Customer Service? Maybe on your home planet.

[Art_Vandelay]

I usually have a high tolerance for rudeness and inappropriate behavior, but yesterday I reached my limit. This patient is always verbally abusive toward staff, speaking with an acid tongue and tone. He claims that the nurses write down the wrong time in the narc book. "No, she didn't give it to me at that time. Your clocks are all wrong; none of them say the same time."

The man has nothing nice to say, regardless of the issue.

Yesterday, I finally grew tired of apologizing for something I didn't do, and called him on his behavior, stating, "You are being rude. Do not speak to me that way."

He retorts, "I just give what I get. You nurses are always rude to me."

I reply, "I am never rude to you. In fact, I hardly say anything to you because you have nothing nice to say in return."

He says, "You were rude to me just now." "If I sense a sarcastic tone, I will be sarcastic right back."

I say, "I was not sarcastic toward you, and I do not deserve to be spoken to the way that you speak to people."

It turns into a bit of back and forth, and then I realize, what is the point? In no way do I want to be having an argument with this man, but I am tired of being treated like ****. Some people, sick or not, are just jerks. If I weren't in the professional atmosphere, I would have told this guy off. No joke. I have been around enough people that are verbally abusive to be able to put them in their place. However, I somehow do not defend myself in the professional atmosphere for fear of repercussions from management.

Now, I have never been written up nor do I want to be, but it was at the point with this patient that I was thinking, Oh well, if I get written up for refusing to be treated poorly, so be it. Then I realize, this guy was probably raised without any manners to begin with, and my "educating" him now is not going to change anything.

Funny thing is, later he winked and smiled at me. What the heck was that? Now he was being nicer to me? He still had the same verbally demanding and demeaning tone when asking for pain meds though from his PO med nurse.

Anyhow, I still haven't reached a "happy medium" when it comes to dealing with this issue. I know there has been ongoing debate on AN regarding the "customer service" attitude. Funny, the first thing this patient said when I refused to tolerate the behavior was, "The customer is always right." Wrong.

[eriksoln, BSN, RN]

This is not irony. One would expect someone that had a long history of working with the public to be able to resolve a conflict. Furthermore, one would expect a new grad to encounter difficultly in handling new patients and families. However, it would be ironic if a new grad with no customer relations experience was able to diffuse a situation easily.

The irony is this: some patients have a sense of entitlement, and act accordingly.

Restaurants have a unique way of dealing with "entitlement". Ever watch the movie "Waiting"?

[tyloo]

Now that we are on the customer service kick maybe we could put a tip jar on the nurse's station?

[sharkdiver]

Rule #1: Never argue with an idiot - they'll just drag you down to their level and beat you with experience.

Rule #2: When something a patient says makes you want to react verbally, see rule #1.

[eriksoln, BSN, RN]

Now that we are on the customer service kick maybe we could put a tip jar on the nurse's station?

We actually do already have a "tipping" system in place TBH. In the public's eyes anyway. If things are good, PG scores go up, if not........they go down.

To me, that is like telling the restaurant: You can't charge for the dinner you serve unless the service is Five Star.

Now, in "RL Customer Service", you still pay, minus any tip to the server, and you have the option of not going back or informing the manager. What restaurant would stay open and tolerate the system we are under? "Oh deary, my iced tea had too much ice in it, soooo..........the whole dinner should be free."

[nursel56]

This is what nurses that have never worked in another profession don't realize.

In EVERY profession where customer service is promoted, it doesn't matter how nasty, saracastic, etc., a "customer" is, you are expected to keep your cool and remain polite and courteous.

I don't think we live in a vacuum. Most of us have had jobs in other professions at some point, or we live with someone who does, and the rules for handling difficult people really are not rocket science. If all it took was working in another profession to impart people skills, why are so many people in those other professions rude, snippy and clueless? I reject the false dichotomy! In fact, I would venture to say that we are oversaturated with this crap day and night with all the Oprahs, Dr Phils, books, stuff our kids bring home from school etc etc etc until you want to scream. Is there any large institution today that has not had a seminar, inservice or the like on this topic?

What has changed is (from my vantage point) is that people used to accept a nurse's words as having some level of authority and now they don't. Consumers have now got the idea that whatever makes them comfortable in the short-term is what the healthcare team needs to deliver. I know it is better for people to "own" their choices and strive toward autonomy, etc, but when they interact with people who have specialized knowledge what feels good in the moment may be at odds with what will make sure they still feel good in 2 weeks.

If management and nursing staff could get on the same page regarding these issues it would help a lot. I can't stand to read how a nurse manager has undermined a nurse when the nurse advocates for best practice and the patient advocates for what will make him happy in the near term -- let's say over the common problem of a diabetes or renal patient not wanting to comply with diet and fluid restrictions.

However, for some reasons, nurses don't think that they owe it to the patients that are rude, to try to turn the situation around, then wonder why they get into trouble with management. It doesn't matter, if you don't need a job...but this isn't going away folks, regardless of what realm of healthcare you choose to work in.

I don't owe anything to a patient who is rude other than that I continue to treat him no differently than the patient who isn't rude. Most nurses in fact do try to turn the situation around, not because they owe it, but because they genuinely want that person to get better regardless of their cranky, obnoxious nature. I don't think for a second that we as a group are so shallow that we can't see past that behavior and focus on the optimum outcome for them. Many times these people have family members that should be considered for sainthood, which often is reason enough to keep giving, giving and giving.

It's kind of ironic as someone else mentioned - that so many times it's a pointed, or humorous or even a bit gruff comment that the most difficult patient responds to. Sometimes they laugh at the absurdity of it all, and a lot of tension is defused. This requires that an employer actually trust their nurses have enough going on upstairs to determine what approach will work best, though, and not some corporate cookbook answer.

[MyUserName,RN]

I worked in customer service for 8 years prior to going to nursing school. I do think that experience has taught me how to handle difficult people. I worked as a tech through nursing school and have found myself using the same skills with talking to patients that I used in my other jobs. There is a professional way to call someone out who is being unnecesarily rude to you and it's not inappropriate to do so. You don't have to get into a boxing match with them but just by simply saying "Excuse me sir/mam, I am here to help you today and want to give you the best care possible, but I do not appreciate being treated this way. We can either work together or against each other, it's your choice" Something like that. I have also just simply said "Why are you being rude?" and it worked. It shocks them to call them out. Or if they are cursing at you "Sir, I do not appreciate you talking to me that way, now if you can talk to me nicely I will help you with what you need....." Many times pointing out their behavior does help. Other times, it's useless, but atleast you tried. I did the same thing when I worked customer service in the bank. If somebody came in yelling at me because they overdrew their account or whatever, I would calm them down this way and it almost always worked. Many times they would apologize before they left.

I am against the belief that a customer service attitude shouldn't be incorporated into nursing. It's not necessarily about "customer service" but just treating people professionally, with respect and just being nice. That's all customer service really is anyways and this is how we should be treating everyone, patient, customer, or friend! I've seen how some nurses and other healthcare workers talk to pts and sometimes I wonder if they have lived under a rock their whole lives because they really don't know how to deal with people. If you are abrupt and unfriendly to your patients they are probably gonna get rude back and not like you/or complain about you. It's not that hard to be nice. Some people are rude no matter how nice you are, but we're not gonna change that.

Edit:

I have also been a patient on the other side who had dealt with a very unfriendly nurse who was abrupt, didn't want to answer questions, talked down to me and my family, and was just rude for no reason. Anytime we simply asked a question she acted like it was an inconvenience to her to answer. We were inconveniencing her simply by being there. I have also been in rooms with pts along side other nurses who were completely disrespectful to the patients who didn't deserve it. It goes both ways.

[Poi Dog]

I was once so stress out with a foul mouthed SOB that I told him he could go do something to himself (along with a finger gesture).

I have my limits too and I get stress out and ****** off too -

If my manager herself is going to use profanity with the bedside staff, then I sure well do it too when i have satanic pateints making my life terrible.

Whats sauce for the goose is sauce for the gander

You rock!

[BabyLady, BSN, RN]

Well, I'll give you an example of what I see.

You have a parent that comes in and has some questions on their baby. That is our entire job, is to answer questions. Parents (smart ones) at least attempt to do some research and it is inevitable that they may get conflicting informatino. I have no problem explaining to parents what they read vs what WE do and why...I am always respectful.

Here is what I see a few more senior nurses do. The parent starts asking questions, the nurse answers them, the parent asks more questions and when the patient may have a different opinion, here is what will almost always lead to an altercation:

"I have been a nurse for ____ number of years and I have been working here for ___ number of years. I have taken care of ____ number of babies with this condition and I happen to know that ".

I have never seen that particular flow of conversation...come out good.

[melsman1904]

I've only been a nurse for a little over 2 years, so my experiences are somewhat limited. However, most (in the neighborhood of 95%) of the rude pt behavior I've experienced has been over things out of my control. Examples are giving pain meds early and allowing food items not on the prescribed diet. The other 5% have been a mixed bag of things. A lot of folks don't want to do PT after ortho sx and that can get heated. Explaining the benefits of ambulation over bedrest falls on deaf ears for some of those pts. More to the point, healthcare and customer service seem to be much like oil and water. They just don't work well together. In healthcare, the customer is not always right. In fact, much of what we do daily as part of our jobs is exactly opposite of what the "customer" views as best practice. For instance, non-compliant diabetics may see a candy bar as appropriate and so they insist that they should receive such foods. We all know, though, that will only hinder a positive outcome. Also, to compare healthcare to any other occupation where dealing with the public is a central component is illogical. What other industry would provide services regardless of a "customer's" ability to pay and still tolerate rude behavior?

[MyUserName,RN]

Also, to compare healthcare to any other occupation where dealing with the public is a central component is illogical. What other industry would provide services regardless of a "customer's" ability to pay and still tolerate rude behavior?

Not illogical at all. Handling people professionally whether as a customer or as a patient requires the same kind of "people skills" and professional way of talking with people. Whether you want to tolerate it or not, you have to. It's your job. When I worked in customer service at the bank, it didn't matter if a customer came in being rude for no reason, I still had to provide a service to that person and handle them professionally. Now working in healthcare, whether a pt is rude or not, I still have to provide care for that person and handle them professionally. In both jobs, if I lashed back at the patient or (customer in my other job) because they were "rude" I would probably be written up or fired, understandably so.

[melsman1904]

Not illogical at all. Handling people professionally whether as a customer or as a patient requires the same kind of "people skills" and professional way of talking with people. Whether you want to tolerate it or not, you have to. It's your job. When I worked in customer service at the bank, it didn't matter if a customer came in being rude for no reason, I still had to provide a service to that person and handle them professionally. Now working in healthcare, whether a pt is rude or not, I still have to provide care for that person and handle them professionally. In both jobs, if I lashed back at the patient or (customer in my other job) because they were "rude" I would probably be written up or fired, understandably so.

Please understand that I'm not asserting that unprofessional behavior is acceptable, no matter the circumstances.

Now, let's look at this a little more in depth. We've all heard about patient rights and responsibilities, right? Well, a lot of attention is paid to pt. rights. But what about those responsibilities?

Here are some that I found HERE.

• Maintaining Healthy Habits
  
• Being Respectful to Providers
  
• Being Honest With Providers
  
• Complying with Treatment Plans
  
• Making Decisions Responsibly
  
• Meeting Financial Obligations
  
• Avoiding Putting Others at Risk
  

From the examples I gave in my previous post, most of these responsibilities are not being taken care of by the pt.

If we were talking about a bank and not a healthcare facility, the story would be much different. Let's take a look at a few of these.

-- Healthy habits-- Bounce a few checks and see how accommodating a bank will be with rudeness.

-- Respect toward employees-- Drop a few F bombs when your bank returns a check and see how far that gets you.

-- Honesty -- Give false information involving a banking transaction and you might just get hooked up on fraud charges

-- Comply with tx plan-- Miss a few mortgage payments and you may be living in your car...until it is repossessed because you chose not to pay the note on it as well.

--Responsible decisions-- See Healthy habits

--Financial Obligations -- See Tx plan

-- Avoid putting others at risk-- Threaten a teller with bodily harm if she doesn't do exactly what you want and see if you still have an account with that bank tomorrow.

[nursel56]

Well, I'll give you an example of what I see.

You have a parent that comes in and has some questions on their baby. That is our entire job, is to answer questions. Parents (smart ones) at least attempt to do some research and it is inevitable that they may get conflicting informatino. I have no problem explaining to parents what they read vs what WE do and why...I am always respectful.

Here is what I see a few more senior nurses do. The parent starts asking questions, the nurse answers them, the parent asks more questions and when the patient may have a different opinion, here is what will almost always lead to an altercation:

"I have been a nurse for ____ number of years and I have been working here for ___ number of years. I have taken care of ____ number of babies with this condition and I happen to know that ".

I have never seen that particular flow of conversation...come out good.

That is bad. It's also unfortunate in that a nurse with that many years of experience could be a reassuring resource to people if the nurse didn't put the parents off by becoming defensive like that. Even without the "customer service" name that is poor communication, so the addition of a typical customer service script would not make it customer service.

Maybe someone should explain that the new reality is that people who are anxious and fearful usually take it to google where they can have instant access to information that could be disturbing to them. I know some doctors will still say do not do that or you will very quickly drive yourself insane . . . human nature being what it is they most likely cut a bee-line to their computer anyway. Or maybe they start with their iphone while the doctor is still talking to them.

MyUsernameRN - now I feel horrible! A bank employee I was speaking with hung up on me! The people who will not get off the script no matter how much I wail and gnash my teeth about being in a hurry and wanting to cut to the chase ahhhhhhhh!!!