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 ER/Trauma.
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.
O.M.G! I could hug you about now! The number of times I've had to call pharmacy for re-stocking my Pyxis (I don't get it. My old hospital did a MUCH better job of re-stocking when we ran out of XYZ meds. Why can't my current place do it without 4 phone calls?! No, I'm not talking about meds that are on back order etc!) or Lab about add-on labs (When I call and say I have add-ons, they say "did you send the lab slip?". When I try and be pro-active and send the lab slip and it is still not running, I'll call and I get asked "well, did you call?" :arghh:)

I'm tired of security not being pro-active when there is/are belligerent patients/family (within audible/visible distance). You don't necessarily have to DO anything - but it does help if you saunter over and keep a closer eye on things!

We will get to things like customer service
[just to clarify - I'm NOT directing the following post at you personally :-)]

Did you go to school to be a "customer service representative"? Does your license say "Registered Customer Service Agent"?

I wrote about this a while back in a different thread:

being a nurse doesn't = 'customer service representative.'

there is no "customer" here - there is however a "patient". call it 'semantics' if you want - but don't cheapen my profession while you're doing so. if you want "customer service", hire a "customer service representative".

and leave "nursing" to the nurses...

- "patient care" doesn't = "customer care".

this isn't walmart. this isn't tgif. this isn't best buy. heck, this isn't even an escort service!

a "customer" is different from a patient.

let us all be kind to our clients

"hello mr. smith. my name is roy. i'm a customer service specialist. i understand you're a client of big healthcare mob. how may i serve you today?"

- my obligation and my duty is for the well being of my patient. not my "customer". not my "client". my patient.

- a good part of that "obligation/duty" involves setting limits on behavior. this involves pts. who are compliant and non-compliant with therapy.

Back then I was dating a girl who was going through nursing school. While helping out with homework, I noticed multiple references in her textbooks to "clients". Not "patients", "clients." It felt awkward when during homework sessions and speaking out loud she kept using the word "the client states..." or "the client is in respiratory distress..."

Some folks think I'm being dramatic. That it's just semantics.

I happen to think that words DO have meaning. For ethical and moral reasons, a "patient" is not the same as a "customer".

If not, why aren't we talking about "customer satisfaction" instead of "patient satisfaction"? There is a "patient bill of rights", not "customer/client bill of rights" (although now that I've said it, maybe they'll change that too. Maybe they'll )

Sure, you can 'rig' the game and have the nurse "script" and say "I'm closing this curtain for your privacy" so that when the survey asks "were the nurses concerned for your privacy", the patient will remember "Oh yes" and check the appropriate box. But what of those nurses who close the curtain but don't say a word and the patient responds negatively - is the standard of care any less? Wasn't the patient's privacy protected equally?

You don't need a "patient satisfaction score" to ensure compassionate treatment of your patients from your nurses. You need compassionate nurses not weighed down by 900 bureaucratic requirements and competencies and mandatory meetings and double-charting. You need management to stand up to the idiots who came up with the rule that Betadine cannot be stored in a LOCKED cabinet in a patient room because it is a "medication" and needs to be in a "medication room" and not a "patient room because it is a treatment area" and tell them to piss off!

Nurses are more than SICK and TIRED of useless micromanagement. I can take care of a sick, septic patient with a pressure in the toilet, on multiple pressors and CVP monitoring while in therapeutic hypothermia - but I won't be allowed to sign up for my next shift unless my annual glucometer (the SAME machine we've used for the last 10 years!) re-cert isn't done!

You need to hold doctors more accountable for the stuff they are truly responsible for - at the very least, placing legible, sensible orders. Actually talking to patients and families and addressing their questions and concerns (and not say stuff like "I'm tired of their nonsense. I don't want to deal with them.") And no, I get it, everyone has their bad days - but ask any nurse and s/he will tell you there are some who have "constant bad days." If they want me to do their job for them, I want a cut of their paycheck.

If YOU want ME to buy into this "patient satisfaction" model*, then YOU have to buy into this "nurse satisfaction" model. Because I guarantee you, 'Happier Nurses = happier Patients.')

My $0.98 cents (adjusted for inflation - and which I'm told, with my nursing license will buy a decent cup of coffee at Starbucks)


* : I obviously don't buy into the "patient satisfaction model" - even if it is going to be "this is how things will be done from here on." I DO think it needs to be not only resisted, but actively FOUGHT. And I hope you Managers and Directors and Upper Management will join us in restoring some common sense to our healthcare fiasco.

PS: Please stop buying us "stuff" for "Nurses Week." I'd rather you put some extra cash into our bank account, or a "gas card" or something equally useful. And if you REALLY liked what we did over the year (unit based obviously), a bonus or an 'incentive break' for vacation would be well and truly appreciated!

Specializes in ICU.

Lawyers and escorts have clients. Nurses have patients.

Lawyers and escorts have clients. Nurses have patients.

LOL! I think part of the trouble with using clients instead of patients is that professionals who have clients try hard to keep them coming back for repeat business. If nurses are doing our jobs as well as we can we should be trying to keep them from coming back over and over!

Specializes in Family Practice, Med-Surg.

The highly skilled customer service representative

I have been on the other side of the fence this week and it always makes me a better nurse. My husband became seriously ill in the last 10 days. We don't have a diagnosis yet, but he most likely has non-alcoholic cirrhosis of the liver and perhaps cancer. His health is deteriorating rapidly. We had to go to a large medical center out of town for an MRI today.

First of all, my children and I (two physicians and a pastor) are totally blown away by the diagnosis. He has become very weak and needs assistance with his ADL's. He has become so weak in 10 days he needs a wheelchair to get from place to place in the hospital.

First, parking was a pain, even though I thought I was prepared. The MRI techs complained that my sedated benzodiazepine-naive claustrophobic husband kept falling asleep and they "couldn't get good pictures" and the radiologist would "see what he could do" when he read it.

On the other hand, I was stopped several times and asked if I needed help when I looked lost. Most of these kind staff members were physicians.

Just remember who your customers are. Often they are very ill, frightened people who are naive to the medical system. I can't imagine going through this if I wasn't a seasoned nurse and NP.

Specializes in Med-Surg.

Hospitals will never pay enough to have a nurse to patient ratio that would allow the nurse to actually be able to do their job at the high standard we are held to. Such a ratio would be so ridiculous that administrators would laugh.

Last week I somehow ended up having only 4 patients on my med surg night shift. Usually we have 5-6. At around 02:00, I was taking an elderly post op patient to the restroom who kept apologizing, "I am so sorry you have to help me, I don't want to be a bother, I know you are busy". As I reassured the patient that I had the time, was not busy, and was doing my job ("this is what I am here for"), I had a realization- I actually DIDN'T have anything else to do for once! No patients waiting for pain medication, antibiotics to hang, no assessments to chart, no one else ringing... I was completely caught up. It was a wonderful moment because I was able to truly attend to this patient without having to rush with fifteen other things on my mind.

I can't remember least time I have said, "is there anything else you need? I have the time!" without having been lying through my teeth. I said it to this patient, I meant it, and I left that room feeling fabulous. That night I did my job and in my heart knew I did it well.

1:4 as a standard would never happen on med surg, ever.

I won't list all of the examples for which "patient satisfaction recovery" is impossible. At least 1/5 of my patients are completely impossible to satisfy, with unrealistic expectations. These could be the drug seekers (for whom the only dose of narcotics to satisfy them would also be lethal), the manipulative personalities (admitted each month), or the CEO's daughter (VIP's), ect... There are always going to be patients who you can't please, no matter how above and beyond you try. Kiss their press ganey goodbye as soon as their room is assigned to your unit.

Some of our press ganey results are completely laughable and ridiculous. I will share one- poor ratings, and the expectation that "we need to invent wireless pulse oximetry monitoring and oxygen tubing, because in this day and age with technology it's unacceptable to have all these lines and wires attached". WIRELESS oxygen tubing!!! I would be a billionaire if I could figure that one out.

This whole topic is depressing. The only real solution is better staffing, to the point that it's a fools dream.

I am going to continue to do what I do- which is to truly give 100%, to the point that there is nothing left in me.

Any administrator needs to work four weeks on the floor (now, not ten years ago) before I would believe any single thing they say about "customer service". You are paid a lot more than me, you are certainly higher educated than I am, but you are ignorant of what I have to do on any given shift for twelve hours. Research all you want and put together an article with lots of action phrases and cheerleader optimism, but it means nothing to me unless you have worked the floor recently.

Specializes in Med-Surg.

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.

But I don't have the time. As you so clearly explained, 1/3 of my time is charting. This, after patient safety and care, is an incredibly high priority for me. If it's not charted then it's not done. If I'm called before the BON or brought to court, my charting is what I rely on. As for reimbursement? I need to chart that I called the doc about scds/vte prophylaxis so we don't have a core measure fall out. Now I better not forget to document that I've applied those SCD's! Charting actually probably takes up more than 1/3 of my time.

So I now have 8 of 12 hours to do patient care, since 4 hours is charting. I have 5-6 patients, that's a max of 96 minutes per patient for the entire shift (if I have 5 patients, less if I have six). I have medications to administer, orders to review, doctors to call, and I have to pee at some point. Everything I do I need to double check. SAFETY is the number one priority. Hourly rounding? Patients need to sleep? I need to eat lunch? Patient unexpectedly codes? Where do I have time for all of this??

96 minutes MAX for each patient out of 12 hours, not including the unexpected or a bathroom break/lunch break for myself. Think about that for a while. 1.5 hours total a shift. Do the math.

You (administration in general) are asking us to do more and more, but are in denial about the TIME we have to do it. Find a solution. Adding more responsibility and tasks without more tools and resources is NOT the answer. A cheerleader pep talk with buzzwords is insulting, and truly shows how out of touch you are with what WE do in twelve hours.

Any good nurse or halfway decent person understands kindness and compassion, and will use that when interacting with people/patients. I don't have the time to go above and beyond. I give 100%, but literally can't give more than that.

Added this after thinking more-

OP article said a lot about what nurses need to do and what customers/patients need from us. What will YOU do (as an administrator) to help ME do this? What do NURSES need? You said "like it or not" customer service model is here. So... What are you going to do to help? This pep talk isn't working. Find a new solution.

This is my strong suit - I was built for this game !

Oh, I must say this is a good one. Over the years , I have become an expert at ,"Giving the people what they want ! " My hospital loves me for it too ,and have received multiple awards in the past. The secret is pass the buck after trying to explain once and only once-Yes ! For example, pt asks , " Can I smoke weed in here ? " My response is ," Hold on -let me find out ." See the key words , "Hold On ". I never said ,"No" . Get someone else higher up to explain policy and tell them ," No ". Try this one as an answer , " Let me go see ." . When it's all said and done , the surveys/letters are more important than even the care you give. My Super Magnet Teaching hospital will take a wonderful survey , instead of infection prevention any day. Matter a fact , we better kiss the pts family and friends ______ too. So many times , I have seen great nurses get punished for rightfully promoting policy . So , in the end , be on time , say nice crap in meetings , and give the people what they want all with a smile - you will be a Titan .