the same self-preservation tendencies.

The customer service fad will pass in time..... likely to be replaced by something equally goofy. Isn't it good to be an optimist?

[blueheaven]

At nurseconnect.com there is an excellent article called "Is it the nurse's job to keep patients happy"

We do a survey that is like PG and some of the things written are RIDICULOUS!! Many things that OPs have written about and more. One that really gets me is, "I couldn't rest because the alarms were always going off and the nurses kept coming in the room and waking me up. (note they didn't mention the 400 or so fellows, residents, sub Is, attendings etc etc) Ummm, you were in an ICU and you had 5 different specialties taking care of you and you were very close to pushing up daisies. And they complain about the alarms, the food and the nurses!

The script that is coming down the line at my facility includes "Is there anything else I can do for you? I have the time." I will give my best put-on smile and run to get a ginger ale while my other patient on 3 pressors etc is trying to crump...NOT.

[blueheaven]

Also, I have told a few A and O patients who were nasty and combative that I had absolutely no problem filing a police report and pressing charges on them. A cop would be waiting on them on D/C. (I would too!) I'm not a punching bag. Confused or mental issues is a different story.

[Ruby Vee, BSN]

okchug said:

Everyone knows everything! Used to, if the nurse said "Do it" you did it! People trusted and respected nurses.....Now they treat ya like an idiot or a slave.
I'm all for pt rights & the ability to refuse treatment. But if you don't want to take any meds or do the therapy or the is, breathing, walking etc.....Then go home and let the internet take care of you. But you'll be back with complications & then you'll blame me anyway- can't win.

Either we're bullies by pushing people to do what they need to do or we get bad outcomes because we let the surveys get in the way! Don't people (management & patients) realize that the ultimate customer service is a healthy outcome!!!

& trying to give personalized service to 8 "Total care" patients.....Impossible

I love that line: "The ultimate customer service is a healthy outcome"! may I use it?