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 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.
thank you.
a couple of things. we don't have one cna per nurse either. we have three to four who split the unit, so one cna will work with two or three nurses. i wish i had a personal cna! also, even though we do have computerized charting, doctors still write their orders in paper charts, by hand, so we still have to try and decipher their chicken scratches. our administrators are also business people, not nurses. we may have a pyxis for prns, but scheduled meds still have to come from the main pharmacy, which is seven miles away, and delivered to the floors via a tube system. so, still we have to wait. even though the rooms are more spacious, whoever designed them should be taken out and shot. just to get to the thermometer or blood pressure cuff on the wall, or reach the oxygen knob, requires rearranging furniture and family members. the point is, this shiny new facility is a facade for the same old crap. the *intent* of the design of this place was specifically to feel like a hotel, not a hospital. everything was designed with the idea of pleasing the "customer" in mind, while convenience for the people who work there does not appear to have been taken into consideration. the administrators make no secret of this. the emphasis is on "customer satisfaction", complete with multi million dollar advertising campaigns. and patients and their family members are eating this up and behaving accordingly. i am not exaggerating. if this is what is happening here, then i am sure it is happening all over the country, and this is what i am hearing from other nurses.
this is what i'm not sure you're seeing, and is the reason so many of us are frustrated.
When you communicate with anyone, it's important to find out and start with things upon which you can agree. I imagine that's what your management had in mind when they suggested that you agree with patients. Progress is made in "baby steps"; and what it sounds like, from your post, is that your objective is to let your patients see how right you are (which implies that they're wrong). Often they're not. Only by walking in their shoes, would you know how they feel. I lost 20# on Atkins, and was none the worse for it.......
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.
I appreciate your reply, lamazeteacher, however, I only gave example of the times I do NOT agree with patients. 99% of the time there are no disagreements, and I listen to the patients, answer any questions/concerns they have, and provide their nursing care, and everything goes great! I'm just talking about the few patients that need a little more direction. There are many ways to communicate with them, and if you can start on something you agree with, they are more apt to listen (I agree with you on that). But sometimes you have to tell them something they don't like. I'm glad the Atkins diet worked for you, however, I do not know if you are a 50+ male with HTN, HLD, DM, and admitted to my unit for atypical chest pain. When I asked him to explain the diet to me (even though I've already known about it), in his words he explained that this is one of the most high fat diets. I would not feel like I did my job as a nurse, meant to promote health and prevent future disease, if I did not discuss his current diet choice and his current admission for a possible heart attack.
I don't look at my patients as customers. Never have and never will. Don't care if that's not PC either. I provide excellent patient care and I'm a qualified and educated professional. I do my best to keep my patients safe, stable, comfortable, and on the road to recovery. I advocate for them when they can't for themselves. I find it insulting to the patients to see them as customers and equate them to people getting an oil change. Focus on them being happy with their meals and pillows rather than on the level of medical and nursing care they receive is absurd.
The priorities are entirely out of whack at some facilities. The emphasis needs to be first and foremost on patient care and our energies should be on our patients not the crazy neighbor complaining she was asked to leave the room while the patient got a foley or the family member complaining they want a meal too and don't like what we have on the menu. Visitors need to realize it isn't about them but the patient. Be respectful of their needs to heal and get better. Let's get the focus back where it should be.
After reading the ENTIRE thread I've come to the conclusion that I'm happy that I work in a public hospital in Australia.
While we get some patients who think they can make unreasonable demands on the nursing staff, they aren't actually paying for their stay in hospital because they are on medicare. So we don't the whole customer service thing, in fact because of our elective surgery waiting lists, lack of beds they are lucky they even have a place to stay in the hospital. Private hospitals are a different matter and I'd never work there for this reason.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
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.
i've been a nurse since june of 1977. and i beg to disagree with you. patients, by and large weren't as sick 32 years ago, nor were they as "entitled." people were grateful for the things you did to help them, families were respectful of the nurse. there were visiting hours. if you have no recent bedside experience, you have no idea how much things have changed. as a nurse who has been at the bedside (with 6 months off for back surgery) for nearly 32 years, i can tell you with authority that press-gainey has changed things for the worse. and that the emphasis now is on "customer service" rather than patient care. and although we may attempt to keep people happier, patient care is getting lost in the scramble for those great p-g scores.
I think in all areas of health care patients are much more demanding now. Not only are they sicker- once upon a time you stayed in ICU for things that they now have same day surgery for!- but they are well informed and anxiously watching you for any possible lawsuit trigger. No one in healthcare is trusted or respected. I see it even in the attitudes towards doctors. They are not considered above reproach anymore. Patients constantly challenge everything they do.
The stresses we once had - low staffing, no breaks, no support staff, no time to do your job correctly, these still exist. Now they are in a highly charged volatile health care environment where everyone is suspicious and most employers don't give a d**n about anything but profit margins which are small indeed.
I work for a hospital, but not at the bedside anymore. You could not pay me enough. I believe nurses need to be respectful and treat patients as they would want to be treated, but I also think that it is a wonder that there are any bedside nurses left. There is just so little to motivate anyone to stay.
WOW, long thread....guess it touched a sensitive nerve.
I didn't wade through all the posts so maybe this point has already been made:
(heard from an extremely competent charge nurse, after smiling at a patient BUT firmly telling him he couldn't have/do/whatever the request was.) Out of hearing of the resident the charge nurse said to me, "I'm here to save his ass, not kiss it!"
I believe we've become so consumer oriented, that we've forgotten about the patients.
A hospital is NOT a hotel. Do I think we should go out of our way to make our PATIENTS happy - absolutely - within reason and within policy and patient safety. It begins to get ridiculous when you've got to get cousin Harry a soda, great aunt Martha some coffee, and a blanket for granddad - and none of these people are the patient!!
Again, if I was having a slow shift, I wouldn't mind a little kissing bum's to make everyone happy, but I am first and foremost there for my patient - like it or not.
I do believe we should have visiting hours - it's damm difficult to schedule complicated dressing changes or bedside procedures when the whole fam damily is in the room and spilling out into the hall!! So I'm 100% behind that. Maybe, just maybe, if we weren't kissing visitiors orifices, we might be able to give better patient care!! How's that for an idea administration!
After reading the ENTIRE thread I've come to the conclusion that I'm happy that I work in a public hospital in Australia.
While we get some patients who think they can make unreasonable demands on the nursing staff, they aren't actually paying for their stay in hospital because they are on medicare. So we don't the whole customer service thing, in fact because of our elective surgery waiting lists, lack of beds they are lucky they even have a place to stay in the hospital. Private hospitals are a different matter and I'd never work there for this reason.
Hey Scrubby, you could not have said it better! I know that this is a little off topic, (but then half the thread has been) there are benefits to a universal healthcare system, even if it means less of the "customer focus".
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Virgo_RN, BSN, RN
3,543 Posts
thank you.
a couple of things. we don't have one cna per nurse either. we have three to four who split the unit, so one cna will work with two or three nurses. i wish i had a personal cna! also, even though we do have computerized charting, doctors still write their orders in paper charts, by hand, so we still have to try and decipher their chicken scratches. our administrators are also business people, not nurses. we may have a pyxis for prns, but scheduled meds still have to come from the main pharmacy, which is seven miles away, and delivered to the floors via a tube system. so, still we have to wait. even though the rooms are more spacious, whoever designed them should be taken out and shot. just to get to the thermometer or blood pressure cuff on the wall, or reach the oxygen knob, requires rearranging furniture and family members. the point is, this shiny new facility is a facade for the same old crap. the *intent* of the design of this place was specifically to feel like a hotel, not a hospital. everything was designed with the idea of pleasing the "customer" in mind, while convenience for the people who work there does not appear to have been taken into consideration. the administrators make no secret of this. the emphasis is on "customer satisfaction", complete with multi million dollar advertising campaigns. and patients and their family members are eating this up and behaving accordingly. i am not exaggerating. if this is what is happening here, then i am sure it is happening all over the country, and this is what i am hearing from other nurses.
this is what i'm not sure you're seeing, and is the reason so many of us are frustrated.
i appreciate your honest response.