Now, if ALL places were run like this...tell me what you think!

Nurses General Nursing

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Specializes in med-surg, psych, ER, school nurse-CRNP.

Hey guys!!

I was reading a few threads on 'customer service' running amok, and wanted to share how things owrk at my current clinic. I swear, if all places would impart these rules/guidelines, the world of nursing would be so much better to work in.

First, I work in a general medicine clinic. My collaborating doc is well known for treating pain, but we are NOT a pain clinic. The patients get schooled on this at the first office visit, if not before. My OM, (the doc's daughter) is a gem, she is PHENOMENAL! She (well, all of us, really) has a zero-tolerance policy for bull, and once you're on her list, you're on it.

*We don't tolerate abuse. Period. If you come in and raise sand, you're out. Dismissed from the practice as a patient. If you have a friend or family member come in and raise sand for you, you're still out. If you bring a friend to your office visit, and that friend steals someone's wallet in the waiting room, you're still out. You brought them.

*We talk to each other. Actually had one lady tell me when I was new that the doc always gave her extra meds "in case she had a bad day". When I baked and said I'd have to verify that, she proceeded to tell me that our MA knew how to call them in, and no, he didn't write down the extra pills, just added them in when the script was called to the pharmacy. So, staff-splitting does NOT work.

*Behavior really does count. We have a 200-person strong waiting list to be a patient here. I databased it myself, from a tattered little book. Every time someone calls or comes by to ask where they are on the list, I can tell with a click of a mouse. People who come in and flip an attitude or demand to be seen immediately either get bumped to the bottom of the list, or taken off of it altogether. Posted a story relating to THAT on my other thread about things you'd love to tell patients. We even drew up a memo detailing the rules, that we hand out when someone comes by to add their name. For the ones that phone their order in, I call personally and explain the details.

* We keep records. Since we do prescribe controlled substances, if we hear or see that a patient has been arrested for DUI, selling, possession, or other offenses, we dismiss. If we get a call that someone is selling, we dismiss. If someone fails a drug screen, we dismiss. We have a closet full of dismissed charts, all carefully organized and databased (I love my computer) with names, reasons for dismissal, etc. You'd be amazed at what people will try to sneak back in. Different hair, different NAME, fit-throwing, wheedling, threats, etc. This souldn't be a surprise. All our patients are required to sign a behavior contract when they come to the clinic, that clearly states what comprises grounds for dismissal.

We have no doorknob leading from the lobby to the clinic proper. It was removed. We had people coming in without permission for 'sidewalk consults', demanding pain shots, and one lovely lady who proceeded to stand there, even though it was quite obvious that my OM was on the phone, shaking her pill bottle in her face and screaming, "WHERE are my %^&* refills?!?!?" Yep, bye-bye, sweetie!

We have a medication policy, as we call all prescriptions in. The meds are guaranteed by a certain time, period. No, you don't get an early call in without a darn good reason, and some people get REALLY creative. No problem, they get moved to the bottom of the pile. Every time they come back in (some of these people must LIVE at the pharmacy) wanting to know why they haven't gotten their meds yet, to the bottom they go. May sound mean, but they get the point after a while.

Point being, we just DO NOT reward bad behavior. There's no sense in it. Sure, we may lose a patient here and there that doesn't want to comply with the rules, but there are dozens ready to fill their spot in the chart rack. We're not outright mean, we just refuse to take abuse lying down.

So, my question...if it works for us, why on Earth can hospitals and other places make it work, too? Set policies and adhere to them, that's really all it is. Why is this phenomenon so difficult to replicate? They sure don't care to policy the staff to death, so I know it's not that. Why not go in the other direction?

I wish my ER would do this if just for the abuse of staff.

Seriously. I don't know why management and we put up with it. I don't care if you're sick. If you're A&O x 3 and you become abusive, your ass should be escorted off the property. Period.

Good for your practice. Do you work for a pain clinic?

Specializes in med-surg, psych, ER, school nurse-CRNP.

No, it's not a pain clinic. Doc does general medicine, he used to be a renowned pathologist, and he's well-known for treating pain. But he refuses to make the practice purely a pain clinic. He likes to treat everything, and nothing makes him happier than a complicated diagnosis he has to research.

No, it's not a pain clinic. Doc does general medicine, he used to be a renowned pathologist, and he's well-known for treating pain. But he refuses to make the practice purely a pain clinic. He likes to treat everything, and nothing makes him happier than a complicated diagnosis he has to research.

Awesome. I'm so sick of seeing patients show up at the ER who have a pain clinic doc as their primary MD.

I don't know why we're so conditioned to take abuse as nurses. And I'm tired of management conditioning patients with all their "customer service initiatives" to think it's okay to be abusive.

I joke that I don't feel like I've truly worked a shift until I've been threatened or called a ****, mostly from someone expecting something entirely unreasonable. It's just not acceptable.

Specializes in geriatrics, IV, Nurse management.

Threatened or physical abuse seems to be a day by day thing now. Isn't it funny since there is a no tolerance for elder/patient abuse (not that I want to abuse anyone), yet if anyone in the intra personal team gets abused, just carry on because they're a paying customer.

I joke that I don't feel like I've truly worked a shift until I've been threatened or called a ****, mostly from someone expecting something entirely unreasonable. It's just not acceptable.

I agreed. Completely unacceptable.

Specializes in ED, ICU, Education.

That's awesome. You're very lucky. ;) I hope that one day soon, all medical facilities will work as effeciently and as fairly as yours.

Threatened or physical abuse seems to be a day by day thing now. Isn't it funny since there is a no tolerance for elder/patient abuse (not that I want to abuse anyone), yet if anyone in the intra personal team gets abused, just carry on because they're a paying customer.

I agreed. Completely unacceptable.[/quote

Patient-care is now being shifted to "customer-care" attitude. Funny how the monetary connotation comes in now that healthcare is treated more like a business and money-making venture. Scary.

I wish my ER would do this if just for the abuse of staff.

Seriously. I don't know why management and we put up with it. I don't care if you're sick. If you're A&O x 3 and you become abusive, your ass should be escorted off the property. Period.

Good for your practice. Do you work for a pain clinic?

Ill tell you why management puts up with it..... I would LOVE to know what percentage of these nurse / staff abusers are on some form of social welfare/handouts. The payer in all of this is in fact NOT THEM, its the Federal Government (you know..... YOUR taxes). If the Federal Gov is the one cutting the check for the care, the management has to deal with the middleman (the difficult patient) to get the check. This is why you have this crap with the press ganey surveys etc. Management will do ANYTHING for that government money. BANK ON IT.

I would be scared to do anything out of line in this clinic, wouldn't wanna get "dismissed", LOL.

Must be an amazing doctor (or a super under-served area) if patients are coming in practically begging to be seen. I am not sure where you live, but in NYC, patients seem to enjoy "doc shopping", instead of sticking to one clinic for a long time. Then again, there are countless physician practices on every corner it seems.

In theory your policies and practices sound great, but I can only imagine how difficult it would be in practice. I know it's never good etiquette to call in asking for a refill in the last hour of the day, but sometimes after a busy day, I go to take my allergy meds, only to realize all the recent stress has made me forgot to call for a refill. Good thing the RN who works at my doctor's office is incredibly sweet and understanding of unforeseen circumstances, and is always willing to work with the patient with an air of compassion. I would be scared of doing that in your practice, living with the fear of being "put to the bottom of the pile" or even worse..."dismissed".

But in theory, sounds like an ideal set up, and a good way to keep away the rif-raf.

I would be scared to do anything out of line in this clinic, wouldn't wanna get "dismissed", LOL.

Must be an amazing doctor (or a super under-served area) if patients are coming in practically begging to be seen. I am not sure where you live, but in NYC, patients seem to enjoy "doc shopping", instead of sticking to one clinic for a long time. Then again, there are countless physician practices on every corner it seems.

In theory your policies and practices sound great, but I can only imagine how difficult it would be in practice. I know it's never good etiquette to call in asking for a refill in the last hour of the day, but sometimes after a busy day, I go to take my allergy meds, only to realize all the recent stress has made me forgot to call for a refill. Good thing the RN who works at my doctor's office is incredibly sweet and understanding of unforeseen circumstances, and is always willing to work with the patient with an air of compassion. I would be scared of doing that in your practice, living with the fear of being "put to the bottom of the pile" or even worse..."dismissed".

But in theory, sounds like an ideal set up, and a good way to keep away the rif-raf.

I think her dismissals were because of pain med seekers.... not oops I need my allergy meds... if i'm not mistaken...

Specializes in Cardiac Telemetry, Emergency, SAFE.

OP..

...did you say your clinic was hiring? :D

That really sounds great. I wish more places would be able to do things like that.

Specializes in Psychiatry.

Administrative nonsense in hospitals, such as referring to patients as "customers" fuels the fire for their bad behavior and sense of entitlement.

I got out of the hospital and now work home hospice. I love it.

If someone gets out of control and abusive at a BAR they get booted. If they behave like this at a hospital, it's ok. And often, we as RNs, are the ones having to apologize for them because their food is cold...

What a complete lack of respect in our profession. It makes me really sad.

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