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Customer Service Model

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I am of the belief that no one goes into nursing because they believe it is the "easiest job in the world". Each nurse goes through so much to be in a place to care for others at their worst. And speaking of worst, is a customer care model complete with scripting something good for nurses?

Customer Service Model

I beg to differ. When nurses are forced to focus a large amount of time in their day to customer service "Thank you for letting me take care of you" models, can it dumb down nursing practice? Further, are we dumbing down our patients?

Think of it this way. If a model on your unit for continuity of care is that the same nurse have the same patient whenever possible, 2/3 of the "script" that a number of units are using as their customer service tool are well known to the patient in your care. You told them on the first, and perhaps the second day that you are "Nurse Jade" and that you will be taking care of them today. The nurse handing the patient off to you (at bedside, at 7am) introduces you (again) and makes some comment about how you generally rock, that you are an incredible nurse with mad skills. (again). That they will be "in good hands" (Uhm, providing for a theraputic relationship, the patient knows this). You write on the white board. The patient would like to get a little rest before breakfast, but lets discuss goals for the day. (then we all sing a verse of Kumbya, and you get a Press Gainey about how you sing off key).

In all seriousness, scripting out what a nurse is to say, what an off going nurse is to say, assumes that we all are in a place that we are inappropriate, don't have a clue how to communicate, and that all of our patients are clearly demented if they have no sense of who we are and what we are doing for them after caring for them over a period of time.

Even a short term patient can look at one like having 3 heads if we are enthusiastic cheerleaders attempting to convince them we give good care. We do that by showing, not by saying.

Nurses get into nursing due to a desire to help others. Even the most jaded and burnt out nurses on autopilot would not let someone suffer needlessly. With that being said "key words" and phrases that in the end have all to do with reimbursement as opposed to really caring about what a patient is feeling is a huge disconnect.

Further disconnecting is the questions that a patient receives on a survey after they are discharged. "Were the nurses nice to your visitors", in my opinion has not one thing to do with care that a patient receives. And if we are waking patients up to do bedside rounding and make appropriately scripted commentary, there goes the score on if the unit was "quiet".

I am all for patients advocating for their needs. I am all for nurses advocating for their patients. I am further all for patients being an active part of their healthcare process. However, how far away are we from a new nurse script reading for communication, becoming robots who can't anwer a patient's question or completing an assessment without a teleprompter dictating "customer service model" appropriate answers?

jadelpn, LPN, EMT-B

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23 Comment(s)

VivaLasViejas, ASN, RN

Specializes in LTC, assisted living, med-surg, psych. Has 20 years experience.

NAILED IT!!!

Thank you for so eloquently stating what needs to be said in healthcare settings everywhere. :up:

monkeybug

Specializes in Public Health, L&D, NICU. Has 15 years experience.

Thank you for stating what many of us feel! :up: I think it does dumb us, and them, down. Not to denigrate waitresses, but there is way, way more to what I do than waitressing, but that's exactly what all that makes me feel like. Especially after a higher-up told me that a family probably wouldn't even care if I killed someone as long as I was NICE, and that patients don't care if I'm smart. Well, I've always subscribed to the "here to save your butt, not kiss it" model, so all this stuff has been really hard for me to swallow.

Tina, RN

Specializes in Acute Care, CM, School Nursing. Has 20 years experience.

I think it "dumbs" everyone down: Us, patients, families, the whole facility. As mentioned in OP, how many times can a patient hear the same stupid script? It makes us all look like the geeky kid trying desperately to impress the popular kid. :no:

I think this is generally a product of privitized healthcare where profit margins trumph patient care. Here in Canada patient satisfaction is a foreign term, something I hear of only when I visit this forum. Public healthcare emphasizes family/patient-centered care which focuses on doing things that are in the best interest of the patient. Our job as healthcare providers is to return you back to optimal health so that you are able to intergrate back into society. I'm still shocked when I read that patients fill out customer service surverys after discharge, how bizarre.

A hospital is a hospital, not a hotel.

monkeybug

Specializes in Public Health, L&D, NICU. Has 15 years experience.

I think this is generally a product of privitized healthcare where profit margins trumph patient care. Here in Canada patient satisfaction is a foreign term, something I hear of only when I visit this forum. Public healthcare emphasizes family/patient-centered care which focuses on doing things that are in the best interest of the patient. Our job as healthcare providers is to return you back to optimal health so that you are able to intergrate back into society. I'm still shocked when I read that patients fill out customer service surverys after discharge, how bizarre.

A hospital is a hospital, not a hotel.

Oh, but don't let a nurse manager or admin in the US hear you say that! We're supposed to be better than a hotel. In fact, our reimbursement is going to be tied to patient satisfaction. If that's not a case of the inmates running the asylum, I don't know what is. If you are a non-compliant diabetic, good nursing care dictates that I not provide a slice of chocolate cake with an ice cream chaser, but patient satisfaction says I should. And now, we'll be dinged if the non-compliant diabetic goes home unhappy but alive. At least if they're dead they can't complain, I guess. It puts nurses in an impossible position.

AJJKRN

Specializes in Medical-Surgical/Float Pool/Stepdown. Has 6+ years experience.

Ode to the wonderfulness of being Magnet!!! (Magnet status is an awesome thing when done for the right reasons and in the right way)

We are doing this now where I work at and scripting came about as a way to improve our plummeting Press Ganey scores from the prior year. Management did not seem to see the correlation between staff working short all over the hospital while also being in an unprecedented high census for that year. Not to mention newly opened and disorganized overflow areas. :drowning:

Nope, no thank you for working our tails off and doing the best we could with what we had to work with...:whistling:

Apparently, scripting during nurse patient interaction is what's really going to boost our scores...instead of having enough staff consistently to meet Pt needs and better outcomes for health and safety. Who'd a thought! :banghead:

Edited by AJJKRN
weird inserts

applewhitern, BSN, RN

Specializes in ICU. Has 30 years experience.

Monkeybug, that once happened to me! He wasn't a diabetic, but was on a clear liquid diet. The family pitched a fit and went straight to the DON, trying to get me in trouble because I wouldn't give him what "they" wanted. (The actual patient was too sick to care.) Of course when the doctors round, and make those decisions, their mouths don't open.

No doubt there are extremes, no doubt the physical welbeing of the patient is the most important, and no doubt administators then to take things to the extreme, but one cannot deny that it takes money to run a facility and pay wages, one cannot deny positive experiences in any field help drive that income. Step on the other side of that equation, the meal was great so how it was delivered has no bearing, I fixed your car so customer service is really a mute point, you came here to buy gas so why would you expect me to be polite and thank you. While they are extreme and there is a big difference between the skills and education of nurse to a burger cook, the concept has some application. The emotional welbeing of a patient has been proven to have an affect on patients recoveries. While admin may be overboard, it is not entirely irrelevant. Given the pressures a nurse is under, some of these efforts, while burdensome, may fill in when a nurse is so preoccupied with the physical that the rest gets lost. Lynch me if you choose but my intent was not to dismiss but to give thought

I couldn't agree more! Thank you for expressing out loud what I've been screaming inside.

No doubt there are extremes, no doubt the physical welbeing of the patient is the most important, and no doubt administators then to take things to the extreme, but one cannot deny that it takes money to run a facility and pay wages, one cannot deny positive experiences in any field help drive that income. Step on the other side of that equation, the meal was great so how it was delivered has no bearing, I fixed your car so customer service is really a mute point, you came here to buy gas so why would you expect me to be polite and thank you. While they are extreme and there is a big difference between the skills and education of nurse to a burger cook, the concept has some application. The emotional welbeing of a patient has been proven to have an affect on patients recoveries. While admin may be overboard, it is not entirely irrelevant. Given the pressures a nurse is under, some of these efforts, while burdensome, may fill in when a nurse is so preoccupied with the physical that the rest gets lost. Lynch me if you choose but my intent was not to dismiss but to give thought

But this is all assuming that a nurse has not a clue how to be appropriate, focused and have dignity for a patient. It is also assumng that a patient would not have any idea that we are spouting off a scripted verse. A new graduate needs to learn how to communicate with a patient accordingly--we all did. But "Hi welcome to --insert fast food joint here--how can I help you?" Is ENTIRELY the same as "Hi I am leaving you in the capable hands of Nurse such and so. She has been a nurse for a really, really long time and her interests include......" Cross between a chain store and a personal ad......

I understand and agree sometimes it is taken to an extreme and crosses to "geeky" but often the "script" is implimented to instill or reinforce a mentality or phylosophy. If you review the posts many were challenging the concept of customer service not just the mechanics such as "scripting" The "I am here to save your butt not kiss it" is a mentality that like it or not runs counter to the business of healthcare today. I heard an advertisement for Rush in Chicago today talking about private rooms, state of the art facilities so nurses can monitor without waking, private nurses rooms for patient privacy and quiet. If a potential heard that mantra and save not kiss, which do you think would attract the most patients. Then there is this, the patient pays the bill, large bills, if you review the posts it is not hard to imagine how that manifests itself to the patients. the script is a reminder or reinforcer.

No doubt there are extremes, no doubt the physical welbeing of the patient is the most important, and no doubt administators then to take things to the extreme, but one cannot deny that it takes money to run a facility and pay wages, one cannot deny positive experiences in any field help drive that income. Step on the other side of that equation, the meal was great so how it was delivered has no bearing, I fixed your car so customer service is really a mute point, you came here to buy gas so why would you expect me to be polite and thank you. While they are extreme and there is a big difference between the skills and education of nurse to a burger cook, the concept has some application. The emotional welbeing of a patient has been proven to have an affect on patients recoveries. While admin may be overboard, it is not entirely irrelevant. Given the pressures a nurse is under, some of these efforts, while burdensome, may fill in when a nurse is so preoccupied with the physical that the rest gets lost. Lynch me if you choose but my intent was not to dismiss but to give thought

I really enjoyed this comment because I was thinking the same thing myself. Granted, I would much rather not have to be nice to people most days. I would rather just do my job without having to cater to the often disturbed or illogical "feelings" of the people around me. I would rather not have to put up with the ungrateful patient/family who cannot appreciate the fact that I am, for example, wiping poop off his butt while he acts like I don't deserve simple civility.

However, sometimes, I am grateful for the "script" or versions of it (that, interestingly enough, I learned from school rather than the hospital) because, without it, I very well might have lost it with some of my patients/family. And, let's face it, that really isn't going to help their outcome. Furthermore, unfortunately, while most of us don't need the script to say the right thing, there are some in our profession who actually do. Since we already act accordingly anyway, maybe we can not take it so personally (ie, "they think we're so stupid that we don't know what to say!") and just take it as constructive assistance for those who actually need it. C'mon, you can't tell me you haven't met a nurse who could use one or two lessons in basic manners and social interaction.

tiddles

Has 25 years experience.

All that nonsense just makes me want to vomit.

tokmom, BSN, RN

Specializes in Certified Med/Surg tele, and other stuff. Has 30 years experience.

Oh, but don't let a nurse manager or admin in the US hear you say that! We're supposed to be better than a hotel. In fact, our reimbursement is going to be tied to patient satisfaction. If that's not a case of the inmates running the asylum, I don't know what is. If you are a non-compliant diabetic, good nursing care dictates that I not provide a slice of chocolate cake with an ice cream chaser, but patient satisfaction says I should. And now, we'll be dinged if the non-compliant diabetic goes home unhappy but alive. At least if they're dead they can't complain, I guess. It puts nurses in an impossible position.

Amen..

We do courtesy calls within 24 hours after discharge. The calls are automated, but if there is an untoward comment, it goes to a manager or charge nurse who has to return the call. How do they know there is a disgruntled person? They have to carry a pager!

Well, I will be getting a disgruntled phone call this week. I'm the poor sucker that has to carry the pager AND I do discharges.

I d/c'd a pt last week, who was a very negative person and was difficult to discharge. As a courtesy, even though I was freaking swamped, I offered to fax in her script which I did and as I always do, gave her back the hardcopy. As you can imagine, my fax said it went through and when she got to the pharmacy, apparently it did not. She was so mad, she didn't even give them the hard copy and wait for them. Instead she went home without her meds and called us to complain.:banghead:

kalevra, BSN, RN

Specializes in ED, Telemetry,Hospice, ICU, Supervisor. Has 5 years experience.

It's not called "dumbing-down", sounds too harsh. Lets call it "streamlining" so everyone is one the same page here.

Its not called "cheerleading", it sounds too unprofessional. Instead lets call it "synergy".

This is what I think goes on in the mind of admin as they roar about "customer-service". I swear I think on of our big-wigs used to be a district manager for McDonalds.

Most customer service models involving such things as scripting, rounding logs are put in place by those that are not at the bedside. They have no concept of what the nurse at the bedside does. They have little to no respect for the nurse taking care of the patient. Administrations want the patient to have a perception of good care. Sadly perception and reality are not one and the same.

If only they would be as concerned with safe staffing ratios.

carolinapooh, BSN, RN

Has 10 years experience.

If we can figure out a way to show them that safe staffing ratios actually MAKE or SAVE them money (and strict logic says they do: better staffing = more time to pay attention to detail and must = lower HAI, fewer falls, fewer pressure/skin problems, etc, which all = less money the facility absorbs) they'll be on that in a second.

HEY - I GOT A MASTER'S THESIS IDEA OVER HERE FOR THE TAKING!! Should've kept my mouth shut!