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.

[Art_Vandelay]

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.

My thoughts exactly, it is not illogical. Perhaps the poster meant that it is implausible to expect to be treated in healthcare the same way one is treated in a restaurant or hotel? Oftentimes, in healthcare, the ideal answer is not what the patient wants to hear, nor does it please the patient.

However, I strongly disagree that nurses have to "tolerate it" because "it's [their] job." I am not a saint. Do not talk to me like a piece of trash because I will not give you your pain medication earlier than 4 hours. I would prefer not to overmedicate or kill you. I suppose most of my frustration comes in dealing with patients like this while at the same time caring for a patient who is having a serious COC. And it is definitely not in my job description to tolerate abusive behavior because "it's my job.".

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

No, but it is next on my Netflix list!

[MyUserName,RN]

My thoughts exactly, it is not illogical. Perhaps the poster meant that it is implausible to expect to be treated in healthcare the same way one is treated in a restaurant or hotel? Oftentimes, in healthcare, the ideal answer is not what the patient wants to hear, nor does it please the patient.

However, I strongly disagree that nurses have to "tolerate it" because "it's [their] job." I am not a saint. Do not talk to me like a piece of trash because I will not give you your pain medication earlier than 4 hours. I would prefer not to overmedicate or kill you. I suppose most of my frustration comes in dealing with patients like this while at the same time caring for a patient who is having a serious COC. And it is definitely not in my job description to tolerate abusive behavior because "it's my job.".

No, but it is next on my Netflix list!

When I say tolerate it, I mean it as, we still have to treat that patient, we can't just decide that we aren't going to treat them or give them care or we could lose our license. But I don't mean tolerate as in, you have to keep kissing their butts while they're being hateful, like I said before, I agree with calling people out on their behavior.

[MyUserName,RN]

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.

I agree with you on the patient responsibilities. But we can't control what they do. This doesn't really have a lot to do with rudeness though. We don't put up with pts attacking us or threatening bodily harm, that's usually when they get restraints, sedation, and a sitter right?? I wish I could have done that to some of my customers at the bank! lol!

[nursel56]

This post is one of my all time favorites underlining the point that sometimes going off script can break through outward appearances. Nobody in this thread ciriticized Josh1974. Primarily because he and old grumpy (thread title)had a track record. You wouldn't want to take this approach with someone you are assessing on their first visit to your domain.

Just wanted to share this cause it helped make a stressful day a little better. Im work in an ltc. been there a couple months now, still a newbie in the field. Ok, so much for background. I have this resident that is depressed and a super grump and can really be an a.. also. Today I went in to ask him his pain level before I got his 8p meds. By the way, he and I joke around a bit when hes in a good mood. He said he had some pain in his rt knee, and me being me said "Man, if I looked liked you, I'd be in pain too".

Well he got the biggest smile I have ever seen on his face, I mean ear to ear and maybe some more. He just said "buddy, thank you, I really needed that". When I came back with his meds he was still smiling and told me that I made him feel a lot better by just being one of the guys with him. Oh yeah, states been here all week too!

[justavolunteer]

I am 'justavolunteer' (on a pt. unit). Hospitals are big on the 'hospitals as hotel' concept these days, but there a few key differences that really matter in the comparison:

1. Hospitals will often put restrictions on your movements and/or your diet. Hotels will let you come & go as you

please. Hotels don't care what or how often you eat, as long as you don't get drunk & cause a disturbance.

For obvious reasons, diabetic pts. who come in with blood sugar through the roof can't have sugary snacks,

CHF patients are often on fluid restriction, etc.

2. Behavior that goes on in a hospital would get you tossed out of most other places. Patient families who scream

at the staff because they won't stop in the middle of a code blue & make them the center of the universe usually

get to hang around and keep on screaming. Imagine a whole family starting a ruckus in a hotel room or the front

lobby. They would likely be escorted off the premises & even arrested if they kept it up. Someone who actually

assaults hotel staff would definitely be arrested. Healthcare employees are often told this is just part of the job.

I have been complimented on my service by most patients and all of the staff. Unfortunately, I have also been called

nearly every name in the book by particularly nasty patients. Respect, in many cases, seems to have gone out of style.

[ShayRN]

justavolunteer, you hit the nail on the head. " Respect, in many cases, seems to have gone out of style." That is what it all boils down to, IMO, Respect.

[nurse0520]

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.

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.

However, I do blame the facilities for providing zero training of teaching nurses how to handle difficult patients. At the same time, nurses seem to forget that people that enter the hospital don't feel well....that is why they are there. They are not having their best moment. Fear, frustration about your own health condition brings out all sorts of behavior...yet nurses think that patients "owe" them something.

No patient owes me anything, nor do I expect it.

However, learning how to deal with difficult people is A SKILL...it is a people skill that has to be learned and fine tuned. I have had family members yell at me, curse at me, etc. However, I have always been able to turn it around.

In most customer service jobs you have the right to kick the person out for the kind of behavior they are giving you. In healthcare we do not have that right. We also have bosses who are only thinking of the almighty dollar and do not have the same stigma as say Walmart or Target and it is not publically known as well. By the way I have worked in retail, insurance and healthcare I have seen it from all different perspectives.

[RNAM1965]

I don't think that "customer service" in healthcare is a bad thing when it is applied appropriately.

I have worked in service industries before becoming a nurse, all very customer-service oriented--but never have I worked anywhere that is was okay for the "customer" to verbally abuse a worker. I think everything goes crazy when it is "customer always right"--no matter what.

I read about and hear a lot of resistance to "customer service" in healthcare from nurses on this forum and those I have worked with. But "customer service" (REALLY I hate that term) is the wrong term when applying to health care. Where I work, we are expected to round, speak to patients in a certain polite, professional way, use AIDET, etc and realize that patients and their families are sick, fearful, anxious, . But it is NOT expected that we cannot set limits with patients and/or families or have to tolerate abuse from them. But you should be expected to set limits in a certain way--to remain professional and not escalate a situation.

I hear nurses say things like "I guess because of customer service I have to let Granny have a burger if her family insists on it, even though it isn't allowed on a restricted diet, or I'll get fired" or "I guess I'll have to let my critical patient die because I have to get ice cream for my demanding patient, or I'll get fired because of this customer service".. I mean REALLY, I have NEVER seen anything happen like this. Are people misinterpretating the intent of "customer service"? It's not to let patients and their families do whatever they want, but rather a heightened focus on meeting patient's needs for communication, acknowledgement, and to have a voice in their plan. That is what most patients want. ANd it is our job to set limits when necessary, limit visitors when appropriate, etc. if that is what is best for the individual patient and their situation at that time.

And it is our responsiblity to explain to patients the rationales behind the actions.

I cannot imagine that the nurse who posted this situation would be disciplined. I'm afraid the "customer service" focus is being distorted and is making nurses fearful of doing what they need to do for the patient. It is good "customer service" to professionally and firmly get a patient moving after surgery by insisting on ambulation, even if it doesn't make the patient really happy at that time. You just have to be able to explain why it is necessary and acknowledge the patient's frustration, but be firm in sticking to the plan of care. It is bad "customer service" to let a patient lie and develop pneumonia for fear of offfending the patient. You must follow standards of care, or document why the activities that are minimum standard of care are not being carried out--because that is the legal and professional obligation of the nurse.

If patient is being verbally abusive you say to them "I'm trying to do my job and take care of you, but when you yell and curse at me it prevents me from taking care of you properly. I'm not cursing at you and I need for you to treat me with the same respect. If you continue to yell/curse, etc. I will leave the room and will only return if you agree to not yell at me while I'm trying to do my job." or something like that. It's all in how you do it.

[mstutz0201]

Since this guy always comes across as rude and demanding when asking for pain meds, my first question is: Is his pain being managed correctly? My husband suffered from severe chronic back pain for more than 12 years. It wasn't until we found a doctor who correctly managed his pain issues that I finally saw the lovely man I had married re-emerge. If this guy hasn't had a consultation with a Board Certified pain management specialist, it is about time he got one. Not until you are sure that his pain is being managed correctly can you assume that he is just a rude, ill-mannered person. Right now he may be giving you a clear indication that he needs your help.

[Art_Vandelay]

...

I cannot imagine that the nurse who posted this situation would be disciplined. I'm afraid the "customer service" focus is being distorted and is making nurses fearful of doing what they need to do for the patient.

...

I wish to correct the verbally abusive treatment, but when presented with a patient like this, I respond inarticulately. I fear being viewed as mean, inappropriate, etc., and of being reported. If I don't watch my words, I will be on a direct path to unemployment.

Since this guy always comes across as rude and demanding when asking for pain meds, my first question is: Is his pain being managed correctly? ...If this guy hasn't had a consultation with a Board Certified pain management specialist, it is about time he got one. Not until you are sure that his pain is being managed correctly can you assume that he is just a rude, ill-mannered person. Right now he may be giving you a clear indication that he needs your help.

Pain is what the patient says it is. This patient was taking long acting morphine, dilaudid q 4, and another narc q 4. That being said, the environment was not a hospital environment. Furthermore, this patient was by no means shy, alert and oriented, and able to address these needs with the doctor. I work nights, and if had I called his doctor in the middle of the night for this, when he already had these pain meds, there was NO way this particular doc would given me an order for anything else. This patient may very well have developed a tolerance, but my hands were truly tied. I did not assume anything. He was rude to me. I did not specify the reasons why he was rude, just that he was rude.

[kbrn2002, ADN, RN]

I wish to correct the verbally abusive treatment, but when presented with a patient like this, I respond inarticulately. I fear being viewed as mean, inappropriate, etc., and of being reported. If I don't watch my words, I will be on a direct path to unemployment.

Pain is what the patient says it is. This patient was taking long acting morphine, dilaudid q 4, and another narc q 4. That being said, the environment was not a hospital environment. Furthermore, this patient was by no means shy, alert and oriented, and able to address these needs with the doctor. I work nights, and if had I called his doctor in the middle of the night for this, when he already had these pain meds, there was NO way this particular doc would given me an order for anything else. This patient may very well have developed a tolerance, but my hands were truly tied. I did not assume anything. He was rude to me. I did not specify the reasons why he was rude, just that he was rude.

Yeah, I feel your pain on this one. I work nights also and I know that no on-call MD is going to write an order for anything else when there are already multiple pain management orders in place. Not to mention if I could actually find a doctor that would order another narc, or an additional dose, or pharmacy won't fill the script from back-up without a written prescription being faxed to them....try getting the doc to find a fax machine at 0300 and send that script out right away! BTW, I do work in a SNF so we don't have the luxury of on site MD's or pharmacies. My method for dealing with the rudeness may not be the best, but it's all I have without saying something that will get me fired. I just say "I will do what I can" and walk out.

[billyboblewis]

When someone getting narcotics starts making that kind of complaint just take another staff member with you when giving him a dose and this will shut him up quick,,,ie a witness