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What can nurses do about the perception of nursing?

Part II of a three-part series on nurses and how we are perceived by the public vs. how we are treated by the public. I will also offer some thoughts on how the "customer service" philosophy of care has impacted nursing culture, and changed how we perform our jobs.


  • Long Term Care Columnist / Guide
    Specializes in LTC, assisted living, med-surg, psych. Has 26 years experience.
What can nurses do about the perception of nursing?

I'll never forget the night I first became aware of the utter disregard some members of the general public have for nurses and ancillary staff. It was also to be the first of many times that I've fought back.

I was fresh out of school, working graveyard shift at a local nursing home. The medication aide and I were on our last rounds at 0600 when an A & O resident---a nasty man with an even nastier disposition and a long history of attacking staff members---suddenly and viciously kicked her in the stomach.

"Get outta here, you ****," he growled as the air went out of her in a 'whoof!' and she slammed into a wall. "And you can take these pills and....." There was more in the same vein, but after making sure the CMA was okay, I turned on the resident in a fury.

"How dare you," I hissed. "You might get away with that if you had dementia. But you don't, and so help me God, I'm going to call your daughter and tell her about what you just did, and then I'm going to do whatever I can to make sure you're removed from here and into the gero-psych unit where you can't hurt anyone. You do not have the right to abuse my staff. Got it? GOOD." Then I turned on my heel and stalked out of the room.

The man never so much as laid a finger on another staff member until he died a year or so later. He was still prone to cursing us out for any reason or no reason, but as far as I knew he didn't kick, bite, punch, or otherwise physically harm anyone again.

Of course, this happened a long time ago, and not only did I get away with telling off the resident, my DON actually congratulated me for taming the beast, at least somewhat. What's sad is, the actions I took with him would get me fired today---even though he was a cognitively intact S.O.B. who'd hurt my med aide on purpose---because I was guilty of "poor customer service".

Now, I'm all about making people comfortable and happy whenever possible, and I've been nursing that way since long before the current Burger King philosophy of care came into vogue. But I draw the line at subjecting myself or my staff to physical battery or verbal abuse by patients or family members who are alert and oriented and thus know what they're doing and/or saying. I will not tolerate being assaulted, having objects thrown at me, or getting clobbered by anyone who does not have an excuse such as dementia or mental illness. I may not reciprocate in kind, but I WILL make it understood that I am not a punching bag.......or a garbage can.

Why, then, do nurses as a group allow such things to happen? And what has occurred in nursing culture that prevents us from doing our jobs without the constant fear of being threatened....or disciplined for a lack of "customer service" skills?

Part of it, I believe, has to do with the fact that society in general has become more coarse over the past 40 years or so. Just walk down the average city street and you'll hear swear words routinely that once were saved for the end of the argument, if used at all. Little kids now watch TV shows and movies that would have been rated 'R' when I was young. And the words "please" and "thank you" seem to have fallen out of favor, and replaced by "I need" and "I want".

But I think the majority of nurse abuse has to do with the entitlement mentality that seems to have taken over the healthcare industry in the early 21st century. Patients and their advocates no longer seem to believe that they should have to wait for anything. Managers, driven by the need to keep costs down and Press-Gainey scores up, push nurses to work harder (and take more guff) for fear that patients will go to a different facility for their care. Even co-workers, who should be on the same side, often will turn on each other and report their colleagues for minor offenses that generally do nothing to detract from patient care, but make life on the job miserable for everyone concerned.

What is the average nurse to do?

In the third and final installment of this series, I'll discuss the necessity of demanding---yes, demanding---our right to practice nursing in a culture of respect, not only for ourselves and our patients, but for each other.

Long Term Care Columnist / Guide

I'm a Registered Nurse and writer who, in better times, has enjoyed a busy and varied career which includes stints as a Med/Surg floor nurse, a director of nursing, a nurse consultant, and an assistant administrator. And when I'm not working as a nurse, I'm writing about nursing right here at allnurses.com and putting together the chapters for a future book about---what else?---nursing.

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TheCommuter, BSN, RN

226 Articles; 27,608 Posts

Specializes in Case mgmt., rehab, (CRRN), LTC & psych. Has 17 years experience.

Thank you for this straightforward article. You spoke the truth with no frills!

People do not think twice about disrespecting the nurse because they know that many of our employers discourage pressing charges. However, these same clowns would be readily kicked out of any other place of business for acting in a menacing manner toward the bank teller, theme park worker, flight attendant, or cashier.

I can assure any one of you that the bank teller will not continue to serve the rude customer who threatens physical violence. Security is going to escort the customer out of the building before anything jumps off. Healthcare facilities need to get with the program and adopt a zero tolerance policy against workplace violence.

Also, battering any healthcare worker needs to become a felony.


7,735 Posts

Specializes in retired LTC.

Thank you Viva and Commuter for speaking the truth. I think what distresses me the most about this attitude is that it is WE 'oldsters' who seem to be the ones so tuned into this disturbing change of public perception and treatment. The newbies are too much still in their 'poor me' mode and have not yet seen and/or been on the receiving end of this phenomenon, or they just don't recognize it. The number of us still on the front lines are on the decline and I don't see it changing in the future as it it stands now. Just my observation!


4 Articles; 167 Posts

As a fresh nursing student with previous experience in retail, this article definitely makes me think. In retail, it is so true that we are supposed to act as if the customer is always right, even when they are wrong. The goal is to placate to the extreme so that the customer comes back to spend more money. Thankfully, as a sales person I have usually been able to leave it to the manager to smooth out the situation. I really don't know what the real world of nursing will look like for me yet, but I have been observing how people treat medical personnel whenever I am in a healthcare setting, and it is kind of scary. In the past decade it just seems like "manners" have gone out of fashion. People have forgotten how to say "Please" and "Thank you." Now it's "gimme this, gimme that" etc. It's exactly what you said... entitlement. I think it's worse some places than others, but the overall trend is the same everywhere.

nyteshade, BSN

553 Posts

Specializes in Legal, Ortho, Rehab. Has 20 years experience.

Right on! Nurses everywhere must protect and advocate for themselves. Nurses (and other staff) must learn how to press charges if they are attacked...it is their right. Would a physician or hospital CEO take that treatment? No facility can tell you otherwise. No one will do it for us. I can't stress this enough.

iluvivt, BSN, RN

2,773 Posts

Specializes in Infusion Nursing, Home Health Infusion. Has 32 years experience.

The concept of "patient as customer" is an odd one to me and by using that model they are expecting nurses to provide high quality care with one hand tied behind our backs and with blindfolds on. The so called rules and scripts often go against what therapeutic communication entails and what one needs to do when dealing with abusive patients and family members. I just keep thinking about the concept of appeasment and basic human nature. Often When you appease bad behaviour (and this applies in war as well) the bad behaviour continues and often escalates..not ceases. So it is drawing the line clearly in the sand and being firm in your conviction that this behaviour will no longer be tolerated that the behaviour actually STOPS. I have seen it time and time again happen this way.

allnurses Guide

JBudd, MSN

1 Article; 3,836 Posts

Specializes in Trauma, Teaching. Has 42 years experience.

It's a felony in my state. Convicted her of 2 counts of battery on a health care worker, for biting me.

She bit a security guard in the ED later, filed charges but the DA's office didn't notify the guard until the morning of the hearing, so he couldn't go. She got away with it that time.

Specializes in Correctional, QA, Geriatrics. Has 39 years experience.

Even though this attitude of customer service in place of therapeutic health care is prevalent there is a huge difference from how things are applied in the retail or hospitality industries compared to healthcare settings. Physical violence is generally not an issue in the retail or hospitality industries to the same extent that it is in healthcare settings. When physical violence does occur appeasement of the irate customer goes out the door to be replaced by intervention from security staff and/or the police. Somehow when the customer is always right mantra was imported someone neglected to consider the violence component.

In addition as a society in general accountability and personal responsibility seem to be dirty little secrets anymore and viewed by many people as harsh or unacceptable. I have my personal theories as to why teaching about consequences and respect seem to be so unpopular but it has led to a rude society with a looters attitude of gimme gimme and screw everybody else because everyone has an "excuse" for acting like a spoiled brat. For me I am fortunate to not have to do direct patient care anymore but I never allowed and still do not allow someone to hurt me without defending myself or in some other fashion invoking a consequence for the violence directed towards me.

Specializes in Emergency/Cath Lab. Has 6 years experience.
And the words "please" and "thank you" seem to have fallen out of favor, and replaced by "I need" and "I want".

This about sums up my entire disdain for the general public.

nguyency77, CNA

527 Posts

Also, battering any healthcare worker needs to become a felony.

I agree completely. I've been a CNA for one year and I've already been hit/struck/scratched on 4 separate occasions.

The Kennedy case brought this to light for some people. But for others, they are still under the belief that it is their right and privilege to treat nurses however they please. It's hard to imagine someone kicking a doctor like that.

When are we going to move from being such an entitled society back to the days of respect and courtesy? I'm definitely not old--19 years old. But I know that my parents raised me NOT to behave like that. They came from Vietnam, where providing emergency care is actually OPTIONAL. I know that no one is entitled to anything.