"Customer service" and nursing

Nurses Relations

Published

I've seen a lot of people talk about 'customer service' in a disparaging manner, as if that is not what nursing is about and it's making their lives harder to provide it.

Could someone explain that more for me?

Personally customer service is another way of saying good bedside manner. It doesn't matter what you know if you cannot present it in a way that encourages others to follow you. Many of the things I hear people complaining about for "customer service", could be solved by patient/family education and a less adversarial relationship between staff and family.

What are your thoughts?

Specializes in Women's Health, L&D,hi risk OB.

Or this.... when I (with ice and drink in hand) round preparing you for d/c and you say "Oh I'm fine. 0/10" And as I am walking out of the door I hear you ring the sec'y in tears about some aspect of my "customer service". And then you report about your stay to my NM "She should just have known what I want."

OR WHen doing teaching the pt is really in shock/disbelief peeved that this is part of your job. I have been told "I listen to doctors I don't listen to nurses!" OR "Why are you wasting my time my doctor already talked to me?!!!! OR "who do you think you are?" OR "Where is my doctor, I don't have to listen to you."

:yeahthat: This is a great thread and I agree a lot of what this quote says. I do have some comments. I have some thoughts. I have worked in pediatrics for almost 10 years. Yes, we do have a different perspective and expectation for dealing with their families. We are better staffed than the adult world and that makes it easier. There are extremes to any situation. There are definitely rude nurses/MD's/CNA's etc. out there. A lot of their attitude could be b/c of being overworked and underappreciated. On the flip side, there are a families/people out there that are NEVER going to be happy no matter what you do. The important thing here is for the appropriate amount of perspective. I bend over backward and do the most I can for my families. The people I work with know this and my managers know this as well. I rarely hear about families complaining about me although I am sure it happens b/c they know that I try my best to do everything I can for my families. I also work in a division that is appropriately staffed. In my previous job, I was overworked and there was unrealistic expectations re: customer service. If, by myself, you expect me to work with a doctor who is seeing 70 patients in 8 hours or triage more than a hundred phone calls during flu season... my customer service skills are going to suffer and there is absolutely nothing I can do about it. Even if I try. I was getting written up by my manager on a weekly basis because I did not talk to the families enough (I am sorry, but I cannot talk about the weather, the news etc) or did not spend an hour telling a mom how to treat diaper rash, did smile enough,e of you are going to slam me for this but it really is all about preception. If you are dealing with people that are very self centered and don't appreciate the job you do, they have a warped idea of what is appropriate. You do the best you can!

Great thread!

People often mistake assertiveness with rudeness. Not only patients and families but even our co-workers.

Women, and most hospital workers are women, have been encouraged to be assertive (not aggressive) and there are umpteen books and seminars, etc to teach this skill. Yet when we use our assertive skills, we are blasted for being rude.

Yes, it is only a matter of perception. But from what I've read here, perception or misperception by a patient or family member (or co-worker) can jeopardize your job, your very income (write-ups = no raise), your very sense of confidence.

I worked at a long term care facility a few years ago. There was a nurse there who had worked there for 15+ years and always was considered a great, caring compassionate person and worker. One difficult day, one of the residents continued to hover around her and her med cart, continuous talking, grabbing at stuff. The aids would distract and move the resident over and over again, but she would continue to follow this nurse around. I guess the nurse was finally frustrated because the distraction was causing her to lose her concentration on the med pass and she asked the resident "Please be quiet, Mrs. so and so." She made this statement in those exact words.

A family member overheard this, complained to everyone she could and the nurse was fired.

Now this nurse has this scarlet letter "F" on her record and history. It's a shame there are people in this world that can affect a person's very life by their perceptions and management that are so scared of offending anyone that good people have to work on egg shells.

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
what your viewing as disdain and vitriol towards patients and their families is actually frustration, not necessarily with the patient/families, but with what customer service should not be within a health care setting. nurses are frustrated because they care. people seem to find this a hard concept to grasp, if you truely care about your patients and their outcomes, you are going to become frustrated and perhaps even angry at anything that threatens that. if nurses really didn't care, it wouldn't bother them and they would have left the job a long time ago.

i think your equating "customer service" and providing good bedside care as the same thing. there's nothing wrong with that, what others are saying is that is not how it is being viewed by our administrators. if tptb viewed "customer service" the same way, nurses wouldn't have an issue with it.

in both these instances, the nms should have backed up their employee and taken the time to explain why the soup and the coke was not a priority. instead, these nms reprimanded both these nurses. absolutely inappropriate under the circumstances. how can nurses not be frustrated under these circumstances?

i've found over the years that nurse managers who actually back up their nurses are rare as hen's teeth. years ago, when i was working in another state, i had a conversation with two of my then co-workers about "the nice nurse" vs. the "good nurse." the gist of the conversation was that families really want the "nice nurse" taking care of them -- the nurse who breaks the rules to allow them and their 16 family members including two unruly toddlers visit, who robs other patients' rooms for chairs for the 16 visitors so that the other patients' visitors have no where to sit, the nurse who gives dad everything he wants including that milkshake when he's on a diabetic diet, the hamburger when he's on clear liquids and the extra dose of painkiller that leaves his oxygen saturations dangerously low and his exhaled co2 dangerously high. the nurse who always has time to talk to them although medications don't get given on time, orders don't get taken off, dressings don't get changed and treatments don't get give. what they ought to want is the "good nurse" who enforces the visiting restrictions, ensures that dad gets the diabetic diet, the clear liquids and less than 100% pain relief in the pursuit of adequate breathing. they ought to want the nurse who points out the vending machine rather than getting cokes for visitors and has the meds given on time, the orders taken off, the dressings changed and the treatments given.

cathy agreed with me, susie didn't. (not their real names, moderators!) susie was one of those nice nurses you're always angry with who break the rules so that anyone who doesn't do the same is the "bad nurse" in the eyes of the visitors. years later, susie is our manager, and of course, she still doesn't get it. being nice comes before being right. years of her management and hiring practices ensured an icu full of nice nurses and a dearth of good nurses.

then her father was in our icu. she hand picked the nurses to care for him, and who did she pick? cathy and me. "i knew you guys would keep him safe and help him get better," she said. "i guess you guys were right about the other stuff -- it's different when it's your father in the hospital!"

(unfortunately, once susie got it, she got promoted, and we got another manager who emphasized "customer service" over patient safety.

most units don't keep food on the floor for visitors, directing them to the vending machine was appropriate. i'm sure most of us, if we had change for a visitor don't have an issue with giving it, however, it should not be an expectation. neither of nurses should have even had these instances brought to their attention, these complaints should have been filed under g. neither incident should have been used to write the nurse up or had any impact on an evaluation. again, how can nurses not be frustrated by this?

while i agree with most of what you say, somehow i don't think this visitor was looking for change for his dollar. i suspect he wanted the nurse to dig into petty cash (or her own wallet) to give him money for the vending machine. and i do mind that! i draw the line at spending my own money to placate patients or their visitors. yet this was the expectation in one hospital in which i worked. "our patient population is mostly poor and minority," i was told. "we help them out where we can." yes, the population was poor and minority, but none of them had jobs, either.

this family was allowed to totally disrupt an icu, unacceptable. staff was put in the position of not wanting to take care of this patient because this situation was allowed to escalate, again unacceptable. again inappropiate management. measures should of been taken prior to the situation becoming out of control. if necessary counselling for the family to help them cope with the situation, and most certainly a health team meeting including the family where limitations should have been set.

in both these instances the nurse and the rt could have had liability issues for not counselling these people. health teaching is such an important part of our job and no nurse or other health professional should have to be afraid of being written up when they provide information to patients. again, how can nurses not be frustrated.

it happens all too often that patients and families are allowed to disrupt the unit in this fashion. setting limits is a wonderful thing, but it has to come with the backing of administration, and all too often, administration just doesn't get it.

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
6. i'm really tired of hearing about lilpeanut's box of hoho's.

i'll second that!

Specializes in Med/surg, ER/ED,rehab ,nursing home.

I do not know how many times I am EXPECTED to stop what I am doing for a patient, to get a blanket or pillow for a visitor who desires to spend the night. I wonder if they know that someone has peed on it, vomited, bled, and died on that pillow. Of course they are cleaned, but just the idea!

The hospitial that I work for bends over backwards to help and feed the pt's and their family. When I started there over 15 yrs ago, you brought your own pillow and linen if you stayed with a patient. We get complaints on the linen use from our dept. head, but we are still providing linens for the family. They come to the desk from CCU waiting room wanting our dept. (Med Surg) to stop what we are doing (5-7 pts each) and get them coffee, blankets, etc. How much I wish to tell them then K-Mart and Wal-Mart is one block away. Go buy one!!! In truth, it does not bother me that much, but when I am written up for putting them off a few minutes, till I can close my computer down, THAT IS THE PROBLEM. Would you believe that our "customers" and their visitors are allowed to park in the Staff parking places? Our CEO says it is "customer service". Oh and then when a car has its tires flattened or other damage done to it....I AM EXPECTED to say that this place is safe and secure ? NO WAY.

Specializes in MS, Hospice, LTC.
Customer service in healthcare is nothing but cow patties. I do not take care of customers, I take care of patients. I am there to try to help my patient get well, or at least better.....not to get blankets for the visitors. If you're cold, go home and get a jacket. I am there to administer life-saving meds to the patient, not get a Tylenol for the friend with a headache.

Amen to that!

We are all "customers" - I am the x-ray tech's customer etc. We all use the services of each other making us customers. It may take an extra minute to get a blanket for a family member or answer their questions, but whether we like it or not they are our customers. No we are not a hotel, but how much more important is it to treat our patients and families well since they are our "captive". THey are under stress from illness and lack of knowledge etc. THey have already given up most of their choices, dignity and freedoms. Put yourself in the patient and families place and think how you would want to be treated. Yes, sometimes they are impossible, but we can still be nice to them and go on giving our best care to the patient.

We are all "customers" - I am the x-ray tech's customer etc. We all use the services of each other making us customers. It may take an extra minute to get a blanket for a family member or answer their questions, but whether we like it or not they are our customers. No we are not a hotel, but how much more important is it to treat our patients and families well since they are our "captive". THey are under stress from illness and lack of knowledge etc. THey have already given up most of their choices, dignity and freedoms. Put yourself in the patient and families place and think how you would want to be treated. Yes, sometimes they are impossible, but we can still be nice to them and go on giving our best care to the patient.

Why is it then, that the only recipients of the disrespectful treatment, "slave treatment", is the nursing staff? If the rest of the hospital employees were treated as poorly as the nursing staff, then the "slave treatment", would be a little easier to accept.

However, it is the NURSING STAFF, that receives the brunt of this treatment/attitude. Stress, and lack of choices due to illness are not and excuse to treat the nursing staff as poorly as we are. I don't see patients treating doctors, therapists, radiology as poorly as we are treated. If they can behave themselves for other health care departments, then they can behave themselve for the nursing staff, and show us the respect that they show other departments. Stress is not an excuse for bad manners.

Lindarn, RN, BSN, CCRN

Spokane, Washington

Yikes! I know I only read page one so far but here is how I see it.

Look at American society these days. Everything is instant gratification whether that be fast food, buying a new car, drive thru car wash, hotels and hospitals. This society is also very time bound. Our entire lives are scheduled..kids soccer games, ballet, tv shows, even the birth of our babies whether it be induction or c-section. So pushing back a surgery is a major problem for many families who for the most part are two income wage earners.

Customer service is just a way of defining some of the interactions we have with patients and their families every day. Would you really deny a family member who stayed at the bedside of your critically ill patient for 24 hours a blanket because they were overtired and cold but still keeping watch? I doubt it. Would you not include family in the plans for the day for your patient if they were at the bedside? of course not! Does it really take extra time to say "Is there anything else I can do for you" before leaving the room. No. I personally said that LONG before Studer or whatever customer service program hospitals have invested their hard earned money in.

Yes it can be a pain and there is a lot of additional pressure on nurses that there never was before. More patients, sicker patients, less staff, more meds........you name it. The reality is the structure of pay for performance for hospitals is coming in the not too distant future. Which means that places with high satisfaction scores (very good or excellent depending on the survey) and high quality procedures are going to receive more money from insurance companies and Medicare/Medicaid. If your hospital does not receive good reimbursement for their patient stays and procedures that will eventually all roll down to staff and those consequences are very high.

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We are all "customers" - I am the x-ray tech's customer etc. We all use the services of each other making us customers. It may take an extra minute to get a blanket for a family member or answer their questions, but whether we like it or not they are our customers. No we are not a hotel, but how much more important is it to treat our patients and families well since they are our "captive". THey are under stress from illness and lack of knowledge etc. THey have already given up most of their choices, dignity and freedoms. Put yourself in the patient and families place and think how you would want to be treated. Yes, sometimes they are impossible, but we can still be nice to them and go on giving our best care to the patient.

The issue isn't about nursing staff not wanting to be polite and treating our patients/families well, far from it. It's the lack of realistic expectations forced upon nurses in the name of customer service.

Don't even get me started on on XR techs. They are as much my customer, even more so, than I am their's. I've dealt with some who have the mentality and behavior of 2 year olds over things as idiotic as the doctor not putting a requistion where they want it on the chart, even though they know exactly where it is. Threatening not to do a procedure, thereby threatening my patient's wellbeing, over WHERE a requisition is, when they know where it is. When unit clerks, housekeeping, NAs, staffing, admission/bedmanagement, lab, pharmacy, PT/OT, RT, central supply, dietary, physicians, XR/diagnostics, and let us not forget management/administrators, etc, DO NOT do their jobs or do them adequately it infinitely impacts far more on the nursing staff than nurses will ever impact their jobs. Who is always held accountable when these other departments don't do their job and it impacts the patient? The nurse.

my hospital actually paid thousands and thousands of dollars to disney to help us get our customer satisfaction scores up. what a ridiculous waste of money! instead, they could have thrown some of that money at having more linen available, better food for the patients and chairs for the visitors to sit in when they visit rather than expecting the nurses to offer our chairs to the visitors. back when visitors were allowed into the icu for only 15 minutes four times a day, that was feasible. not now, when they're a constant presence.

my facility has adopted what i call the centre of the universe campaign. exact words in promos, and in written policy regarding customer service. all our customers are supposed to feel like they are the centre of the universe while in our facility.

i've found over the years that nurse managers who actually back up their nurses are rare as hen's teeth. years ago, when i was working in another state, i had a conversation with two of my then co-workers about "the nice nurse" vs. the "good nurse." the gist of the conversation was that families really want the "nice nurse" taking care of them -- the nurse who breaks the rules to allow them and their 16 family members including two unruly toddlers visit, who robs other patients' rooms for chairs for the 16 visitors so that the other patients' visitors have no where to sit, the nurse who gives dad everything he wants including that milkshake when he's on a diabetic diet, the hamburger when he's on clear liquids and the extra dose of painkiller that leaves his oxygen saturations dangerously low and his exhaled co2 dangerously high. the nurse who always has time to talk to them although medications don't get given on time, orders don't get taken off, dressings don't get changed and treatments don't get give. what they ought to want is the "good nurse" who enforces the visiting restrictions, ensures that dad gets the diabetic diet, the clear liquids and less than 100% pain relief in the pursuit of adequate breathing. they ought to want the nurse who points out the vending machine rather than getting cokes for visitors and has the meds given on time, the orders taken off, the dressings changed and the treatments given.

cathy agreed with me, susie didn't. (not their real names, moderators!) susie was one of those nice nurses you're always angry with who break the rules so that anyone who doesn't do the same is the "bad nurse" in the eyes of the visitors. years later, susie is our manager, and of course, she still doesn't get it. being nice comes before being right. years of her management and hiring practices ensured an icu full of nice nurses and a dearth of good nurses.

then her father was in our icu. she hand picked the nurses to care for him, and who did she pick? cathy and me. "i knew you guys would keep him safe and help him get better," she said. "i guess you guys were right about the other stuff -- it's different when it's your father in the hospital!"

(unfortunately, once susie got it, she got promoted, and we got another manager who emphasized "customer service" over patient safety.

:yeah: :yeah: :yeah: :yeah: deja vu, i've had this conversation, i have worked with "nice" nurses.:uhoh3: you are absolutely right, people want the "nice" nurse not the "good" nurse. wouldn't it be prudent if along with promoting customer service, the consumer was actually educated on what they should be looking for in a "good" nurse, the one that has their best interest foremost when taking care of them?

while i agree with most of what you say, somehow i don't think this visitor was looking for change for his dollar. i suspect he wanted the nurse to dig into petty cash (or her own wallet) to give him money for the vending machine. and i do mind that! i draw the line at spending my own money to placate patients or their visitors. yet this was the expectation in one hospital in which i worked. "our patient population is mostly poor and minority," i was told. "we help them out where we can." yes, the population was poor and minority, but none of them had jobs, either.

if they were looking for a free handout and not change for a dollar, i agree, we should not be giving them our own money, nor should we be expected to.

it happens all too often that patients and families are allowed to disrupt the unit in this fashion. setting limits is a wonderful thing, but it has to come with the backing of administration, and all too often, administration just doesn't get it.

that's right, administration often does not back their staff and allows these situations to escalate, ironically, at the expense of their other "customers"/patients and their nurses.

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