Perception is reality (Long)

[abbaking]

I just had my Ah Ha! Moment. Bear with me as i try to explain my idea.

Having read the posts on here and attended numerous staff meetings, I can now safely say that hospital nursing is all about perception. And for patients and visitors, their perception equals reality.

Take for example the post discharge survey. A list of vauge and misworded questions all at the aim of constant preformance improvement. "Was your pain needs addressed in a timely manner?"

Now here is the big problem. If a patient is in pain (and I have been one) but they are not due for another dose of pain meds, then we get burnt for not providing good customer service. What people (patients, contract people {press-Gayney}, and some upper managers) often fail to realize is the medical implications and the desperate attempts the nurse has made to make the patient more comfotable. The patient thinks we are being mean and withholding meds.....they dont see us paging the resident, paging anesthesia, paging pain management, arguing with the doctor, looking up vitals, doing assessments, fighting with the pharmacy, and so on. So, in the patients eye of course we are bad because we didnt give them the shot in a timely manner.

Someone said something on here to the likes of walking around and staying physically busy. Many people seem to think that nurses just come into to work, sit on the computer, or read, or gossip and check the patient a few times and give pills.

Those of us who work know its a different story. Sitting at the desk charting is not a pleasure cruise....I HATE charting. But then comes the patients percetion. "Well your just sitting there not DOING anything"

There is no easy solution to this one. If i am constantly running around (as i usually am the first 4 hours), then i am perceived as being either manic or diligent, but if i sit i am being lazy.

Now is my biggest peeve. Attitude and smiling. We all have been told the same line of crap - smile and the patient feels less X, Y, and Z. Your attitude is a direct reflection of the hospital and you must show a positive attitude all the time. I am in agreement that we as healthcare professionals should make a good first impression and be nice, have geneuine empathy and have compassion BUT management and the public takes this to a whole other level. Many people expect us to burst into a patients room with boudless energy, smile, dance and save the world. People also seem to think that if we don't always have a smile or a good "energy" that we must be the worst of the worst. I am not sure where these idea come from but I am sure that I am not going to go room to room with a Miss America phony smile, sing songs and be all sunshine and rainbows. I work in Oncology - the pits of fear, terror and depression. But for some reason, the powers that be (weather patients or management) seems to think that if a nurse does not smile then they are unprofessional. "He was mad at me. he was rude to me beacuse he didnt smile when he woke me up at 4am to give me my meds".

In closing, Perception Is Reality. Just when you think it cant get any worse, it always does. Many times it feels like a double edged sword. Thankfully, my hospital management realizes that I am a nurse. I am NOT an angel of God. As long as i get my job done and people are nice to me, its all fine.

[Tait, MSN, RN]

I think you're right about most people. Unfortunately, all it takes is one person to tarnish your reputation, if you've even been there long enough to create a reputation.

I wrote a thread here not too long ago about a patient that turned on me. Didn't see it coming at all. What I didn't mention in that thread was that I got called out on it by my manager.

Since that time, I have been asked by my co-workers to deal with three particular patients who were very difficult and driving the other nurses crazy. I'm actually good at it. The patients calmed down, became more compliant with cares, laid off the call bells a little. I even had an experienced nurse say to me, "You have a lot more patience than I do!" I didn't get a pat on my back from the manager for that because he does not know and will never know about it.

I, too, believe in treating patients the way you want to be treated. In fact, I'm not too upset by the idea of customer service in healthcare. I actually enjoy making my patients comfortable, spending time with them when I can, keeping them abreast of what's going on with their plan of care, providing them the little comforts that can make a big difference in their perception of care. Interacting with patients is the reason I wanted to become a nurse!

However, getting called out isn't fun, especially when you know that the patient's perception was just a wee bit off. I think that's what this thread is about--what they feel becomes real, even if it's not.

I hate sounding jaded only four months into my career, but being called out so early on when other events have shown that I can effectively deal with difficult patients is...disturbing.

ETA: Just for clarification. The complaints are handled with a serious meeting in a closed-door office. The kudos and the cards from patients thanking us for the work we do...stuck on the dirty old bulletin board in the corner of the nurse's station right next to the notice to get our flu vaccinations and reminders of hand washing from infection control. Without a word spoken. Maybe that's my issue.

I can agree that it is frustrating when one bad issue clouds weeks and months of great moments. Unfortunately this permeates pretty much every part of our lives. I know I have personally had a week of terrific days ruined by one bad comment. When it comes to management I pretty much do not expect the bulk of my hard work to go noticed until reviews. If my review is good than I figure in the end, even if my kudos are tacked on a dirty board in the corner, that they are noticing my effort. However if you have crappy management who doesn't care (or shoves Disney customer service videos or the idea of baking cookies on the floor, which I admit are both terrible practices in nursing) than it is a whole other issue. However that brings about the question...

Is it really customer service that gets our goat or the lack of support, compassion, and vision from management and administration?

On a side note the book Radical Loving Care by Erie Chapman helped me visualize a hospital where providing meaningful care to patients not only improved their lives, but the lives of the staff as well. However Mr. Chapman, as a hospital administrator, also understands that staff can't do it alone and that administration must be there with them. He discusses how nurses are there to support the patients, but administrators are supposed to be there to support the staff, and important idea that most workplaces lack completely.

Now before the cynics appear and start chanting about how idealism is for the young and reality sucks take a minute to think about how idealism is a driving force for what we have. We may not get exactly what seems to be the ideal situation, but it does lead us to a new understanding, and potentially a better place.

[xtxrn, ASN, RN]

I sent my last PG survey (for MD office) back telling them that PG was responsible for causing safety issues as nurses were forced into concierge roles to keep people "happy", and having all of that xxxx to deal with instead of the MAIN focus being on the patients' physical well-being. I had fun with that one. :)

If I've had an issue, I wouldn't tell some survey company who is going to get paid regardless of my "experience".... I'm going to send a letter to the unit/"customer relations" (which, ime, has been a total joke w/form letter of "aiming to provide excellent care" blah, blah, blah.....).

The part about administration being critical is SO true. The last hospital I worked at had an administrator who LOVED to send out monthly newsletter about the latest thing that could lead to disciplinary action "up to and including termination". Now THERE is a motivating leader

[martymoose, BSN, RN]

shoves disney customer service videos or the idea of baking cookies on the floor(or makes toast), which i admit are both terrible practices in nursing) than it is a whole other issue. however that brings about the question...

is it really customer service that gets our goat or the lack of support, compassion, and vision from management and administration?

.

it is not customer service alone that is a problem. i dont mind doing what i can when i have the support from management.for them to say " you must sign this piece of paper and recite the canned phrases" or risk losing your job, while taking on a load of pts that is unsafe is what gets myy goat. just the other day i was told by the off shift manager that "lack of staffing is not an excuse to refuse admits from ed"

that is what gets my goat. i really don't mind getting sodas and sadwiches for the 8 family members crammed in the room. what i do mind is realizing that i might be missing something important(like myy guy on the nitro gtt or the guy with the art line getting a huge hematoma) you know, life threatening things i should be paying attention to , as opposed to " can i get you potty,pain meds( which arent ordered) and position, while lying , oops i mean saying "i have the time????"

ughh beat horse is beat.

[canoehead, BSN, RN]

I really don't mind getting sodas and sadwiches for the 8 family members crammed in the room.

I mind.

I'll get little comfort things for families, AFTER all my patients have their comfort seen to. I won't be doing anything for eight (EIGHT!) family members in one room. They are In. The. Way. (unless they are popping in and out in 15 minutes) If I can't get at my patient or equipment, eyeball the patient from the door, and if I can hear their multiple conversations in the next room, they are In.The.Way.

If they all ask for sandwiches and sodas, they are Moochers. In. The. Way. Why would I want to encourage that behavior?

[Tait, MSN, RN]

I mind.

I'll get little comfort things for families, AFTER all my patients have their comfort seen to. I won't be doing anything for eight (EIGHT!) family members in one room. They are In. The. Way. (unless they are popping in and out in 15 minutes) If I can't get at my patient or equipment, eyeball the patient from the door, and if I can hear their multiple conversations in the next room, they are In.The.Way.

If they all ask for sandwiches and sodas, they are Moochers. In. The. Way. Why would I want to encourage that behavior?

Yeah I have no problem telling these people exactly where the cafeteria and vending machines are. However if my patient is dying for a ginger ale and my techs are busting tail I have been known to run to the floor vending machine and get them one, but only if everyone else is safe.

[canoehead, BSN, RN]

Absolutely- the patient gets whatever they need.

[martymoose, BSN, RN]

oh we are told to treat the families this way too.

and after today when i was told " big brother is watching" via pagers sensors, audits for rounding, etc, i realized thatt waas the kick in the butt i need to move on. even if i have to go back to factory work or drive truck.