"Customer service" and nursing

wooh, BSN, RN · Apr 10, 2007

LilPeanut, I think you have to realize that peds is just an ENTIRELY different ball of wax from adult nursing. Generalities coming: People are grateful when you get their kid better. Parents are so consumed with getting their kid better, that they don't care how uncomfortable they are, just make Little Suzie better. When I'm starting an IV on a kid, the parents just want it in with minimal discomfort to the kid, so they stay out of my way. On more than one occasion, I've been in the middle of starting an IV on an adult, and their family member, mid-cannulation, has asked me to go get them coffee. Not to mention, I go and tell someone "I'm sorry it took me so long to get in here, I was stuck in another room" at my peds job, mom will be, "Oh, I understand you're busy, all these poor kids being sick." Say the same thing walking into an adult room, "Well I needed you too!!" Basically, with peds, families have their priorities in order, and don't mind ME having MY priorities in order. Adult nursing, it's all about making them feel like they're at the Hilton.

RNDreamer · Apr 10, 2007

sorry, but I HAVE to ask...what(or who) is TPTB? thanks in advance

TazziRN, RN · Apr 10, 2007

sorry, but I HAVE to ask...what is TPTB? thanks in advance

The Powers That Be

DusktilDawn · Apr 11, 2007

You have encapsulated my thoughts, very nicely said.
Perhaps the real question is then: why are adult hospitals so vastly understaffed in comparison with peds?
People cope and show fear in different ways. I would ask everyone to take a look, an unbiased look, at the posts that have been made. While many have a good point and a very valid point of view, the disdain and almost vitriol for families is apparent. Something needs to change about that.

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'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?

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.

Sorry, but if I'm juggling a bunch of patients on a busy med surg floor with no PCA to help me, and one of my post-ops suddenly starts bleeding, I'm not going to leave that bleeding patient to go warm up a bowl of soup. The manager was well aware of the circumstances but she still wrote me up for it anyway.

I got called to NM's office next day and yes she understood the situation entirely but I still got written up because the Grandma-needs-a-coke person had complained that I told them I was too busy to get Grandma a coke. That was "poor customer service." Told NM I don't have customers, I have patients, the one with her guts lying all over the bed came before grandma and her coke, and he could jolly well have walked his big butt down the hall and got Grandma the coke himself.
Customer service, my eye.

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 shouldn't have to be written up because a visitor asked me for a soda or snack and I directed them to the vending machines.

I don't think things like not having change so my patient's boyfriend can buy a soda should not have any bearing on my annual eval.

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?

We had a experience recently on our ICU. We had a pt who was admitted Jan 26,07. Still inpatient. All problems started one night when the nurse asked the family to please go to the waiting room because the pt needed to be stabalized. The family was pissed that they were asked to leave at this time. So they put in a complaint to the manager and demanded that she not take the pt again. This was agreed upon by mgt. Another nurse had this pt and in the succeeding time let family stay and as did I except for bathing and changing. No issue with me at this time, but with the other nurse they had issues (I am not sure what). Again put in complaint to mgt. (not about me) and this nurse not allowed to have this pt. As time went on more and more staff were put onto this list for "frivilous" complaints. Like "Too many people to turn him making me feel like he was fat." The pt was a large man about 6'5" and 350 pounds. On nights took 2-3 staff to turn due to male staff able to help. On days many of the women are pettite so it would take more to turn him. We also had her complain that while cleaning him a RN lifted his leg and he winced. He was getting stiff so he was probably sore but we had to lift his leg so we could make sure we got all the stool off of him. Staff explained that and a complaint was written that she "Threw his leg up in the air and hurt him". We had it so one nurse couldn't work one whole side of the unit. The pt wife would say "nurse jane is looking at me and laughing at me" This would occur even when she wasn't on duty. Eventually mgt was getting pages from this woman at home. She was so "Out of control" due to our inability to set limits with her due to "Customer service". Her son threatened a nurse that answered a call light saying "You have abused my father by having his trach too tight and he can't defend himself but I can defend him. I have taken on guys bigger than you." Due to all the problems with the family we had to transfer the pt to another ICU. I didn't have a problem taking care of this pt, but I was never sure what would put me on the "List". At one point half the floor was on the list. I understand that the family was having control and coping issues. I am empatheic and sympathetic to that. But we definately needed to set limits. It was to the point that no one wanted to have this pt but becasue of the family.

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.

I got written up for bad customer service for giving a mom smoking cessation information while her baby was in the hospital and would desat every time mom came back in from smoking (the woman stunk of smoke!) I was nice when I did it, but if she doesn't want to hear it, it doesn't matter how nice I am. My patient's safety called for me to do something mom didn't want. Customer service wise, I guess I shouldn't have though.

An RT recently got written up by a family member when he told the family it would be best if they did not smoke in front of the pt anymore, who was in the ER and being admitted for COPD exac. The family claimed he gave them a rude lecture, when all he did was make one comment.

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.

Cattitude · Apr 11, 2007

DuskTilDawn~~~~ Thank you for taking the time to quote all that. Sometimes people that have never experienced the wrath of families simply cannot understand. You made perfect sense. Frustrated, yes, I think so! Many of us are.

Cattitude · Apr 11, 2007

Also, it is not the norm in retail or waitressing to deal with life and death, mortality and morbidity, getting sued for one misstep. Please don't compare these lines of work to Nursing.

:yeahthat: :yeahthat: :yeahthat:

brendamyheart · Apr 11, 2007

I do not think that "Customer Service" has a place in nursing. I believe everyone in entitled to good nursing care. I am sorry if I offend the original poster but sometimes I am so sick of bending over backward to make some patients family happy.
Sometimes I think we go WAY beyond common sense and have to bend over backward to please someone we will NEVER make happy.
We had a experience recently on our ICU. We had a pt who was admitted Jan 26,07. Still inpatient. All problems started one night when the nurse asked the family to please go to the waiting room because the pt needed to be stabalized. The family was pissed that they were asked to leave at this time. So they put in a complaint to the manager and demanded that she not take the pt again. This was agreed upon by mgt. Another nurse had this pt and in the succeeding time let family stay and as did I except for bathing and changing. No issue with me at this time, but with the other nurse they had issues (I am not sure what). Again put in complaint to mgt. (not about me) and this nurse not allowed to have this pt. As time went on more and more staff were put onto this list for "frivilous" complaints. Like "Too many people to turn him making me feel like he was fat." The pt was a large man about 6'5" and 350 pounds. On nights took 2-3 staff to turn due to male staff able to help. On days many of the women are pettite so it would take more to turn him. We also had her complain that while cleaning him a RN lifted his leg and he winced. He was getting stiff so he was probably sore but we had to lift his leg so we could make sure we got all the stool off of him. Staff explained that and a complaint was written that she "Threw his leg up in the air and hurt him". We had it so one nurse couldn't work one whole side of the unit. The pt wife would say "nurse jane is looking at me and laughing at me" This would occur even when she wasn't on duty. Eventually mgt was getting pages from this woman at home. She was so "Out of control" due to our inability to set limits with her due to "Customer service". Her son threatened a nurse that answered a call light saying "You have abused my father by having his trach too tight and he can't defend himself but I can defend him. I have taken on guys bigger than you." Due to all the problems with the family we had to transfer the pt to another ICU. I didn't have a problem taking care of this pt, but I was never sure what would put me on the "List". At one point half the floor was on the list. I understand that the family was having control and coping issues. I am empatheic and sympathetic to that. But we definately needed to set limits. It was to the point that no one wanted to have this pt but becasue of the family.
The OP works in a different department than most. Most of us on this thread work with adults. Adults as patients and family aren't always reasonable when it comes to explaining that someone else needs me more at the moment. I have also had to explain to famlies that I couldn't get to them right away, there was a emergency with another pt. Sometimes they understand and sometimes they don't. Usually they do, but there are going to be the unreasonable ones that we run into. I had a pt that I was late with her pain meds and was there to give them. I came in and said "I am here with your pain meds. I am sorry I had tried to get in here a few minutes ago and I had to go see a pt having a emergency." I was told by the pt "I am having a emergency I HAVE ABD PAIN". She was pissed that I was taking care of someone with chest pain and not her belly pain from a skin abscess.
I am so fed up with customer service and the customer is always right crap. Not true in the hospital. You are there to GET BETTER not have a blast. People need to remember that the hospital is just what it is, a hospital not a hotel.
I am all about making the paitnet comfortable and quality care. I should not have to worry about the fact someones soup isn't warm enough when I am caring for a critical pt.
I have been on the other side of the bed and no it wasn't a good experience. I had to wait 1 1/2 hours to see a RN when I was having chest pain since the RN who was assigned to me was in a STAFF MEETING. I am sorry but I should have been the priority. Was I pissed? Yes I was. I didn't make some huge fromal complaint though I could have.
Yeah this customer service bull cakka gets to me. A patient is a patinet not a customer/consumer.

That squeaky wheel gets the grease. What happens to the one's that do not complain? Were I work we a so consumed with customer care, not nursing care to the point were those whom do not complain get less attention.W are a business and customer care is important, however to what what extreme do we provide it?

brendamyheart · Apr 11, 2007

Not being able to say you were busy, that's just management's way of passing the buck. If we can't say we were busy, then the patients can blame it on lazy nurses rather than the real problem, which is inadequate staffing (or even if adequate, the fact that we aren't private duty nurses!)

:yeahthat:

brendamyheart · Apr 11, 2007

But, Tweety, we can't run around quitting q time something goes wrong.

:yeahthat:

LeahJet, ASN, RN · Apr 11, 2007

And I will go so far as to say....yeah, gonna say it...if getting your coke with ice is going to prevent me from getting to the cafeteria on time before they close, causing me to miss my lunch....NOT GONNA HAPPEN.

My sentiments exactly.

I don't do the martyr thing very well.

Make no mistake, I can and I WILL take care of my needs before I run around trying to take care of frivoulous requests.

Does that make me a bad nurse? No.

Does that make me a tad selfish as a human being? Maybe.

But here come the huge news flash.....

Nurses are indeed Human.

I don't get all up in arms over this asinine Customer Service bullcrap. I just go to work, do my job, act professionally, and take care of myself along the way. I don't do "scripts" and I don't lie to people and tell them that "I have the time".

I just do my thing.

It seems to work for me and my patients.

Indy, LPN, LVN · Apr 11, 2007

Some random thoughts from having read this thread.

1. I get paid to work, and that precludes me from giving anyone money while I'm there, including change for a vending machine.

2. If complaints are too much, I don't mind writing down my director's name and phone number and giving it to the family. Seriously, give 'em the correct outlet and maybe they'll hushup talking to me about what they don't like, that I can not change.

3. I have no problem telling patients and/or their families that "there was an emergency so I'm behind, I'm very sorry." The night I had 2 GI bleeds and a woman going crazy with a femoral sheath in, nobody got snacks and/or meds on time.

4. Certain things I will NOT do for people, include: lady partsl exam on a patient's pregnant daughter at said daughter's request due to cramps, and for that matter, treatment of family members in general. Good golly. I do tell 'em that I can't be responsible for them if they aren't a patient, and if they need to be a patient, I'll show 'em where the ER is.

5. Some types of patients automatically, in my mind, have me looking to interact with the entire family that is present, and it's just due to the patient's circumstances. Especially young cardiac patients, patients who are obviously dying, pre-open heart patients, come to mind. Maybe I'm biased there. Maybe I just have a soft spot for those families in particular situations, where I ought to be doing more for everybody, but I'm human.

6. I'm really tired of hearing about lilPeanut's box of hoho's.

We all have stories. We all have emergencies that come up and require our full attention, no exceptions. If our patients were expected to be more acute, we might actually be staffed better. It's the unexpected that ties us up in knots, and usually that's when people get bent out of shape about the lack of hotel-style service.

There are family members I've seen that got on my last nerve telling me how worried they were about gramma's breathing and/or her anxiety, and it would be exactly the same as it was before, that is, not a good baseline but not bad either. Until the last time, when she was in respiratory failure and was intubated and shipped off to ICU. At which point I had to tell them thank you for bugging me or we might not have been able to help her.

There are those that you can't please and sometimes it isn't just in the hospital. I was in a restaurant a couple months ago and my waitress was just taking the abuse from some lady who had the worst attitude ... Very nasty tone, nothing was exactly the way she liked it, stated her opinions ABOUT the waitress to everyone within earshot, and that was most of us. Yeek. People like that don't realize that their problem with needing 4 pickles instead of 3 on their burger is not something the rest of the world cares about. They'll come see their family member, and sure enough, I didn't get 'em enough blankets or I looked at somebody wrong, and it'll be a nice, loud, complaint for all to hear, including my manager. It is not a myth that people like this exist, and it is not a myth that we can't please them. Yes, we are all human, but some humans are darned inconsiderate of everyone else. Complaints should not be acted upon if they are frivolous; doing so is equivalent to harrassment.

/rant off

Tweety, BSN, RN · Apr 11, 2007

An RT recently got written up by a family member when he told the family it would be best if they did not smoke in front of the pt anymore, who was in the ER and being admitted for COPD exac. The family claimed he gave them a rude lecture, when all he did was make one comment.

I'm beginning to wonder what you mean by "written up".

When I say "written up", I'm talking about a disciplinary action taken by management and put in your personnel file permanently. This can be done by charge nurses and managers.

Family's, patients, doctors, and coworkers can't write us up. Families complain, most often in person or on the phone, about a multitude of things (99% of which are petty and management smiles and says their sorry and it's thrown in the trash) we do for sure but this isn't the same in my mind as being "written up".