"Customer service" and nursing

[LilPeanut]

I've seen a lot of people talk about 'customer service' in a disparaging manner, as if that is not what nursing is about and it's making their lives harder to provide it.

Could someone explain that more for me?

Personally customer service is another way of saying good bedside manner. It doesn't matter what you know if you cannot present it in a way that encourages others to follow you. Many of the things I hear people complaining about for "customer service", could be solved by patient/family education and a less adversarial relationship between staff and family.

What are your thoughts?

[Tweety, BSN, RN]

:yeahthat:

I responded to that the post you're saying "yeah that" to in post number 95, do you have anything else to add?

[Roy Fokker, BSN, RN]

what i am about to say is still under "review", so i have to be as vague as possible.

but about 3 months ago, we had a rather bad night.

we are a 34 bed 'dedicated' surgical floor (meaning we see post surgical patients only).

of the 34 beds that night, all were full. and only 24 of the 34 were "surgical" patients. the others were filled with the floatsam and jetsam of the hospital - from medical to tele with drip.

we were 7 patients/nurse on night shift with just one cna.

our patients were a mix of "post ops" and some "pre-op-awaiting-surgery".

i started my shift at 2230.

i didn't sit down till 0630 - that was when i started doing my 24 hr chart checks! (0630 is when we usually finish taping report for am shift). i mean, forget "lunch" or "coffee breaks" or "i need to go pee".

right from when i managed to get report from the harried nurses on pm shift, i was on the ball::

- i had one patient who had blood going in

- one with unresolved nausea (post op)

- one with unresolved pain (shoulder fracture)

- one who was in restraints following post-op confusion/dementia

- one with bilateral knees (total assist)

- one patient on tele with cardizem drip and labetolol prn (which we are not supposed to have on our floor)

- and one with an sbo repair who needed constant re-orientation q 15-20 minutes because of his confusion (hospitalist refused to sign restraints order because "patient was alert and oriented" 4 hours ago )

i was way beyond "over worked".

but if this wasn't bad enough:

two nights after that one, the cna who worked that night came up to me and asked if the director had called me about that night. it seems that 4 patients had complained to their surgeons "about the lack of care they had received".

one of them was my patient - the same one who was getting blood. of course, she forgot to mention the fact that she cussed at me for "disturbing her sleep" everytime i was in there q 10', q 20' and then q 60' doing assessments as part of blood administration protocol.

she chose to complain because she was sitting around "in her own urine because no one came to my aid!". hey! it doesn't matter that my unstable tele patient is having runs of pvc's and also have an iv go bad, right?

or how about the son of one of my sundowners who seemed calm and cooperative in the morning when he saw her but refused to believe the reports of any of the nurses who worked nights with me?

or how about, during the same night; my "un resolvable nausea" patient decided to start throwing up blood?

that night was pure hell.

but you know what burned me the most?

management asked none of the nurses about that night.

management sure did go about asking the cna working that shift about the incidents that night! including questions such as "were the nurses doing their jobs?"

huh??!!

i mention this because i remember that night well.

and i also remember that night well because it doesn't seem to have gotten any better (we recently had a 12 year old on tele. none of the nurses here are pals certified!)

all i hear management moan about it "costs" and "satisfaction scores".

i understand they have a business to run.

but i can't help but think that some of their practices come about because they know that we as nurses really can't abandon our patients.

cheers,

[RNsRWe, ASN, RN]

what i am about to say is still under "review", so i have to be as vague as possible.

but about 3 months ago, we had a rather bad night.

we are a 34 bed 'dedicated' surgical floor (meaning we see post surgical patients only).

of the 34 beds that night, all were full. and only 24 of the 34 were "surgical" patients. the others were filled with the floatsam and jetsam of the hospital - from medical to tele with drip.

we were 7 patients/nurse on night shift with just one cna.

our patients were a mix of "post ops" and some "pre-op-awaiting-surgery".

i started my shift at 2230.

i didn't sit down till 0630 - that was when i started doing my 24 hr chart checks! (0630 is when we usually finish taping report for am shift). i mean, forget "lunch" or "coffee breaks" or "i need to go pee".

right from when i managed to get report from the harried nurses on pm shift, i was on the ball::

- i had one patient who had blood going in

- one with unresolved nausea (post op)

- one with unresolved pain (shoulder fracture)

- one who was in restraints following post-op confusion/dementia

- one with bilateral knees (total assist)

- one patient on tele with cardizem drip and labetolol prn (which we are not supposed to have on our floor)

- and one with an sbo repair who needed constant re-orientation q 15-20 minutes because of his confusion (hospitalist refused to sign restraints order because "patient was alert and oriented" 4 hours ago )

i was way beyond "over worked".

but if this wasn't bad enough:

two nights after that one, the cna who worked that night came up to me and asked if the director had called me about that night. it seems that 4 patients had complained to their surgeons "about the lack of care they had received".

one of them was my patient - the same one who was getting blood. of course, she forgot to mention the fact that she cussed at me for "disturbing her sleep" everytime i was in there q 10', q 20' and then q 60' doing assessments as part of blood administration protocol.

she chose to complain because she was sitting around "in her own urine because no one came to my aid!". hey! it doesn't matter that my unstable tele patient is having runs of pvc's and also have an iv go bad, right?

or how about the son of one of my sundowners who seemed calm and cooperative in the morning when he saw her but refused to believe the reports of any of the nurses who worked nights with me?

or how about, during the same night; my "un resolvable nausea" patient decided to start throwing up blood?

that night was pure hell.

but you know what burned me the most?

management asked none of the nurses about that night.

management sure did go about asking the cna working that shift about the incidents that night! including questions such as "were the nurses doing their jobs?"

huh??!!

i mention this because i remember that night well.

and i also remember that night well because it doesn't seem to have gotten any better (we recently had a 12 year old on tele. none of the nurses here are pals certified!)

all i hear management moan about it "costs" and "satisfaction scores".

i understand they have a business to run.

but i can't help but think that some of their practices come about because they know that we as nurses really can't abandon our patients.

cheers,

oh, roy, do i ever feel for you....except for a change here and there in the specifics of each patient (and making it 8 patients) that was my night a couple of weeks ago. when the least problematic patient began banging the complaint drum that she didn't have her pain meds fast enough, they weren't good enough, yada yada. never mind the train wreck that was dumped on us from another unit (has no business on our unit, but that's another story), the fresh post ops, the total cares, and the less than adequate cna staffing.

the only positive note was that management at least wanted my version of the story and actually did not bash me. even though i felt like crap because i now had a complaint against me (that was new), they said they knew i did my best under the circumstances. they know staffing is shot to hell and they're in danger of losing even more nurses.

but the bottom line is, it's my license on the line every time we have a night like that.

roy, they know you can't abandon your patients, but they should also know you "vote with your feet" and just might not be there to take a patient load tomorrow. the threat, however, has to be very real to be effective.

[Tweety, BSN, RN]

Roy, one good thing about our management is they will look at the ratio and take some things into consideration if they get complaints. If they come to me with a complaint and I say "well, I was having blood, had an unstable cardiac patient, blah blah blah" they usually shut up with understanding. I'm lucky for that because I would hate to get all righteous on them. :)

In our staff meeting they said the main complaints we've received lately were that we're too loud on night shift and we aren't keeping the patients informed of their plan of care. No one complained they didn't get a pillow fluffed or a coke. :)

[fmwf]

Greetings all. A newbie here. Sparing the hx, but after my first 6 months of nursing this issue is glaring to me. Searched "Customer service" and nursing on allnurses just to hear what nurses are saying. This will be the proverbial straw to break the camel's back. Here is why.

1: Nurses are trained, taught, socialized to give pt care according to the nursing process. We are taught to prioritize according to this NOT customer service. Can I get a refund of my nursing education?

2: There is a certain oxymoronic cynicism to systematically critique the "customer service" of a licensed, dedicated, altruistic pt advocate, caregiver and educator. Duh.

3: Management does themselves a disservice and (inherently) assumes liability of every (perceived) customer service issue.

4: Rats to nurses (and NMs) who will not claim/empower their professional status and identity. Chickens shall come home to roost on this one. Limit setting is perfectly legal and important. (Did I say that? Maybe I need to explore this idea more). I cannot defend my (customer service) actions in a court of law.

5: Management needs to be in the business (rationale, see 3) of educating the public that nurses are professionals available in the hospital stay to implement a care plan to address a patients health status. Pt needs that will be prioritized and addressed over time will include pain, perfusion, hygiene, hydration etc you get it. Any "complaints" and decisions s/b considered in this context. Patient care representatives are there for customer service.

6: Allowing oneself to be subjected to this skewed conversation is perilous.

7: Any deviation from professional service needs to be considered in an ethics or staffing context not customer service.

8: I really, really like the restricting vistors hours/privilege thing. Almost ALL of my "customer service" inquistions occurred relative to family/visitors being around too long, in droves. These pull on resources and poison an environment. Change the culture at this level. Inform visitors b/f the stay about expected behavior.

9: Nurses have NO more professional capital or psychic energy to give about this. I have been working 6 months already and this is draining.

10: Why do call buttons have the "Lil Miss Nurse" icon on them? How about an "N" or "Nursing Professional".

Does anyone know how physicians are handling these customer service ratings issues?

Newbie FMWF

[brendamyheart]

Roy, one good thing about our management is they will look at the ratio and take some things into consideration if they get complaints. If they come to me with a complaint and I say "well, I was having blood, had an unstable cardiac patient, blah blah blah" they usually shut up with understanding. I'm lucky for that because I would hate to get all righteous on them. :)

In our staff meeting they said the main complaints we've received lately were that we're too loud on night shift and we aren't keeping the patients informed of their plan of care. No one complained they didn't get a pillow fluffed or a coke. :)

LOL about the pillow and the coke

[tazzyjo]

Customer service is providing a service to a person or persons, we provide the service of health care not in room hotel services. I have seen a patient press the call bell, and immediately after we hang up the family member is in the hallway wanting to know what is taking so long. In the meantime the CNA or nurse is on the way to the room. Last time I checked we didn't have instant teleportation to "service" as stupid request that they could easily have done themself or a family member could have done...like get ice.

In this day and age of computer charting, computer medication dispensing, high acuity (which hospitals NEVER take into account when creating assignments) we spend more and more time away from the patient and families spend more and more time at the bedside... if they want instant one on one service then they should start hiring their own private nurse and maybe hospitals should offer that... instead of expecting us to balance 5-8 very sick patients with little support.

[wibobr]

I am really amazed that most of the responders in this forum are on the same page of music!!!!! We have 4 Emergency Rooms in our little part of the USA (2 are private for profit)and the competition for "PAYING" business is at an all time high. And the key to that business is something called "Press Ganey" (Why do I feel as if I just swore?) More and More we are being held accountable for comments like "I had to wait for so long, the staff was rude, the parking attendant was really slow, etc etc etc(Sound familiar folks?)I agree, it no longer matters that Emergency Room visits are up almost 40% in ten years, it does not matter that more and more rely on the ER for primary care, it does not matter that "REAL" emergencies take priority over the "Walking wounded and cry babies". As long as the Press Ganey scores are up there, management is happy. Sorry, we need to get back to good old fashioned health care. Take care of the sick and injured, teach people how to care for themselves and take responsibility for their health and actively participate in their care. NOT kiss their butts for a score!

[dansdoll]

I love these threads there are always many people who do not work with pts, who want to post here stating that customer serivces imporves care when that is not the case. It is like tryin gto be your childs best friend instead of their parent, it dosen't work. Nurses need to be seen as the collaborators of care not the waitress. People do not follow directions from a waitress, but that is increasingly the perspective of pts that nurses are not trained professionals but the servant of the MD. As long as pts view nurses as waitressess pt outcomes and care will not be imporved but will suffer dire consequences.

[Ruby Vee, BSN]

does anyone else think it's ridiculous to place such emphasis on customer satisfaction in a business when people are frequently faced with that which they do not want to hear??

this is not disney world or a cruise ship. we can't 'make it all pretty' for them.

my hospital actually paid thousands and thousands of dollars to disney to help us get our customer satisfaction scores up. what a ridiculous waste of money! instead, they could have thrown some of that money at having more linen available, better food for the patients and chairs for the visitors to sit in when they visit rather than expecting the nurses to offer our chairs to the visitors. back when visitors were allowed into the icu for only 15 minutes four times a day, that was feasible. not now, when they're a constant presence.

[hecete]

i work in ltc, and i can tell you, everyone has had customer service cramed down our throat to the point of gagging. we have had inservice after inservice on the subject. every time someone complains it's another repetaive inservice. try as hard as you can there are some people you just can't please.

[fmwf]

I love these threads there are always many people who do not work with pts, who want to post here stating that customer serivces imporves care when that is not the case. It is like tryin gto be your childs best friend instead of their parent, it dosen't work. Nurses need to be seen as the collaborators of care not the waitress. People do not follow directions from a waitress, but that is increasingly the perspective of pts that nurses are not trained professionals but the servant of the MD. As long as pts view nurses as waitressess pt outcomes and care will not be imporved but will suffer dire consequences.

Here here. We have twin minds. Reducing the conversation to customer service issues undermines the professional capital of nurses. THe public sees us on a treadmill leased by an MD which they are in control of. OR that they are "IT" while the MD has left the room and nurses are simple maidens or butlers for "him" (the paternal icon) until his return.