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?

[PMFB-RN, RN]

You guys have made me realize how lucky I am. None of this crap would go over at my hospital.When faced with unreasonably demanding family members RN in my unit can (and do) expel them from the room and ban them from the unit until our patient advocate team (or charge & house supervisor on off shifts) can deal with them. Our patients are free to refuse cares, and they sometimes do (usually drunks) but they have to leave AMA if they refuse to listen to sound medical advise.

I, like most of you, have had to deal with abusive family member or patients but have always been backed up by our managers. If ever a neurologically intact patient or family member physically attacks or harms a staff member our policy says we should call security and then police and ask assault and or battery charges to be pressed. We have done this many times. Obviously this is not true for people with traumatic brain injury or those just coming out of anesthesia but our policy allows us to restrain (physically or chemically or both) these people.

[CaLLaCoDe, BSN, RN]

I would suggest another field. I am leaving IT after 18 years. The reasons: (1) layoffs every 2 or 3 years (due to outsourcing, downsizing, economy, whatever)... (2) hard to find another job in the same strain of IT in the same town forcing multiple relocations (3) My pay began at $XX,XXX.XX at job 1...raise, raise, layoff, job 2 started me at the same $XX,XXX.XX.....for the past 15 years! My pay has been stagnant.

To each his own..

Yeah that!!! Nursing is not necessarily a stable career choice, is not necessarily as well compensated as other professions, is not respected by the suits. Dump nursing! I wish I could, but I'm just too lazy, whimper....pfutt. And I don't have the money or brain power to start anew with anything else.

[sparketteinok]

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.

I can't say for everyone else here, but it seems that they have the same thoughts as I do: they try all you mentioned above, and then still are abused, with managment rewarding the patient for thier abusive behavior. I have been on the receiving end of physical and verbal abuse a few times in the year and a half I've been a nurse. As a new nurse, I have been utterly shocked that not only do patients do this, but are then rewarded and the "horrible nurses" scolded.

It is most frustrating, disheartening, and downright depressive when a nurse bends over backwards, neglects the other patients (as best she can without causing harm), involves managers, and does everything but stand on her head to appease these patients and then, managment cuts her off at the knees, and the nurse gets in trouble when she's tried her hardest and done her best and done what any prudent nurse would do.

[canoehead, BSN, RN]

I've got to admit I just couldn't work in that kind of environment. I'd leave, or if I tried to stick it out I'd eventually be fired.

If docs are customers, and other depts are customers, who exactly is the nurse a customer of??

[Cul2]

Batman 25 and some others -- I completely agree with your comments. At the same time, I completely agree with the importance of communication, which was brought up by a recent poster. You seem to convey the attitude that most patients are completely helpless, have no choice about where they are, and are not really willing to cooperate with what's best for them. That may be true for some patients, but not all -- and how they react depends significantly upon how they are approached by caregivers. There will always be the exceptions, the real jerks, along with their families. But even some of these people can be dealt with using skillful communication. There's a great difference between normal customer service, and the kinds of extreme examples being posted here. No nurse should be forced to deal with ridiculous service. But, if you live near a big city that has a lot of hospitals and medical facilities -- do an experiment. Get the city newspaper over a few days and count the medical ads. You'll begin to see how competitive the medical industry has become. Realistic customer service is part of any competitive industry -- I'm not talking about unrealistic customer service. It's not a question of the patient "having their way" all the time. It's a question of making the patient an integral part of the team, recognizing the patient's personal stake in the whole process, and demonstrating that respect by allowing as much patient autonomy as is realistic. Good, honest, genuine communication -- that's the key. It won't always work, but that's true in any industry.

[Chaya, ASN, RN]

Good communication requires that the nurse have enough TIME to allow for a little more involved conversation if the situation warrents. This is what TPTB can't get thru their heads (or budgets, more likely). There needs to be a little extra time built into the day, or dedicated personnel that can deal with situations, including weekends and holidays. If a nurse is already trying to do 10 hours of work in an 8 hour day,an unforseen problem that needs white glove treatment means that something else is going to get neglected.

If the institution VALUES customer service, it needs to commit the resources to make it happen. It ain't brain surgery.