Nursing, the field of medicine or customer service?

[jalvino1]

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?

[LandDRN]

Sort of off topic...but with the ever increasing rise of work place violence on nurses, studies are concluding that the unlimited, open access by visitors is contributing to the rise of this problem. In the "customer is always right" attitude rise, so has there been a rise of workplace violence on nurses. In an attempt to lower this risks, facilities are starting to gravitate back to visitor passes and visiting hours. While I appreciate the views from those practicing 30+ yrs and non-nurse family opinions, the days of unhappy "customers" writing letters to the DON have been replaced with patients/family/friends threatening to harm ( sometimes with weapons present) staff. We had one such incident that turned into a brief hostage situation at our facility. How can anyone benefit from that potential problem?(Incidently, there also has been a rise in reported nurse on nurse workplace violence in the form of bullying and verbal abuse. Great example reading this thread. Nurses are humans with human emotions too and deserve a nonjudgemental place to verbalize their frustrations. There seems to be a cyber shaming/bullying of sorts for those wishes to "let off some steam" amoungst understanding peers. This is a forum for nurses wishing to discuss their issues/concerns/ect.)

[LandDRN]

LOL...I also just happened to note, and be amused, of the posts regarding intrusive/interuptive family members and visitors interfering with nursing duties and care.....they seem to have invaded and provided their opinions on a site provided for and about nursing issues for nurses.

[Wishinonastar, BSN]

Sort of off topic...but with the ever increasing rise of work place violence on nurses, studies are concluding that the unlimited, open access by visitors is contributing to the rise of this problem. quote]

This is interesting, and don't you wonder about the general increase in aggressive behavior eveywhere? I just watched a video the other day on the news about some woman goind ballistic over chicken nuggets at the drive- though. I think it is a result of overpopulation. Too many people causes our aggressive primal instincts to kick in. Remember the days when they had a desk where you had to sign in to visit people? Strict rules, strict times, age limits. Of course it was staffed by little old lady volunteers. Now you would have to have an armed guard behind bulletproof glass...

[lamazeteacher]

Sort of off topic...but with the ever increasing rise of work place violence on nurses, studies are concluding that the unlimited, open access by visitors is contributing to the rise of this problem. quote]

"....wonder about the general increase in aggressive behavior eveywhere?" "..... some woman going ballistic over chicken nuggets at the drive- though." "..... a result of overpopulation. Too many people" ".... Now you would have to have an armed guard behind bulletproof glass..."

It seems to me (as a nurse with almost 50 years of experience in nursing) that people don't submerge their feelings any longer.... possibly as a result of seeing a few too many TV programs with characters leaving nothing unsaid. Also the stress experienced by all of us can become more than "unbalanced" types can bear. There has always been nurse-nurse bullying and power wielding, with irreparable emotional and financial damage done to the victim, many times. Now it seems workplace violence is not contained to memos - think Jet Blue flight attendant!

Always one to initiate change, I believe weapons have no place in hospitals, unless it's held by a prison guard, by an inmate's side. I'm all for metal detectors at all entrances of hospitals. First that became necessary at airports, then schools, now hospitals. We got used to having them there. All of those places have loaded situations, and some (? more, now) types load up when confronted with stress.

I once came across an intimate looking scene on a postpartum unit, at 2 A.M. I started to take the patient's vitals, when the behavior of the young man sitting on her bed seemed a little strange. Usually husbands/partners/baby's fathers are exhausted looking, and they're not particularly amorous, but this well rested looking guy was all over the woman, who seemed resistant. So I asked him to leave the room while I checked her. After he left, the patient confided to me that he was a distant cousin of the baby's father, who just wouldn't leave. She said "he's been there for hours, and makes me uncomfortable". He'd told her that he'd gone to another floor first, and took the stairs to the unit, knowing that her room was at the end of the hall near them.

That was at least 2 decades ago, before cellphones became standard items for nurses, or I would have used one to summon help. When I looked outside the room, he was gone. I ran to the nurses' station and called security, thinking that preventive measures needed to be taken. However that wasn't a thought shared by anyone else. Now it seems that we have to be more vigilant, especially now that hidden weapons have been approved for use. You never can tell when an emotionally charged situation becomes violent. There seems to be more familiarity and less awe and respect for medical environments, these days, which again seems to come from TV programs. Think "Nurse Betty".

A program about personal boundaries needs to be held at the elementary school level, I think. It should continue into High School with age appropriate subjects, including self defense, as well as what used to be called fair fighting, in George Bach's time (the author of the book, "Fair Fighting"). I took a course with him at Berkely, and realized how close rage and love can be, from that.......

[pedicurn, LPN, RN]

Always one to initiate change, I believe weapons have no place in hospitals, unless it's held by a prison guard, by an inmate's side. I'm all for metal detectors at all entrances of hospitals. First that became necessary at airports, then schools, now hospitals. We got used to having them there. All of those places have loaded situations, and some (? more, now) types load up when confronted with stress.

:

I wish our security guards could have weapons ....at least tazers. I work in an inner city ED, in a large Australian city, where we have lots of problems. We frequently have issues with the gangland fraternity.

I am tired of it really ....tired of them and all the issues they bring in to the hospital. Not to mention, their gangland rivals trying to get into hospital to do a job on them. It's a high risk situation for all of us.

Years ago, these people never made it to hospital...they died of their knife wounds or gunshot wounds somewhere else.

Unfortunately we now need weapons, metal detectors and dogs

[lamazeteacher]

Well, so much for my idyllic recall of Australia, the peaceful..... I was there on Christmas Eve, 1984 to Jan. 4, 1985 (when all the banks were closed the entire time! The nice doorman at the hotel where I stayed with my 11 year old son, loaned me $50.) On the flight from Sydney to Perth, there was no security process. When I asked about it, I was told that "here in Australia we don't need that sort of thing". You sure do need the corks on hats to swish away the flies, though. My son adored his, and still has it.

I imagine you have video cameras at work in the stairwells, pedicurn . If you have security guards of higher caliber than those in the USA, and they're burly, trained and licensed, with clean criminal records, I suppose..... it might be OK. But if you have metal detectors at each door leading into the hospital, with the conveyer belt for X-raying all belongings (gifts, approved food, etc.), as airports and courts of law do here, why would security guards need tasers or guns? Of course that whole thing would take funding away from healtyh care. However the gangs might have a lot of money that could go toward that, as they probably deal drugs....

Of course the incoming patients would need to be "frisked", and their belongings placed in a securely closed bag in the ambulance (if possible) before they got in the ER door...... It would be best if everyone had a list of next of kin and their "advance directives" regarding their wish (or not) to have their lives sustained regardless of outcome..... however most people don't keep that on their person.

Perhaps in this electronic age, that might be included with their medical records kept under their private doctor or clinic's names and their own names. Then the doctor or clinic staff members could bug them to get the info included.... Hospital staff should change their photo ID badges with their names, to have electronic approval of their presence there. I wouldn't want a gang member to know my name, which could lead to trouble. I prefer giving my name to patients verbally.

[pedicurn, LPN, RN]

Well, so much for my idyllic recall of Australia, the peaceful..... I was there on Christmas Eve, 1984 to Jan. 4, 1985 (when all the banks were closed the entire time! The nice doorman at the hotel where I stayed with my 11 year old son, loaned me $50.) On the flight from Sydney to Perth, there was no security process. When I asked about it, I was told that "here in Australia we don't need that sort of thing". You sure do need the corks on hats to swish away the flies, though. My son adored his, and still has it.

I imagine you have video cameras at work in the stairwells, pedicurn . If you have security guards of higher caliber than those in the USA, and they're burly, trained and licensed, with clean criminal records, I suppose..... it might be OK. But if you have metal detectors at each door leading into the hospital, with the conveyer belt for X-raying all belongings (gifts, approved food, etc.), as airports and courts of law do here, why would security guards need tasers or guns? Of course that whole thing would take funding away from healtyh care. However the gangs might have a lot of money that could go toward that, as they probably deal drugs....

Of course the incoming patients would need to be "frisked", and their belongings placed in a securely closed bag in the ambulance (if possible) before they got in the ER door...... It would be best if everyone had a list of next of kin and their "advance directives" regarding their wish (or not) to have their lives sustained regardless of outcome..... however most people don't keep that on their person.

Perhaps in this electronic age, that might be included with their medical records kept under their private doctor or clinic's names and their own names. Then the doctor or clinic staff members could bug them to get the info included.... Hospital staff should change their photo ID badges with their names, to have electronic approval of their presence there. I wouldn't want a gang member to know my name, which could lead to trouble. I prefer giving my name to patients verbally.

They guards would still need weapons because the dangerous ones are still dangerous when they don't have their usual knives etc.

Managing these people takes a lot of resources. ED life is frequently interrupted with disturbance of one kind or another from these people.

Many times, I haven't been able to approach a p't and start care until they have been restrained in some way ...usually handcuffed. Or chemically

I think I'm about ready to move to a nice little upscale urgent care clinic somewhere

[Brainiacster]

I love the way that (the more difficult) patients and families are all about their "rights" but never seem to follow their "responsibilities". We actually used to have a placard in every patient's room with said "Patient's Rights and Responsibilities". When we remodeled the unit they disappeared. I have a copy from when I took our son to the ED at a hospital in the same system as I work in...

"Patients have the responsibility to...

Accept consequences for the outcomes if they do not follow the care, treatment, and service plan.

Follow the hospital's rules and regulations.

Respect the property, privacy, dignity, and confidentiality of other patients and others in the hospital.

Respect hospital staff and property and help control noise."

Some people, I really wish I could say "I will respect your rights if you will respect your responsibilities."

These people are probably the same people who feel "entitled" to HC and such...that is, as long as someone ELSE's taxes increase to pay for THEIR cheaper insurance. Unfortunately, that's the majority of the public any more. It's a self-righteous "me, me, me" generation now. People want EVERYTHING, but they do NOT want to pay for it. That's really the bottom line in hospitals too. Patients...er customers...have a sense of entitlement but they do NOT want to pay for the extra care. The very reason staff doesn't have much time to spend with these patients is precisely due to money issues. It's not even the fault of the hospitals; rather, it goes right back to the patients. They do NOT want to pay for their own HC, yet they expect Cadillac service. They're constantly complaining HC is too expensive, yet they can't fathom WHY hospitals don't hire more staff. Folks...news flash: if you want more staff to cater to your every whim, it costs MONEY...and YOU are not willing to PAY for it. You have only YOURSELVES to blame for it. Unfortunately, hospitals are now operating on slimmer margins so are desperately vying for business to the point where they end up enabling such atrocious behavior from patients & their families. No nurse should ever have to put up with this type of behavior. These are the same people who vote for politicians who promise them freebies at other OTHER people's expense. Basically, the Welfare mentality has bled over into the middle class. (Ever notice how self-righteous the Medicaid pts are? The middle class is just as bad any more. It also goes beyond HC. This attitude of entitlement permeates their lives - yet they never want to shell out a dime of their OWN money - they're quite happy to just rip off some stranger to pay for all of this.)

BTW, these will also be the first patients who are SCREAMING about 2 yr waiting lists for elective surgeries if Obamacare is implemented. (Some of these pts will also be shocked to find out their CABG surgery will be considered elective. Yes, that DOES happen in Europe.) Also, they're in for quite a rude awakening when they finally figure out Obamacare is NOT free. In countries such as Germany, the middle class public pays up to 15.5% of their annual salaries for national HC. Can also hear the screaming when the middle class is eventually paying 60% of their income in taxes if the US becomes a socialism. (It's a bit over 60% in countries like Sweden.) These people are letting their own greed override any logic or common sense. They won't figure it out until they actually experience it in a few years. Poetic justice in the end...unfortunately, it drags the rest of us down too. Seems we're on our way to becoming Greece II.