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

Nurses General Nursing

Published

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?

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

If I were a gambling woman, I'd say somewhere in the next two pages, but what do I know? Really, though, comparatively speaking, the heat's not too awful bad so far, lol. Everybody's not going to love it, I knew that, but working there is such a refreshing change.

So glad to hear it too!

Specializes in ..

i love the rules of this office! my wife works at a no-nonsense office like this. what many posters may not realize is that if the providers are this strict about patient behavior, they are also expecting much of themselves and their staff. some posters obviously have never had any dealing with a pain clinic either. i would imagine that most honest patients welcome the strict rules because they don't want to be associated with a pill mill. when you deal with people face to face over time, it's not that hard to tell the good ones from the bad (the good ones don't get attitude & apologize if they do). get rid of the demanding drug seekers. this problem is by far the worst of any drug epidemic. i have always been taught to listen to the customer, but never to allow them to abuse me or my staff. my nursing school emphasized the need to defend one another on the floor and our staff when we become charge or management. when people don't take crap, it doesn't take long for the crap givers to take notice. then they take it to another clinic or do it on another shift.

way to go op!

Wow. I am impressed. My hospital could learn some lessons from your office. I hate that people think they can behave however they please, and get away with it. Unfortuanately this whole customer service thing has gotten a little out of hand. I have always treated my patients and families nicely. Someone needs to protect the staff as well. There are some people who think the only way to get what they want is to behave horribly. I promise I do respond a little bit better to a smile, please, and thank you. I will be a good nurse no matter what, but hopefully the patient will realize we can make this a more pleasant experience. We can both end up positive and happy.

I will say on the flip side, when I have had a family member in the hospital. I have always said please, and many thank you's. When my Dad spend three weeks in the hospital I brought the nurses see's candy, and doughnuts. Not once did any of those doctor's, nurses, or CNA's ever leave the room without a thank you from one of my family members.

I do not think that the patients need to bring us anything, but a pleasant attitude. Tell me if your upset about something. Let's try and work this out together. I will bend over backwards for my patients. I just ask to please be nice to me. I know this is a very stressful situation for the patient. This is not an excuse to treat the staff horribly. You do not have to shout to get anything done quicker. We are doing the best we can with the resources, and information that we have.

Specializes in Medical Surgical.

I totally agree with the OP's office's approach to care. Drug seekers and abusers do not have to be accommodated at a private clinic, nor should they be. Staff are abused shamelessly in the hospital. Not only is this bad for the staff nurses, it is also bad for people with legitimate problems, because everyone becomes suspect of drug-seeking. A few years ago I developed a rip-roaring attack of swollen joints. My hands were so swollen and painful that I laid in bed all night and cried. I couldn't get myself dressed, had to wear splints and slings at night (my idea). Went to several doctors, including my own, an orthopaedist, a rheumatologist and a neurologist. I was treated like a drug seeker and sent off to suffer in silence. The pain was so bad I could barely stand it. All through this time I was working a job and a half and didn't have the strength in my hands to even pull the stopper off an IV bottle. I became good at hiding my disabilities, and my pain. Finally after six months of hell and yet another round of doctors I developed rheumatoid nodules on my elbows and the bursae swelled up to size of golf balls. At this point the not-so-brilliant diagnosticians realized I had RA, gave me Plaquenil and my life got back to normal. I will never get over being made to feel like a drug seeker and a malingerer, especially because in all that time I dragged myself into all but one of my shifts. Maybe if there weren't so much enforced tolerance for the manipulative patient, there would be more empathy and help for those who really need it.

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

Jan, I certainly hope you're feeling better. 'Arthur' sucks in ways those who aren't afflicted can't even imagine.

Then perhaps you shouldn't have?

Seriously, I love my work, I just put up with too much in other facilities to really think that the rules are anything but great. In my clinic, public assistance or not, if I'm seeing you, you can be assured that, barring an emergency or a complicated workup, you'll be out in less than an hour. We call back in order of appointment time, and I have a pretty good 15-minute turnaround, sometimes less if one is just there for refills. Then, you get a brief head-to-toe, meds written, notes put in for Doc to review if need be, for an increase in meds, a change in meds, or what-have-you, and you're all set.

My nickname is Speedy. The patients love it. Of course, the complicated ones take longer, especially if we have to call EMS or write for a years worth of 20-some-odd maintenance drugs, but it all evens out, and no one ever leaves my exam room unless I have been assured that I've covered everything that needs covered, or made arrangements to do so (I have to have an OK from Doc to up controls, so as soon as I know, I call the patient and let them know if he agreed or not).

So, rules aside, you might just find you like it where I work. At least if you didn't, you wouldn't be there in something you didn't like for the whole day. Just saying.

I wasn't trying to imply that your facility is like the one I was describing, I was just trying to say that things are rough on both sides of the fence. Sorry I was unclear.

Oh please. You really have a problem with removing abusive patients from a practice? Really?

I suppose you think healthcare workers should just lay back and take whatever comes their way?

If so, you're part of the problem. No one has the "right" to be abusive, but a private business has every right to remove a "customer" from their property.

Doctor shopping, pill mills, and drug-seeking/selling are very real, very big problems in certain parts of the country. It's THE biggest drug problem where I'm at. Do you really have a problem with an MD taking responsibility and monitoring who he gives controlled substances to? It's his license and livelihood (not to mention his duty) that is on the line if he doesn't.

Do you really think a patient should be able to get whatever they demand?

Really?

Yes sweetie, this is EXACTLY what I said. :banghead:

Specializes in Med/Surg.

This works fine for isolated clinics here and there. However, if everyone did this, there would soon be a large number of people being denied healthcare due to being undesireable to work with. Now, call me crazy, but i think everyone has a right to healthcare regardless of whether I like them or agree with their lifestyle!

Specializes in Hospice.
This works fine for isolated clinics here and there. However, if everyone did this, there would soon be a large number of people being denied healthcare due to being undesireable to work with. Now, call me crazy, but i think everyone has a right to healthcare regardless of whether I like them or agree with their lifestyle!

We're not talking about "liking" or "lifestyle" ... we're talking about behavior ... mostly drug-seeking behavior.

Everyone has the right to eat, too ... but behave in a restaurant or supermarket the way some people behave in the healthcare setting will get you kicked to the curb in a New York minute.

No one has the right to be abusive, no matter how sad your story. Everyone has the right to refuse to be abused and to do what is needed to make the abuse stop.

If everyone did this, addicts would get less reward for their behavior and maybe that behavior would diminish.

If everyone did this, health care consumers would stop treating practitioners like vending machines.

If everyone did this, staff would have the energy and emotional resources to deal with tough situations, including people they don't like and lifestyles with which they don't agree. See my comment above about compassion fatigue. You don't get to demand that practitioners take anything you care to dish out, thus killing whatever compassion they may feel, then complain that there's no compassion.

The rules described in the OP are common-sense limits on the most frequent drug-seeking behaviors. If you are not engaging in those behaviors, then the rules shouldn't impact you. If you are engaging in those behaviors, then you need to deal with the consequences.

Behave and behavior are emphasized for a reason ... behavior is not the person. Behavior is learned and can be changed. Behaviors are strengthened by reward ... by getting what you want. Behaviors are diminished when the reward is absent. I'm no big fan of operant conditioning as a sole means of understanding behavior, but we use it all the time and it's a perfectly legitimate means of changing behavior without getting into complex emotional therapies. This is why strict limits on behavior is part of the standard of care in addictions treatment.

wishing someone to suffer is over the top. really.

wow.

i don't think so. you know, the old saw - walk a mile in my shoes before you judge me. and op's practice wishes suffering upon those who should be presumed innocent until proven otherwise in a court of law - they just don't say it in words, only in their actions. which is worse?

now, diane and others who kudo'ed her - any of you could be arrested today, this very day, for whatever charge, including some that will get you dismissed from the holier-than-thou practice. guilty or not, they will leave out on your bum, left to cold turkey detox. sounds like cruel and unusual punishment to me.

get ready, all, for the pre-crime punishment wave of the not so distant future - the time when people, including you, can be punished (incarcerated, fried? hung? shot? lethally injected?) for crimes you might commit. :eek:

a lot of people have no idea what it is like to be in pain or to be on the receiving end of the treatment op describes. worst of all is her/their attitude. you are scum and we will keep you in your place. we have no respect for you because we would never do the things you do or ever be on welfare. well, i dare say that none of us knows what we will do or just how we will behave if we were in a particular set of circumstances.

her latest statement, about not accepting patients from a shut down practice - well, she is assuming that the patients are why the practice got shut down. don't you see the haughtiness there? even paranoia?

I totally agree with the OP's office's approach to care. Drug seekers and abusers do not have to be accommodated at a private clinic, nor should they be. Staff are abused shamelessly in the hospital. Not only is this bad for the staff nurses, it is also bad for people with legitimate problems, because everyone becomes suspect of drug-seeking. A few years ago I developed a rip-roaring attack of swollen joints. My hands were so swollen and painful that I laid in bed all night and cried. I couldn't get myself dressed, had to wear splints and slings at night (my idea). Went to several doctors, including my own, an orthopaedist, a rheumatologist and a neurologist. I was treated like a drug seeker and sent off to suffer in silence. The pain was so bad I could barely stand it. All through this time I was working a job and a half and didn't have the strength in my hands to even pull the stopper off an IV bottle. I became good at hiding my disabilities, and my pain. Finally after six months of hell and yet another round of doctors I developed rheumatoid nodules on my elbows and the bursae swelled up to size of golf balls. At this point the not-so-brilliant diagnosticians realized I had RA, gave me Plaquenil and my life got back to normal. I will never get over being made to feel like a drug seeker and a malingerer, especially because in all that time I dragged myself into all but one of my shifts. Maybe if there weren't so much enforced tolerance for the manipulative patient, there would be more empathy and help for those who really need it.

Empathy is great. What you really needed, though, was just one doctor who knew what the devil he or she was doing! So even the rheumatologist couldn't properly diagnose you? That is terrifying. Think about it. Couple that with the attitude OP describes and that spells serious suffering, as you found out. Imagine if you'd gotten arrested, too. OP would have been done with you, you malevolent society-destroyer.

The average layperson is completely at the mercy of so-called educated professionals and goes through what you did probably several times in a lifetime. At least as a nurse, you had a fighting chance of diagnosing yourself and going to the right specialists - even though the ones you went to knew not their bums from their eyebrows.

What was the trouble? Didn't they do the right labs or imaging or what for you? Glad you're finally ok.

+ Add a Comment