I'm sorry, but I didn't realize I signed up to please the customer. While the nurses go around reminding the patients this is a hospital, not a hotel, we get notices that we SHOULD make these people feel like they're in a hotel. Or "even if you know they're wrong, you should apologize and let them know that they're right" THIS IS AN ACTUAL MEMO THAT APPEARED IN MY MAILBOX.
... oh but it gets worse.
I got tapped on the shoulder by the "hospital customer service rep" telling me this patient (customer) really really wants a milkshake and would really make her day if she could have a milkshake. And I tell this rep this patient just had a bowel resection yesterday and not only can she NOT have a milkshake, but she probably can't even have water, even ice, for the next couple days. I spend all day listening to this patient whine and complain, and now the hospital has provided her a rep to follow me out in the hallway to whine and complain. And neither of them can admit that although a milkshake would make the patient really happy for about 15 mins, going back to surgery and prolonging the recovery would not. I know there's a lot of things in the medical field that seem downright cruel. But if we go by "the customer is always right" keep the patient/customer happy, there will be consequences.
Should customer service be #1 priority? Or am I just being delusional believing that patient safety is more important than patient satisfaction?
I have been doing this for 32 1/2 yrs, and when I started it was 8 hr shifts and restricted visiting hours. Everyone had to leave by 9pm, the front doors were closing and being locked. The only ones allowed to stay were parents of the pediatric pts, and rules were bent for the dying pt. My manager decided that we would no longer have closed visiting hrs when she went to visit her sister in ICU in another hospital and BARGED her way in...when she came back to my hospital she made a big deal out of stopping visiting hrs. From that day on (19yrs ago) we have had open visiting hrs and it has been a living hell!! We have families that love to tell us how to do our job, "my husband/wife/mother/father is in severe pain why don't you do something?" when we ask in front of them the pt says NO, to the families that won't leave no matter what. We had a pt on a ventilator that the dtr would remove the vent and see how long it took for us to get into the room to reconnect her saying "it fell off," she had the nerve to report us to administration, atty general, and the state board of nursing....documentation saved us there. Or the pt that came in and the family camped out in the room, hallways, and waiting room so they could be here to tell us how to care for mamma. They went to our manager, so did we, and the doc too...what came out of it you might ask?? We were told that we had to be nice to them because the pt was sick and they are OUR customer!!! The doc complained to us to do something about the family and supported us at the desk but when it came to the family bombarding the doc all of a sudden we were the enemy. We even had 1 doc write an order that 2 family members can visit twice a day...that didn't stop them, in fact they came in and camped in the room even more. This went on for over a month, and we were told that we weren't friendly enough toward the family by administration. Where does the nurses fall into customer service in this situation? I am all for having family in the room if they are a calming effect on the pt; but when you start to dictate how to do my job, get in the way and refuse to move or leave when I need to do care, and won't let the pt rest then you need to leave and not come back the rest of the night. Everyone knows, or should know, that the body needs uninterrupted sleep at night in order to heal and regenerate....but for some reason families turn dumb and administration turn a blind eye to what the families are doing...then wonder why nurses leave. duh!!!!
Specializes in Telemetry, Home Health, Geriatrics.
As a former customer service manager in outpatient healthcare, soon to be RN, I see this from both sides. First it is absoulutely imperative that RNs are able to provide safe care. At the same time, families need to be together, and the patient needs to feel "cared for" not just "taken care of". Yes, we have to say NO sometimes. Often it is how you say it more than what you say and if you can offer alternatives. I know this doesn't always work (like the milkshake or an NPO pt). I have had to teach MANY healthcare staff HOW to 1. Depersonalize the pts anger...usually they are upset with the situation, not you and 2. How to respond (even say no) in a way that doesn't further escalate the situation. Sometimes pts just want to be heard and understood and feel some sense of control over their lives and dignity.
Yesterday, I was assisting with a pt who came to the outpt Heart & Vascular unit to prep for a port insertion. She was a 30yo single woman, just dx with breast cancer. She was obviously very angry and the RN who started her prep was complaining about her attitude. She was asked several times if she needed anything and she simply refused. After a few minutes, my preceptor and I went back in a took her a food box wrapped for her to eat (post-procedure) because she wasn't coming back to the floor. (Not something we have to do b/c she leaves directly from the IR...the trays are really for pts on 4-6 hrs bedrest post proc, but we always get 1-2 extra. We spent a few minutes (5-10) talking to her and the bottom line is the staff at the doctors office told her she would only be there for about 45 mins (thats the procedure time not the total arrival, labs, prep & proc time...more like 3-4 hrs) so she didn't have any family with her and the down time was giving her to much time to think and begin to have self-pity. Just a few mins of talking with her, let her know that we cared and lifted her spirits (these interactions are one of the main reasons I dedided to become a nurse).
Lastly, with regard to visiting hours, I agree that there need to be some restrictions. Like only one overnight visitor (maybe 2 for the elderly pt whose spouse is also elderly and may need assistance) and a maximum number of visitors in the room at one time, based on acuity and specialty.
I am in NOLA and just saw a shirt in a shop that said "Hello, I am your nurse I am here to save your a**, not kiss it". ALso another great one "H is for HOSPITAL, not HOTEL" Enough is enough, we are short staffed, have unsafe pt loads and getting sodas, coffee and juice for the pt's family members, and kids or making milkshakes for pt's that should not be drinking them is absurd.
Specializes in med-surg, teaching, cardiac, priv. duty.
wow. i guess i am just some kind of dinosaur or something. i too remember doing pm care and giving backrubs but i remember it a bit differently. i remember how much all of my patients appreciated it. i remember how much more relaxed they were, how much better they seemed to sleep, how much better their pain meds worked. no, i'm not a massage therapist, i'm a nurse. on my license it says that i am a "registered professional nurse" and that's how i see myself. that includes doing whatever kind of personal care will help my patients get better...not just the high tech stuff though that is certainly important.
i'll share something else too: when i was a patient last summer i would have loved having one, just one, nurse who care enough about my wellbeing to even offer to do something simple like give me a backrub. unfortunately, the nurses who "cared" for me were much too busy looking after my iv pumps, etc. so busy in fact that they failed to ever assess my lungs adequately. they also managed to make several major medication errors and did not control my post-op pain. btw, this was in a hospital that is "one of the top 5 in the us" according to recent news reports.
i've been a nurse almost 18 years. i left the hospital setting 4 years ago. one of the reasons i left was guilt over not having time to give pts the proper care, and do little things for them like backrubs. yes, in my last few years as a hospital nurse, i would have liked to have given pts back rubs but... i saw a lot of changes over the years. hospital patients in general became much more acute, yet the nurse to pt ratio stayed the same. i usually had 8 pts on average and increasingly none of them were "walkie, talkies" - they were sick, higher acuity patients. it would be rare to have a night where something did not go wrong - someone's bp bottoming out, a re-occluded heart stent and transferring the pt to ccu, wacky heart rhythms, crashing blood sugars, etc. it was all i could do to properly monitor/assess the patients, deal with emergencies, pass the meds, hang iv's, etc.
give a backrub??!!!???!!!! yea, right!!!! i was too busy!!
hmmm....deal with the pt in 3rd degree heart block or give a back rub? take care of the blood sugar that is 20 or give a backrub? hang the cardizem drip for uncontrolled a fib or give a backrub? sorry, no back rubs!
quote: "i'll share something else too: when i was a patient last summer i would have loved having one, just one, nurse who care enough about my wellbeing to even offer to do something simple like give me a backrub."
this hurts. i did care! i would have loved to have given each pt a backrub but simply no time if safe nursing care was going to be given. this is one of many reasons i left hospital nursing. add to that demanding families who wanted "customer service" which i had no time to offer...grrrrr.... i ran from the bedside screaming. i could no longer do the impossible and work incredibly hard, only to have people say i did not care or complain that their pillow was not fluffy enough, that they didn't get a back rub, or they did not have fresh ice in their water jug. how about being thankful that i promptly hung your cardizem drip and kept you from going back into rapid, uncontrolled a fib??
Did I say it was the nurse's fault? Or am I always supposed to simply assume it was 100% the family member's fault?
People typically have a reason, sometimes valid and sometimes not, for being leery. Seems to me that a little self-review of how we as nurses come across to family members in a particular situation isn't a bad thing.
Apologies for replying so late but I didn't notice your reply until today.
Your original response was an imagined scenario that bore no weight whatsoever. After a little self review, I'm sure you can see that.
Nurses tend to be an oppressed group and the manner of your post reminded me of the way women were treated in the 1950's and before. For example, imagine the battered wife with a broken nose, broken ribs etc. in hospital and the police ask "What did you say to make your husband so mad he would beat you up like this"
Your response sounded as if you were a management tool of the system that beats down and oppresses nurses.
now that's what family members could do - back rubs! however, they'd probably complain that it's what we're being paid to do, if we suggested it..........
in fact it is what my family members did, in addition to monitoring my medications, my respiratory status, my pain status, and making sure my iv didn't run dry. oh wait, isn't that all what my nurses were supposed to be doing?
...this hurts. i did care! i would have loved to have given each pt a backrub but simply no time if safe nursing care was going to be given. this is one of many reasons i left hospital nursing. add to that demanding families who wanted "customer service" which i had no time to offer...grrrrr.... i ran from the bedside screaming. i could no longer do the impossible and work incredibly hard, only to have people say i did not care or complain that their pillow was not fluffy enough, that they didn't get a back rub, or they did not have fresh ice in their water jug. how about being thankful that i promptly hung your cardizem drip and kept you from going back into rapid, uncontrolled a fib??
this is not a personal criticism of you but my own experience with nurses on all shifts, all days in the hospital iwas in. thankfully i did not personally need a cardizem drip. what i did desperately need and did not receive was adequate pain control after major abdominal surgery. i also needed my lungs assessed and appropriate intervention taken but that didn't happen without strenuous intervention on the part of me and my family. i am quite sure that we were all labeled as difficult by the nurses who were not doing their jobs and that doesn't hurt my feelings one little bit. a patient should not have to threaten to call the jcaho in order to get an individualized pain control plan, rather than being told "it's not in our policy" when there is a physician order in the chart to give a medication immediately post-op. these same "professionals" also told me a great deal of hipaa protected information about my roommate.
what frightens me is that there are many patients every day who do not have the benefit of many years of experience in the heathcare environment, do not know their rights or what should be happening and so do not know how to protect or advocate for themselves as i did for myself and my family did for me. this is why family members want to stay in the hospital, because they have heard the same horror stories on 48 hours and 60 minutes that we have.
what truely saddens me is that there seem to be so many nurses who resent these family members who are only trying to care for their loved ones the best way that they know how. a big part of our job as nurses has always been and continues to be to advocate for the patient and their support system. florence nightengale wrote about this in her book "notes on nursing" which, by the way, is still very pertinent in 2009 if you read past the part about chamberpots!
I think the point here is that this trend toward "customer service" is hurting patient care.
Our brand new hospital is gorgeous. It looks like a resort. In fact, our brand new state of the art hospital was designed by an architect that designs....you guessed it, hotels! The patient rooms are all private and have day beds for family members to spend the night. There are no visiting hours. The patients and family members love it.
Our med rooms are closet sized, and nothing is easy to find. It takes far too long to find the supplies you need in order to do just about anything, because the supplies are all scattered between the clean supply room, the med rooms, and the nurse servers in the hallways. The halls are so long, you can look around and be the only nurse in sight. The clean supply room is a long hike, just to get a warm blanket or a new gown, and nothing is ever where it makes sense for it to be. It takes five minutes for the code team to arrive to a code, because the hospital is so huge. Add to this that administration wants to increase our patient to nurse ratio for our heaviest, sickest patients, and they are cutting staff. Our requests for time off are being denied because they "just can't take us off the schedule", and to top it off, the break room where we're supposed to get a few minutes to nourish our bodies and minds is a windowless hole not much bigger than the med rooms, while the family waiting rooms are full of plush furniture, coffee, tea, a computer with internet access, and a flat screen plasma TV.
And this is a "good hospital", and we are union. I can't imagine what kinds of hell holes the crappy hospitals with no union support must be.
Yes, the "customers" love this shiny new hospital, but if you ask any of us who work there......in the name of "customer service", we have to smile pretty and pretend it's the best thing since sliced bread, and ask what else we can do to make them more comfortable, since we have all the time in the world.
Now imagine you're running your butt off, doing the best you can, getting no CNA support, being told by your charge nurse to "suck it up", and you have family members camped out, demanding your attention constantly over little things like their stable Grandma being cold or needing fresh water, when you've got another patient in distress, one with an arterial sheath on frequent monitoring, one in extreme pain and blood pressure through the roof, and your charge nurse is trying to hand you an admission slip.
THANK GOD I don't work Med/Surg. They don't have telemetry, their patient loads are higher, and they have all those PCAs, TPN, and fresh postops. Those nurses deserve credit simply for keeping their patients alive.
Now, this may not have been the case during your hospitalization. But please understand why some of us become so defensive by the tone of your posts. They just seem so darn sanctimonious, as if your individual prejudices are showing.
ETA: I think that those of us who are angry about this deserve a little credit, because if we didn't care about our patients' well-being, we wouldn't be so angry. The fact that I am angry about this proves that I give a crap about my patients, thankyouverymuch.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
now that's what family members could do - back rubs! however, they'd probably complain that it's what we're being paid to do, if we suggested it..........
back rubs, foot rubs, feeding the patient, fluffing his pillows, readjusting his blankets, changing his tv station and telling him what the weather is outside. family members can do all of those things instead of putting on the call light to demand that the nurse do it, never mind that her other patient is being intubated right now. but t hey seem to be able to use the call light ok . . . .
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
lecturing, admonishing, and belittling others is abusive! the objective of any nursing measure is to help a patient feel better, physically, emotionally, and in their own eyes. if you have trouble with that, you might look into working with unconscious patients - like or, neuro, etc.
lecturing, admonishing and belitting others is abusive. the objective of a vent thread is to allow each other to vent. a little humor, or perhaps a heartfelt "i feel your pain" helps our colleagues feel better physically, emotionally and in their own eyes. if you have trouble with that, you might look into skipping the vent threads.
I love those shifts where I have time to cater to the patients' every need. It means my patient load is manageable, everybody's stable, I'm actually going to be able to sit down and analyze my patients' rhythms (the reason they are on our floor in the first place) instead of praying that the monitor tech will call me if anything happens. Family members can provide a great deal of comfort to the patient, and I have no problem taking care of them too, getting them a sandwich or a cup of coffee...when I have the time and nobody is trying to die on me. People just need to realize my job is to keep patients safe, first and foremost, and that being a waitress is way down on my priority list. I think this "customer service" trend minimizes the role of the nurse to that of handmaiden, not licensed professional.
i think the point here is that this trend toward "customer service" is hurting patient care.
our brand new hospital is gorgeous. it looks like a resort. the patient rooms are all private and have day beds for family members to spend the night. there are no visiting hours. the patients and family members love it.
our med rooms are closet sized, and nothing is easy to find. it takes far too long to find the supplies you need in order to do just about anything. the halls are so long, you can look around and be the only nurse in sight. the clean supply room is a long hike, just to get a warm blanket or a new gown. when we first opened, it took two hours to get an amiodarone drip for a patient who had been coded from the main pharmacy, which is not on site. it takes five minutes for the code team to arrive to a code, because the hospital is so huge. add to this that administration wants to increase our patient to nurse ratio for our heaviest, sickest patients, and they are cutting staff. our requests for time off are being denied because they "just can't take us off the schedule", and to top it off, the break room where we're supposed to get a few minutes to nourish our bodies and minds is a windowless hole not much bigger than the med rooms, while the family waiting rooms are full of plush furniture, coffee, tea, a computer with internet access, and a flat screen plasma tv.
and this is a "good hospital". i can't imagine what kinds of hell holes the crappy hospitals must be.
yes, the "customers" love this shiny new hospital, but if you ask any of us who work there......we have to smile pretty and pretend it's the best thing since sliced bread.
now imagine you're running your butt off, doing the best you can, getting no cna support, being told by your charge nurse to "suck it up", and you have family members camped out, demanding your attention constantly over little things like their stable grandma being cold or needing fresh water, when you've got another patient in distress, one with an arterial sheath on frequent monitoring, one in extreme pain and blood pressure through the roof.
now, this may not have been the case during your hospitalization. but please understand why some of us become so defensive by the tone of your posts. they just seem so darn sanctimonious, as if your individual prejudices are showing.
i do understand. but things were no better "way back when", just different. we had more patients jammed into smaller spaces plus family members camped out in chairs. we were trying to manage iv pumps and any other equipment we could squeeze in behind all that. when i was first out of school, i worked on a primary care neuro floor. that meant we nurses each had 6 patients for whom we did absolutely everything. if we were lucky there was a na or an orderly who could help us lift or do a bath but that was 1 for the entire floor not 1 per nurse. we didn't have computers, we did everything on paper which meant of course trying to read a dozen or more different different mds hand- written notes and orders. there was no pyxis, meds had to be brought up from the pharmacy individually when needed. we mixed most of our own ivs and antibiotic drips. getting the picture? so yes, i understand. and staffing issues with administration has always been an issue. back then the difference was that most hospital administrators were business people or mds. no chance that a "mere nurse" would ever reach that pinacle of success so it was pretty rare to have anyone topside who had ever had boots on the ground no matter how long ago. the more things change, the more they stay the same. the only way that anything will improve is if we can all just believe that we all have hard jobs but no matter what the patient comes first...that is, the person patient, not the patient as dysfunctional medical machine.
dede1956
70 Posts
I have been doing this for 32 1/2 yrs, and when I started it was 8 hr shifts and restricted visiting hours. Everyone had to leave by 9pm, the front doors were closing and being locked. The only ones allowed to stay were parents of the pediatric pts, and rules were bent for the dying pt. My manager decided that we would no longer have closed visiting hrs when she went to visit her sister in ICU in another hospital and BARGED her way in...when she came back to my hospital she made a big deal out of stopping visiting hrs. From that day on (19yrs ago) we have had open visiting hrs and it has been a living hell!! We have families that love to tell us how to do our job, "my husband/wife/mother/father is in severe pain why don't you do something?" when we ask in front of them the pt says NO, to the families that won't leave no matter what. We had a pt on a ventilator that the dtr would remove the vent and see how long it took for us to get into the room to reconnect her saying "it fell off," she had the nerve to report us to administration, atty general, and the state board of nursing....documentation saved us there. Or the pt that came in and the family camped out in the room, hallways, and waiting room so they could be here to tell us how to care for mamma. They went to our manager, so did we, and the doc too...what came out of it you might ask?? We were told that we had to be nice to them because the pt was sick and they are OUR customer!!! The doc complained to us to do something about the family and supported us at the desk but when it came to the family bombarding the doc all of a sudden we were the enemy. We even had 1 doc write an order that 2 family members can visit twice a day...that didn't stop them, in fact they came in and camped in the room even more. This went on for over a month, and we were told that we weren't friendly enough toward the family by administration. Where does the nurses fall into customer service in this situation? I am all for having family in the room if they are a calming effect on the pt; but when you start to dictate how to do my job, get in the way and refuse to move or leave when I need to do care, and won't let the pt rest then you need to leave and not come back the rest of the night. Everyone knows, or should know, that the body needs uninterrupted sleep at night in order to heal and regenerate....but for some reason families turn dumb and administration turn a blind eye to what the families are doing...then wonder why nurses leave. duh!!!!