Patients as customers????

[MJAJKJ]

I am in block 4/4 of nursing school and one of the themes throughout school has been patients being referred to as customers. Some test questions are written to reflect this, and we are told hospital philosophy is beginning to reflect the same. I work in medical records (boring as s***) and the hospital I'm at has endless patient satisfaction polls. I worry about patients starting to feel like customers and they are always right, which of course is not true. I fear that administration will look down on an RN giving a patient morphine despite the "customer" request for diluadid because 8 mg of morphine "just doesnt work for me." We are also taught to be patient advocates, but advocate for their best interest, not their every request. I really believe this is a dangerous position for hospitals and patients/customers alike.

Customers go to Sears.

I'd be interested to hear RN's point of views and if other hospitals are adopting this philosophy.

[Ruby Vee, BSN]

"customer service" is a trend. it's a bad trend as far as health care goes, and will probably last about as long as any of the other trends . . .

there are times you just cannot make a patient happy, nor can you explain it to their satisfaction. in those cases it may be passive-aggressive, but ignoring constant and unreasonable demands is a choice, too. i actually had a patient complain to my manager that i kept her awake all night by drawing her hourly blood sugars, doing her every 15 minute vital signs and basically just not leaving her bedside until she stopped bleeding, had a stable glucose and was weaned off the pressors. and yesterday a patient complained about poor customer service (actually used that phrase) because i was trying to explain to her why coughing and deep breathing after surgery, though uncomfortable, are a good idea. the surgeon, overhearing that conversation, intervened by explaining to the patient again why pulmonary toilet is so important, concluding by saying "if you don't do it, you'll get pneumonia." the patient's response? "i don't care." and she was alert and oriented!

[GoodNP]

Ahhh, customer service, or the general lack thereof. One of the few things I wish I could change about nursing (along with wrinkled scrubs and those bacteria-magnet cartoonish stethoscope covers).

Guess what, the patient IS a customer, and the only reason we all have jobs. As nurses, I think we often forget that, or perhaps it never crosses any of our minds. Of course the customer-as-patient can't always be right, but let's be real, nobody is going to expect a nurse to kowtow to a patients demands for dilaudid when morphine is written. However, since my days in nursing school, I have noticed an overwhelming amount of complacency in healthcare. I've made this observation as a nurse and also as a patient.

Nurses (even though this really applies to all staff working with patients and their families, I say nurses b/c that's the forum we're on) need to smile more, speak politely, learn basic customer service phrases such as "my pleasure" "I'll be happy to" "let me see what I can do about that" or, when necessary, "I'm very sorry Mr./Mrs. so-and-so, but ." Let's manage our patients' expectations on wait times. Night shift, try to be as quiet as possible. Appear as if you are happy to do your job (b/c these days we are all lucky to have one).

It's been said that every person should work in retail at some point in his/her life. That's b/c of the invaluable customer service lessons you learn, both as a provider and as the consumer. I would love to see a customer service elective in nursing school. Patient safety may be our number one priority, but why can't a positive patient experience be high on the list too?

[nursel56]

Was at Wally World the other day. There were only three people working check-out and about a dozen customers in line. After standing in line for about 20 minutes it was finally time to unload my basket. You guessed it! A "customer service" manager came and informed me that line was shutting down and I would have to go to another one and start waiting all over again.

Point is, if this is what passes for "customer service" these days, do we really want to refer to patient care as "customer service?"

I agree! "Customer service seems to be the first thing on the chopping block when a business decides to cut costs and why?? My cable company used to have dream customer service! So did my bank! I stayed loyal to both for that reason alone, and now dealing with both of them is a nightmare of telephone trees, conflicting information and people who cannot utter a syllable "off script" even if you beg them to! Yikes!

Ahhh, customer service, or the general lack thereof. One of the few things I wish I could change about nursing (along with wrinkled scrubs and those bacteria-magnet cartoonish stethoscope covers).

Guess what, the patient IS a customer, and the only reason we all have jobs. As nurses, I think we often forget that, or perhaps it never crosses any of our minds. Of course the customer-as-patient can't always be right, but let's be real, nobody is going to expect a nurse to kowtow to a patients demands for dilaudid when morphine is written.

I disagree. The patient should be aware of and an active participant in his/her healthcare choices, but they are not a "customer" as one would be at a restaurant or other retail establishment. If the customer can't always be right, but they've picked up on the notion that they are a "customer" in a traditional sense, when do they stop being right? How much harm are we to allow them to do to themselves before we step in and say "you aren't right anymore, I'm going to take over now"?

These boards are replete with stories of patients demanding and getting Dilaudid over morphine, refusing to wear their TED stockings, get up and walk after surgery, follow restricted diets and on and on ad nauseum. One ED doc actually set up a station in the waiting room so that drug-seekers wouldn't need to be seen before they got their fix and out the door. Nurses are disciplined all the time for not kowtowing to the patient and their visiting families with iced soft drinks and snacks even if the nurse has a much sicker patient next door.

However, since my days in nursing school, I have noticed an overwhelming amount of complacency in healthcare. I've made this observation as a nurse and also as a patient.

Nurses (even though this really applies to all staff working with patients and their families, I say nurses b/c that's the forum we're on) need to smile more, speak politely, learn basic customer service phrases such as "my pleasure" "I'll be happy to" "let me see what I can do about that" or, when necessary, "I'm very sorry Mr./Mrs. so-and-so, but ." Let's manage our patients' expectations on wait times. Night shift, try to be as quiet as possible. Appear as if you are happy to do your job (b/c these days we are all lucky to have one).

Sorry - but I have never needed a sheet of canned phrases or a "service with a smile" sign on the wall to know how to talk to patients and what you're saying is pretty condescending to all of us who've been around interacting with patients for decades before the customer service trend started. Maybe you live in a part of the country where all the nurses just happen to be rude, I don't know.

It's been said that every person should work in retail at some point in his/her life. That's b/c of the invaluable customer service lessons you learn, both as a provider and as the consumer. I would love to see a customer service elective in nursing school. Patient safety may be our number one priority, but why can't a positive patient experience be high on the list too?

Actually, I've never heard anyone say that but I've worked as a salesperson, a waitress, a restaurant hostess and assistant manager of a clothing store all before I went to nursing school. The two things are miles apart. I don't know very many nurses who have not developed a communication/pt education style that is unique to her or him that in fact may sound gruff to an outsider but are beloved because of how they get what they know into the other person's head. It would be patently ridiculous to force them to say dumb, out-of-character and cheesy phrases like that. I guess I have a higher opinion of nurses in general than you do. I trust them to say the right thing the right way in most cases.

[ChristaRN]

Ah, the customer thing, one of my biggest pet peeves. I've got to say in Peds the child is usually pretty easy to deal with but the FAMILY! Here's some customer service complaints I have seen on my unit:

1. Parents should NOT have to sleep on a cot or a recliner chair apparently. I have had numerous parents state that it is our job to make sure THEY are comfortable so we should make sure actual BEDS are available for them to sleep in

2. Courtesy meal trays should be given to ALL visitors (we do give them to breastfeeding mom's but that's it). It's not enough that at our facility the cafe will take visitor orders over the phone along with a credit card for payment and then deliver it to the patient's room - these meals should be free for everyone.

3. Nurse's should not be coming into the child's room when they and the parents are sleeping, the parents should be able to call when it's convenient for meds and vitals to be done. Lord knows that better be convenient for you or they cry "my nurse is never in the room". I flat out refuse this request most of the time.

4. Providing accomidations for parents to stay in the room is not enough - I have had a family yell at us for not having accomidations IN THE PATIENT'S ROOM for the patient, both parents, grandma who won't drive at night and the patient's three siblings who can't get home because neither parent will leave and Grandma is afraid to drive at night.

5. Patient snacks should be regularly offered to visitors and to tell them that they are for patient's only is rude.

I could go on and on.......... I'm not a parent yet but I still feel like I would live on water and sleep on a wooden chair if it meant being with my sick child. We have many wonderful parents who are like that and I do try to go above and beyond for those people. Some are just unrealistic though.

[kmmRN,BSN]

I feel that the patient is definitely a "customer" of the hospital, they are paying the hospital to provide medical service. With that being said, there are also rules that must be followed, no matter what. When you are a customer in a store or restaurant, it is just the same. You can't order something not on the menu, you can't smoke somewhere that is a no smoking establishment, you can't tell a cashier that you only want to pay $2 for milk when it costs $3, that is because every establishment has rules that must be followed or they would ultimately end up going under for some reason or another. The patient is still a customer! We are working for them! I tell my patients when I admit them, that we are there working for them to get them well again, and with that they have the right to question any treatment or plan of care that they are concerned about. Yeah, it might just set us up for a billion questions, but, after reading a different post about some of the horrendous things nurses and docs have done to patients, I don't think it hurts for our patients, or customers, to question things we do.

[nursel56]

I think a more apt comparison would be if you were a customer in a restaurant and wanted to go back to the kitchen and tell the chef how to cook.

As for who is paying for someone's healthcare, rarely is the patient paying for the service. If the person who calls the shots is the person paying for the care, it would be the taxpayers and private employer provided insurance. When a patient is admitted to the hospital, the hospital calls the insurance company/Medicare/Medicaid or whatever. Those things are shared risk. People who underutilize are paying for those who overutilize benefits. So technically some will pay for others - it isn't a simple a+b=c transaction.

Medicare tax from my check goes right straight into the kitty for the "customer". In fact, intrusive laws such as helmets, seatbelts, and mandatory immunizations recognize the reality that the pool is the customer and it's trying to cut costs in trauma treatment and the treatment of acute illnesses.

Educating patients about their rights is not synonymous with "customer service". It sounds to me like you think there is something above and beyond the call of duty to tell patients to ask questions about their treatment and that if you are not a customer service nurse you will attempt to shut questions down to avoid answering too many of them? What you are describing as customer service are things intrinsic to nursing already.

[kmmRN,BSN]

I understand your POV, however, I still stand by my belief that the patient is the customer. They are a person that we are doing work for, regardless of how they pay, insurance, selfpay, etc. I never ever let a patient tell me what to do, however, as I am the nurse and ultimately know the correct way of doing nursing care (just as I wouldn't tell my repairman how to fix my wash machine). I do, however, welcome patients to question the care that I and my coworkers perform, and I fully explain all tasks, and give choices to the patient (when options are acceptable)

[Batman25]

Explaining what you are doing and why and encouraging patients to ask questions is good patient care and an essential part of your job. That's part of what your employer hires you for and pays you to do. Nurses failing to do this aren't providing bad customer service they are providing poor patient care. I think this distinction often gets lost.

[GoodNP]

Perhaps this is a matter of semantics. Maybe some of us are talking about Customer Service as a formal operation or process forced down by administration, while others are referring to the general notion of customer service which compels an individual employee to behave in a certain manner. (In my discussion, I refer to the latter.)

It was certainly not my intent to condescend to any of my peers, no matter their tenure in nursing. My opinion of nurses is quite high. So high, in fact, that I believe as nurses we should hold ourselves to a high standard and deliver the best quality product possible. We educate ourselves on how to deliver the most effective therapeutic clinical interventions for our patients; and, while this is clearly the largest and juiciest piece of the pie... in my very humble opinion, it is not the only piece.

It is doubtful that the parts of the country that I have worked have a monopoly on complacent allied health workers. In an outlet such as allnurses.com, where the members love nursing so much we take the time to read and post on professional forums, we are likely all good stewards of our profession. Nevertheless, don't we all know the nurse that drags him/herself in and merely "checks the box?" They may pass meds on time, but they are generally irritated by patients' questions or even the simplest requests, much less do they go out of their way proactively for a patient/visitor/co-worker.

There are countless stories out there of unreasonable, demanding, boorish patients. We've all had to deal with them or their families. And by no means should any nurse should be forced to endure verbal or physical abuse. I don't. I have turned my back on a patient and walked right out of the room rather than be mistreated. (Same with doctors) However, for every story we have of one nightmare patient, I bet there is another patient at home who has a story of a nightmare employee at a health care facility.

So for the purposes of this discussion, maybe we should define what it is we are referring to as "customer service." In my mind, there are a lot of aspects of "good patient care" which could also be labeled as "good customer service." There is overlap. To me, good customer service is not the requirement that I take time from double-checking my drips in order to pass out coffee and doughnuts. Rather, it is the cognizance to go out of my way make people comfortable and anticipate their needs, clinical or otherwise, as my other priorities allow.

[MadNursePa]

My experience has been that the trend changes. When I was in school, it was "client", then it changed back to "patient", now "customer". The bottom line is the same. Treat people with respect, as you would like to be treated if you were the "customer".

[nursel56]

Steph.rn and kmmRNBSN - I think you are both right when you point out it is a matter of wording and that good patient care and good customer service are often the same thing in our activities. I'm probably just touchy from reading so many accounts from nurses who've been talked down to by management and managers who won't go to bat for their nurses when a survey complaint is completely unwarranted.

I've been blessed with some really great Nurse Managers - I recognize that now more than ever. Thanks to you both for your replies.

[Cul2]

Look at the words -- patient, customer, client. What do they define? They define and describe relationships. Relationships between whom? That seems to be one of the issues. Hospital business management seems to see the relationship as between the "customer" and the "hospital." To them, the "patients" are customers or clients. The relationships patients have with the "hospital" or "health care" in general is one thing. The nurse/"patient" relationship is another thing. Does it include elements of customer service? You bet. Can it be reduced to that? Of course not. I think most patients (and their families), at their best, realize that. But when patients are in the hospital they're not always at their best. Also, they're dealing with several relationships here -- with the business office, with receptionists, with med techs, with doctors, with nurses, with cna's, with the cafeteria staff, etc. It can be confusing. Patients are often getting mixed messages from different sources within the medical community. Basic "customer service" isn't about "the customer is always right." It's about treating people respectfully, recognizing their humanity, understanding they're not at their best always in the hospital, being empathetic, and having the courage to set proper boundaries that dignify your role as a nurse and that of your patient/client/customer.