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

[Purple_Scrubs, BSN, RN]

JSlovex2 said:

I had a man ask me not long ago if we were going to come in and wake him up in the middle of the night. This was while the cna was getting his vital signs at about 8pm. I said, "Yes, actually we'll have to come in and get them later and you'll probably be sleeping, but we'll try to be quiet and do it quickly so you can go back to sleep. We've gotten good at working in the dark."

He says, "You people are the reason I hate the hospital" to which I quickly replied, "So, why'd you come in today?" I really meant, "If you hate the hospital so much, stay at home" but I said it in a way that could be interpreted as a genuine, "What brought you to the hospital today?"

He just stared at me. I feel your pain. I bite my tongue daily, but there are always those patients who push the envelope and make it nearly impossible to provide this "Excellent customer service." he practically told me he hated me and that he didn't want to be bothered. Then go home!!

Then, later on his brief needed changing. He wanted his wife to do it so I brought her a clean one. She complained about how it was too big and horrible quality and I told her it's all we have - they are meant to fit multiple sized patients, but if she wanted to bring her own, we would be happy to use them. The next day, she complained again to which I replied, "Like I was telling you, if you have some you prefer then we'll be happy to use them, but this is what we have here." she said, "Well, I have one in my purse, but then he won't have one when we get home." okay? So shut up. That's what I felt like saying.

Your story reminded me of one from my days on a cardiac step down/tele. We had a frequent flyer who was always raising ten kinds of heck about getting woken up. He made a similar remark to me one night about how we were constantly annoying him in the middle of the night. It pushed the wrong button with me and without thinking, I popped off with "Sorry, but I'm worried about keeping you alive not keeping you happy". As soon as it was out of my mouth I froze. He just looked at me with this shocked look on his face, then after a long uncomfortable pause he busted out laughing.

He was never exactly friendly after that, but he did seem to lay off a bit. Apparently he told his cardiologist about it, because the doc discussed it with the nurse on day shift, and let her know that he gave the patient a stern talking-to about respecting nurses and the reasons why we "bother" him all night. I loved that doc!

[canoehead, BSN, RN]

J Slovex- if the patient wants to refuse vital signs and monitoring get the doc on the phone so you get a witness. Same with AMA, get the form, sign here, bye,bye.

[OCNRN63, RN]

Chin up said:

Oh hell to the NO!

This has become one of my favorite expressions lately.

[OCNRN63, RN]

Purple_Scrubs said:

Your story reminded me of one from my days on a cardiac step down/tele. We had a frequent flyer who was always raising ten kinds of heck about getting woken up. He made a similar remark to me one night about how we were constantly annoying him in the middle of the night. It pushed the wrong button with me and without thinking, I popped off with "Sorry, but I'm worried about keeping you alive not keeping you happy". As soon as it was out of my mouth I froze. He just looked at me with this shocked look on his face, then after a long uncomfortable pause he busted out laughing.

He was never exactly friendly after that, but he did seem to lay off a bit. Apparently he told his cardiologist about it, because the doc discussed it with the nurse on day shift, and let her know that he gave the patient a stern talking-to about respecting nurses and the reasons why we "bother" him all night. I loved that doc!

That was a thing of beauty.

[kcmylorn]

This 'Customer service' crap has relieved the patients from being responsible for their own healthcare. It's a good way for management and the Bean counting CEO's to make sure the patient keeps getting readmitted and keeping the cash flowing into their greedy pockets. Come on socialized medicine!!

[stephva1008]

As a manager, I take the HCAPS results with a grain of salt. Working in child and adolescent psych, we have to set limits with the kids and give the patient and family a survey at the end. Everyone gets a negative comment posted about them at times, even myself. But if it's a consistent trend I notice from the comments, then I can address it with the staff. I have one nurse who is difficult to work with according to staff, has been for years, and, no surprise, she comes up negatively on the surveys every month as well. So it's "another piece of the puzzle" of performance, in my mind.

You can't fire someone in our organization based on HCAPS; that would be a freaky place to work if we could. I have to have a long history of documentation to fire an employee in most cases.

Overall, our scores are excellent, even though we have kids court ordered to us and have to set firm limits with the kids. Initially they hate the limits but by the end of the stay, they give us good marks because we are setting limits with care and explanation.

I don't hate the HCAPS and I think, in some cases, it can be good for the patient. How often have you been in a hospital when it is extremely noisy at night at the nurses station and can't sleep? Yes, you're in a hospital, you're a patient and it's not supposed to be like home. But you at least want folks to make an effort to be quiet at night, right? Obviously you need to enter the room to perform your job but do you need to hoot and hollar at the nurses station at 3 in the morning? If your scores are low in that area and it is disseminated to the staff to try and be a little quieter at night, then the patient benefits by getting a bit better quality of sleep (when you are not coming in to keep them alive and such).

With all the healthcare changes, and moving to "pay for performance," there is a lot of $ at stake. As much as we don't want to acknowledge it, healthcare is a business as well as a service. I think it can be used as a tool to improve patient care. I do not think it should be worshipped as a golden calf, which it sounds like, in many places, it is.

Sorry to hear it is driving everyone a little nutty. Even as a manager, it is taxing for us as we are held accountable by upper management. I'm sorry your managers are calling you out on stuff that is wrong or plain silly. They should look at the trends and not try and correct one staff whose patient or family is just unreasonable. That is wrong and I'm sorry they are doing that to you.

[MomRN0913]

I manage an LTACH. I know ALL about customer service. Especially since my CEO is not clinical and money money money based. He expects the utmost patient and family satisfaction while expecting a high patient ratio on critically ill patients. They don't go hand in hand. Oh yes, and my CEO hates me and I will probably be fired in the next week

Maybe I suck at my job because I don't believe in customer service at any costs. When my nurses are right, I stand up for them. When they are wrong, then I take corrective action, but if a family member or a patient is abusive and i know they are being unjust, I stand by my staff and explain to the patient or staff that that behavior isn't necessary. I had a family member curse out one of my best nurses. Literally curse her out. I went right up to him and said if he ever talks to one of my staff like that again, he will not be allowed back in and he could be free to take his mother with him. Well, good news was he did shut up after that one.

I don't let customer service interfere with the care of patients. I stand by what is clinically correct even if it doesn't make the patient happy.

Again, which is probably why my staff likes me, but the CEO doesn't;0

[Kooky Korky, BSN, RN]

On 4/16/2011 at 10:33 AM, martymoose said:

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.

It is allowed because nurses allow it. YOU can lead the way to unionizing. Banding together is the only way to stand up to this mess and the evil people who do this to us. Don't wait for someone else to lead. YOU must do it.