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?
nurse2it
63 Posts
Angelfire, where do you live and are you accepting resumes? How lucky are you to work in a place where the boss has a spine/chutzpah to require a contract and enforce it, brilliant! part of the problem is our western culture and pharmaceutical companies that make us think popping a purple pill is the cure. docs who won't confront a pt about prescription drug abuse, attorneys who solicit business by urging you to call their office if your loved one has been injured/neglected, etc. i have had pts follow me while dragging an iv pole and a foley demanding to know when they could have a prn dose of dilaudid 30 minutes after receiving a dose and after the frequency of the order was explained by me and every other nurse on the unit. i had so little time to spend with the pts who were truly ill (and seldom ask for anything) because the drug seekers monopolized it. how can you ask for phenergan for nausea and a sandwich/chips at the same time?