Nursing: The Highly Skilled Customer Service Representative

This article discusses the role of the RN as a customer service agent. It gives an over view of how customer service scores impact and organization and how it impacts individual RNs. Nurses General Nursing Article

Over the course of my nursing career I have heard endless spiels about "customer service" and "patient satisfaction" and the importance of these two things. What no one really explained was how I fit into that equation or what the ramifications of those scores meant to the organization or me personally. With that in mind, I am going to address those things now for all of you.

First, let's define customer service. In healthcare it seems to be this vague, arbitrary term that is interpreted to mean whatever makes the patient happy. Let's be clear on what we're talking about and not taking about here. The phrase "customer service" is an umbrella term that refers to how a person or entity (healthcare facility, professional association, business, individual practitioner) treats the people they serve. By "serve" I mean tending to those who come to us for help, advice, medical care. The phrase "customer service" is not "waiting on people" like a waitress in a restaurant. Nor does it imply that those we serve must be called "customers" rather than "patients." It's the concept not the terminology that matters. The phrase is universal.

I frequently hear things like, "I just want to come to work and do my job" or "I am a nurse not a waitress" or my personal favorite, "Employee satisfaction is going to decrease if I am expected to worry about patient satisfaction." Let's be honest ... nursing is an educational degree that equipped all of us with a certain set of clinical skills and knowledge however, in today's healthcare world, having the degree and skills isn't enough. Healthcare is a customer service industry. Granted, we are a highly educated customer service provider but we still provide a service. Today, being a good nurse also includes being able to provide good customer service. Treating patients and families with courtesy and respect, empowering patients to participate in their decision making, making them feel safe and cared for, providing them with information...all of those skills are part of what used to be called "bedside manner." That was a basic nursing skill because most people went into nursing with the desire to help people.

I've heard nurses say that we do these things "only" for patient satisfaction scores. Of course the scores are tool to measure how well patients perceive their overall care and hospital experience. A patient's perception does play a role in his/her care because we all know that the happier, safer, and more cared for patients feel, the better their recovery; the fewer times they hit the call button; the less inclined they are to initiate a law suit; and the more inclined they are to have good feelings about the facility and it's staff overall. These things are all important to any nurse because it impacts our livelihood. It impacts our livelihood!! I will explain how that happens...

Healthcare reimbursement is decreasing and costs are going up. We can save money on supplies and try to find other cost savings measures, but that will not close the gap. Payroll is around 65% of a healthcare organization's operating budget. With healthcare reimbursement being tied to performance on patient satisfaction scores, of course it will have an impact on payroll and your paycheck. Many organizations have had to freeze wages, decrease educational support, or reduce benefits. Raises cannot be given if there is a decreasing amount of money coming in to the organization.

Every employee is responsible for their piece of "patient satisfaction." Nursing is the single largest work force in the organization and the closest to the patient. We can have a large impact on our patient's perceptions of their care here. That is how you personally fit into this equation and how the organization's reimbursement ultimately affects you personally. Like it or not, the care you give, the attitudes you display, the interactions you have with patients and families have an impact on the scores...the financial health of the organization, and ultimately on your own paycheck.

It's a give/take relationship. It may be one you are not fully invested in or believe you should have to participate in. Perhaps you are feeling like you shouldn't be held accountable for those patient satisfaction scores. I challenge you to find a nursing job anywhere where you are not held accountable. Coming to work to "just do your job" now includes doing a great job with customer service. It does not mean you are a highly educated waitress. It does not mean that you are going to make every encounter positive at the detriment of clinical outcomes. We are never going to make every person happy. It does mean that you need to come to work prepared to spend time with patients and their families communicating clearly and helping those patients and families feel empowered to participate in their care.

Specializes in ICU.

Many have chosen agency or travel nursing so that they can avoid the stupid staff meetings and so they can focus on being highly skilled and highly paid nurses not "highly skilled customer service reps" or management whores.

Don't get me wrong, there are some absolutely fabulous nurses who run their socks off and provide excellent care. I work with some amazing nurses. I'm more concerned with the ones who just don't care.

What is the incidence providing excellent care compared to subpar care? 95/5, 90/10, 50/50, 10/90?

Specializes in ICU.
What is the incidence providing excellent care compared to subpar care? 95/5, 90/10, 50/50, 10/90?

They also have to "run their socks off" to qualify as providers of excellent care.

WTH is the point of this oversimplified opinion piece? Is it a vent as in it is all the nurses fault that HCAHPS are not excellent? Is it a threat to with hold merit increases? Is it to blame low HCAHPS on nurses eating their young?

Let me ask a few questions..

Understaffing for patient acuity exists, yes? If you agree with that, why would you expect good scores? You want to be given a handicap for being short staffed?

I get that many patients/families may be misplacing their feedback on issues that are much less relevant, but if they all came back and said their care was excellent, I guess the short staffing argument would be a straw man, right?

I also believe that short staffing issues existed prior to these current patient satisfaction surveys meaning the same issues existed before, is that correct?

I prefer the saying, "I'm a Registered Nurse. I'm here to save you a$$, not kiss it!"

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
All we want is better nurse to patient ratios so we can take the time to provide the care our patients need and deserve.

I've said that in a meeting that had higher ups..."you can't have good customer service scores with providing good safe ratios" you have to choose.

Tweety's comment made me think of the phrase "fast, cheap and good". You can pick which 2 qualities you want. All three do not exist at the same time.

Specializes in Critical Care.

The bottom line is people are impossible to please! Then management's response is to tie a pay raise or withhold a pay raise for its nurses over patient satisfaction scores. How convenient you then get to save money and make more profit by denying your staff fair pay then have the nerve to blame the staff! Win Win for management's bottom line. Lose lose for the patient's and staff!

You just sound like another cheerleader rah rah trying to make us into stepford nurses! Don't need to hear this crap on my off time! Save it for your own staff that have to listen! Don't try to brainwash the rest of us! This tactic only drives more nurses out of bedside nursing quicker than they would have otherwise left! Don't you get it! We are tired of listening to this crap! We want to be treated with respect to have fair staffing ratio's adequate CNA's that do their job and proper equipment starting with lift equipment!!! Not ******** excuses it's not in the budget while the director holds the budget down to get a nice fat yearly bonus for themselves!

It's nice that management has figured out another way to get their brainwashing crud to nurses when said nurses are off the clock and out of their cold, steely claws.

OP, I am not sure if I entirely believe you are all starry-eyed with exuberant excitement about how this could be a game changer for healthcare if we'd all lie back in the grass and enjoy it. If you are, how cute and oh honey. If you are here to "spread the word", please stop. We get enough of this HCAHPS is the Future crap from our own management. Over and over. On my floor they are taped in our breakroom so we can see our "progress".

You want increased scores? Don't look at the nurses - they can't pull anything more out of their rectums, they've already given about everything. How about cutting back on those C-level bonuses and grand lobby renovations and putting that money into safe staffing? With better staffing and environment, management can afford to be picky about who works there, not just scrambling to hire another warm body to replace the three that just walked out because they can't take anymore of the crap benefits, crap pay, and crap environment. Nurses and aides drive a unit, and yet they are treated like the biggest, most annoying expense on management's sheet. Stop blaming the floor workers for management's failure to provide adequate staff and supplies.

The average American reads at a 6th grade level, can't locate more than 10 countries on a world map, and is 3 months from being financially insolvent. You think they can identify excellent healthcare? Heck no. But they can suuurrrreee tell you about that time the nurse wouldn't give them their dilaudid an hour early, or that time their roommate wouldn't stop snoring, or when the nurse kept changing their bandages even though it hurt. Seems totally reasonable to base a nurses's pay and treatment off of those complaints!

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Tying my merit increases to the impressions of people who have a grade school education and who are so subjective (as stated above) is why I hope never, ever to work in the hospital again. Hell, I could not even go pee without looking at the propaganda crap on the bathroom walls. Yep, posted on the wall were our scores and cheerleader type junk on how we could "please our customers" more.

But I always seemed to lack the tools (working or available equipment), time and adequate staffing to make this stuff happen.....

Enough already..

I am a natural born pleaser---I always wanted my patients happy and well-cared for---- but this crap is ridiculous. Like I said, enough. And like said before me, the management types would do well to learn "HAPPY NURSES equal HAPPY PATIENTS" and that would naturally lead to BETTER SCORES on your feedback. Why don't these administrators EVER get it?

Oh and what about this: NURSES are customers, too? Yep, how about the notion that we are owed the services of housekeeping, pharmacy, lab, ancillaries and management services that are responsive to OUR needs? Let that sink in. See, EVERYONE is a customer and EVERYONE provides a service in the hospital industry.

I was thinking about the reactions in this thread, and it reminded me about mismatch in priorities.

Sometimes when we discharge patients, health teachings will include things like quitting smoking, getting exercise and improving diet. Often the patients we are trying to teach live in a disorganized, chaotic world where survival and getting through the day are priority, and quitting smoking, exercising and eating right are way down the list of priorities in their life, in fact they would love a cigarette about now. Their behavior will not change.

I think there is a parallel with staff nurses. Many of us work in disorganized, chaotic, overworked units where keeping our patients alive and somehow getting through the day is the main priority. We will get to things like customer service only if we can get beyond survival mode. That is all to rare in all too many departments.

Specializes in Family Medicine.
It's nice that management has figured out another way to get their brainwashing crud to nurses when said nurses are off the clock and out of their cold, steely claws.

OP, I am not sure if I entirely believe you are all starry-eyed with exuberant excitement about how this could be a game changer for healthcare if we'd all lie back in the grass and enjoy it. If you are, how cute and oh honey. If you are here to "spread the word", please stop. We get enough of this HCAHPS is the Future crap from our own management. Over and over. On my floor they are taped in our breakroom so we can see our "progress".

You want increased scores? Don't look at the nurses - they can't pull anything more out of their rectums, they've already given about everything. How about cutting back on those C-level bonuses and grand lobby renovations and putting that money into safe staffing? With better staffing and environment, management can afford to be picky about who works there, not just scrambling to hire another warm body to replace the three that just walked out because they can't take anymore of the crap benefits, crap pay, and crap environment. Nurses and aides drive a unit, and yet they are treated like the biggest, most annoying expense on management's sheet. Stop blaming the floor workers for management's failure to provide adequate staff and supplies.

The average American reads at a 6th grade level, can't locate more than 10 countries on a world map, and is 3 months from being financially insolvent. You think they can identify excellent healthcare? Heck no. But they can suuurrrreee tell you about that time the nurse wouldn't give them their dilaudid an hour early, or that time their roommate wouldn't stop snoring, or when the nurse kept changing their bandages even though it hurt. Seems totally reasonable to base a nurses's pay and treatment off of those complaints!

AMAZING REPLY! :yes: