I feel like I am working at Walmart...The customer is always right!

[nlhnurse1982]

I am just wondering how your facility responds when there is a conflict with a patient or their family especially when they are wrong. Will they back you up or will they kiss butt and appease them. I had an issue the other day where a patient refused EVERYTHING! This included an OR procedure which angered the MD so much that he refuses to see her again, she refused to have nursing assess her, physicians assess her, to eat, pain medications, v/s, chem sticks, and to be turned (she had many wounds some of which were to the bone!), and her dressing changes. And more so while trying to convice and help her she attacked me drawing blood and biting and spiting. So I documented everything fully. The following day the patients family member comes in and verbally attacks us saying that we give horrible care and she doesnt care what she refuses we should do it anyway and that she is reporting us to the BON, I explained fully that she refused everything, she basically said I dont believe you and who cares if this MRSA infected patient drew blood on you its in your job description to get attacked. I knew I was right in the situation and the woman had me angry, however what really had me angry was my manager who did the whole I am sorry, I understand what your saying BS and validated this womans accusations instead of saying your wrong and you are not the POA so I can not discuss this with you any furthur. I had the MD come down and vouch for this womans behavior and it still did not make much difference. SO my question is what is a way to professionally handle this without allowing yourself to be a doormat and what would have your manager done?

[nerdtonurse?, BSN, RN]

The customer is always right AND NEVER RESPONSIBLE. This is why I'm leaving nursing to go into IT.

Hate to break it to you, but that's why I left IT.

You'll get a bunch of people working on a multimillion dollar contract where if they'd done due diligence they would have known their choice of software/hardware was incapable of passing instruction sets as fast as the RFP set out, and somehow, it will be YOUR fault because you can't change the laws of physics. I was on a 32 million dollar project where it was never, ever going to work because the vendor pushed a hardware solution that was physically incapable of doing to work as fast as the company wanted. When it fell all apart, who's fault was it? Not the exec (who's wife just happened to work with the hardware company, gee, wonder how they picked the hardware...), not the vendor, it was the poor project manager at my company (me). Luckily, I'd kept a whole raft of emails where I'd warned them it wasn't going to work, and I sent it up the chain when they started saying they were going to fire everyone in the department down to the secretaries.

Guess what happened?

We all got dragged into court as one side sued the other, and then our entire unit got outsourced.

Think people are mean nasty and cruel in healthcare? Wait until there's 30+ million bucks on the table....

[nerdtonurse?, BSN, RN]

And for the OP...I've had a patient try to deliberately infect me with AIDS --- would jerk her arm toward me (not a normal recoil) when we were starting IVs. That stopped when I left, and came back with 3 really burly security guards to hold her arm still. I informed them (in front of her) that she was deliberately trying to transmit an infectious agent, and that if any of us received a needle stick, we were authorized to have her arrested for attempted murder. She tried it with others, but she never tried that with me again.

When I've had the "refuses everything" folks, I chart, chart, chart, exactly what they say, who was in the room, and I never go in the room without a witness (CNA, other nurse, manager). I also make sure I send an email or tell the charge, house supervisor, and the manager. When the patient starts showing off for family or visitors ("you ain't gonna make me take that medicine" or "F U, I'm not turning over"), I pointedly ask their names and tell them that I am entering them in the chart as witnesses to the patient's refusal for any eventual legal action. I also send a email to risk management. I make it a point to just get calmer the crazier they get. And I document EVERYTHING. Don't say, "pt refuses to participate in care" say, "pt refused to be turned for nurse to assess decubitus located at (x, y, z), nurse informed patient that this may lead to worsening of her condition up to and including death, patient stated "F U, you ain't turning me." John X, Jane Y, and Sue Q were in the room at the time and all supported patient's decision not to be evaluated and treated by saying....." That way when it goes to court, and Sue Q trots down to testify, it's in the chart that they were egging on the patient.

[martymoose, BSN, RN]

In our hospital, administration has embraced the Studer philosophy, which makes the nurse the bad guy in all situations! Our manager has even stated that she will believe the patient no matter what the truth is. So we are screwed no matter what.

!

funny how Studer sounds a lot like stupider??? we have that crap too. You are right- this pt behavior is only being rewarded.yep- we're all screwed. And what are we going to do about it? nothing other than cover our butts and hope it doesnt get dragged into court.

[nicole109]

What is unfortunate about our profession is that customer service has now become a priority over actually being a nurse, and all of that has become an issue because of "the bottom line". Hospitals, LTC, all of the places we are working as nurses are all about the $$ and patients and their family members are unfortunately the one's paying the hospital bills. What the people in suits sitting behind desks dictating to us don't realize is that you can't make everyone happy and that patients not only have rights, but they also have RESPONSIBILITIES, and those responsibilities include respecting those that are taking care of them and trying to help them get better, and not abusing, in any way shape or form the staff that stand before them. The "suits" however, would rather feed into their nonsense and send them fruit baskets and serve their meals on china, give them parking passes and whatever (imo) meaningless "gifts" they can muster up to keep them happy, than go in the room and tell them to act like a human being and stop treating their nurses like floormats or to get the hell out! Because they are afraid that they might actually leave, and they will lose the measly $50 or whatever that Medicare is paying them for the bed that day. I, however would hate to be the administrator that has to explain to Sallys family that she is now dead because her nurse was providing ice and fluffing a pillow to Mike when Sally was in distress and needed acute attention, but the nurse couldn't ignore the customer service needs that Mike so desperatley required because he might write the nurse up if she didn't respond immediatley! If you ask the administrators in the hospital that I just left--they actually do have a hard time telling you which patient to see first, and it's not because they are stupid, it's because they don't want to **** someone off--they want to create an air in the hospital that nobody is overworked or understaffed...but that's not reality!

[Plagueis]

I think part of the problem is referring to patients and residents as "customers." (Meaning, they are always right.) I also don't like the word "client," either.

[nlhnurse1982]

--they want to create an air in the hospital that nobody is overworked or understaffed...but that's not reality!

You hit the nail on the head with that. We recently were given new scripting to use which includes us saying at the end of each encounter with a patient is there anything at all I can do for you I have the time...haha I wish I had the time to cater to every whim of each of my 7 patients. It doesnt even seem to occur to the management at the hospital where I work that we are often dealing with at least one critical patient in our mix of patients. At least I know that when I get burnt out from nursing I will be qualified to work at a hotel.

[Batman25]

I am completely against patients being called customers. They are patients in a hospital because their doctor has deemed them in need of 24/7 nursing care. I don't know why some facilities try to work around that fact. They are there because they are too ill or injured at that particular time to care for themselves. Let's just call it what it is and try to stop hiding that fact.

Being in in the hospital is no treat and we all know that. As nurses we have to have them do things they don't want to do...foleys, meds, IVs, get out of bed when they don't want to, etc. And while they can refuse most know it is to their benefit. By catering to the idea that the patient can have it their way when they really can't if they want to heal and go home is disingenuious and misleading. Time to get honest and real with patients again.

[martymoose, BSN, RN]

well where I am, not only are the pts customers, the Dr's are also. We are told to treat them that way because they chose to send their pt to this particular hospital, when they could choose to send their pt to another one if they so choose. I think the thought is if the Dr gets complaints that the staff arent taking care of the pt( oops , customer) that they will take their business elsewhere.

yes, competition stinks. I guess if you look at other service industries, customers feel they can be as rude as possible and still get what they want- the gen . public feels healthcare is no different.

I have always said I am made to be a waitress with a Nursing degree.I don't like it- but have no other choice at this time.

[Not_A_Hat_Person, RN]

What if you were in a queue at Starbucks six deep and one customer was allowed to barge to the front of the line and then complain if he didn't get served immediately? What if that customer were allowed to assault the Starbucks employee, not get arrested but then receive free coffee for a week because his needs were not met?

I've heard of a cop doing that. He was eventually fired.

[diane227, LPN, RN]

We have a strong customer service plan at our facility. But I find, that when a conflict arises, talking to people and explaining things really help. As the charge nurse on my floor I have more time to do this and I am always aware of opportunities to fix the PR problems before they get worse. Example: We are a very small community hospital and we happened to receive the mother of the CEO of one of the large hospitals in our area. I had learned that they wanted the patient in a private room but she was not in one because I had to place her near the nursing station because she was so confused and needed a sitter. I made a point of calling him, introducing myself and explaining the reasons why I had her near the nursing station (because I wanted her to be within line of site, precautions against falls etc). He was extremely pleased and told me to do what ever I needed to do to assure her safety. He did not care if she was in a private room or not.

In another case, we had a very ill woman that we had no diagnosis for. She had a very strange presentation of symptoms and every test we did came up negative. The family was VERY anxious. One day the daughter arrived from out of town and charged up to my desk wanting to know what was wrong with her mother. I finally took all the family aside into the family room and we spent a hour in there reviewing her test results, physician consults, etc. They were very happy and even then, and now, we don't know what is making her sick, they feel reassured that we are doing all that we can to try to help her. The family members, especially the patients husband, think we walk on water now.

Now this type of intervention takes time and it takes skill. And I believe that the most experienced nurses who have the best communication skills should be dealing with these situations as a rule. But when you have time to do it and you do it, you can really defuse a situation and you can make a great impact on how the family and patient views you and the work you are doing. It has never failed me.

[EnkeliRN]

I’m not sure why or who allowed this term to be coined in the medical field “Customers are always right” really, then why not open hospitals every corner. I know some of you will say to me "simply because of competition, etc". We’re not selling goods thou, we’re caregivers! Sometimes it’s really hard to make the families understand that their loved ones are in a hospital setting to get well, so they can move on to their next phase of life. I’ve heard it numerous times in meetings (worded differently) supervisors, CN, etc...pretty much stressing the importance of customer service. Recently, I cared for a ‘frequent flyer’ who comes in always with a vague stomach pain, none other than to seek narcotics. Because he’s a well known “customer”, I mean pt….his doc only ordered morphine IV and few other nausea meds. Initially, the ER had loaded him up with a bunch of narcotics before transferring him to my floor. To make a long story short, he wakes up from his drug-induced coma in the middle of the night, complaining of pain. So, after assessing his pain, I offered to give him morphine. I saw it coming.....he literally started to cry loud, I mean really loud because his physician knows better not to order morphine since it doesn’t work to control his pain (shall I say his urge). I then offered to page his doc….of course he didn’t want to wait then decided to go with the morphine. An hour after I administer the morphine, I get a call from his sister. She was screaming on the phone inquiring why I gave him morphine. I asked if she has a POA over her brother’s care which btw was a 30 year old competent male, of course not. I specifically explained to her that I couldn’t discuss her brother’s care over the phone as it is a violation of HIPAA’s law. Oh boy from there she went on about what a despicable & lousy care we're providing to her brother, blah, and blah. She even threatened me by saying, “Don’t make me come up there!” . So of course after I wasted my time trying explain what happened, I transferred the call to the CN. The CN gets on the phone apologizes and discusses everything what's been done so far to help her brother. I was shocked of course and before I even say a word, the CN states, “Oh btw, I just didn’t want her to come here & create a scene”. I felt really like an ass at first. But, then I know in my heart I did what was right & yes, I did chart pretty much everything. Sometimes though, this is the kind of BS I don’t understand as well.

[EnkeliRN]

What is unfortunate about our profession is that customer service has now become a priority over actually being a nurse, and all of that has become an issue because of "the bottom line". Hospitals, LTC, all of the places we are working as nurses are all about the $$ and patients and their family members are unfortunately the one's paying the hospital bills. What the people in suits sitting behind desks dictating to us don't realize is that you can't make everyone happy and that patients not only have rights, but they also have RESPONSIBILITIES, and those responsibilities include respecting those that are taking care of them and trying to help them get better, and not abusing, in any way shape or form the staff that stand before them. The "suits" however, would rather feed into their nonsense and send them fruit baskets and serve their meals on china, give them parking passes and whatever (imo) meaningless "gifts" they can muster up to keep them happy, than go in the room and tell them to act like a human being and stop treating their nurses like floormats or to get the hell out! Because they are afraid that they might actually leave, and they will lose the measly $50 or whatever that Medicare is paying them for the bed that day. I, however would hate to be the administrator that has to explain to Sallys family that she is now dead because her nurse was providing ice and fluffing a pillow to Mike when Sally was in distress and needed acute attention, but the nurse couldn't ignore the customer service needs that Mike so desperatley required because he might write the nurse up if she didn't respond immediatley! If you ask the administrators in the hospital that I just left--they actually do have a hard time telling you which patient to see first, and it's not because they are stupid, it's because they don't want to **** someone off--they want to create an air in the hospital that nobody is overworked or understaffed...but that's not reality!

I couldn't have said it any better...yap, that's the reality nowadays