"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?

[SassyRedhead]

i've found over the years that nurse managers who actually back up their nurses are rare as hen's teeth. years ago, when i was working in another state, i had a conversation with two of my then co-workers about "the nice nurse" vs. the "good nurse." the gist of the conversation was that families really want the "nice nurse" taking care of them -- the nurse who breaks the rules to allow them and their 16 family members including two unruly toddlers visit, who robs other patients' rooms for chairs for the 16 visitors so that the other patients' visitors have no where to sit, the nurse who gives dad everything he wants including that milkshake when he's on a diabetic diet, the hamburger when he's on clear liquids and the extra dose of painkiller that leaves his oxygen saturations dangerously low and his exhaled co2 dangerously high. the nurse who always has time to talk to them although medications don't get given on time, orders don't get taken off, dressings don't get changed and treatments don't get give. what they ought to want is the "good nurse" who enforces the visiting restrictions, ensures that dad gets the diabetic diet, the clear liquids and less than 100% pain relief in the pursuit of adequate breathing. they ought to want the nurse who points out the vending machine rather than getting cokes for visitors and has the meds given on time, the orders taken off, the dressings changed and the treatments given.

cathy agreed with me, susie didn't. (not their real names, moderators!) susie was one of those nice nurses you're always angry with who break the rules so that anyone who doesn't do the same is the "bad nurse" in the eyes of the visitors. years later, susie is our manager, and of course, she still doesn't get it. being nice comes before being right. years of her management and hiring practices ensured an icu full of nice nurses and a dearth of good nurses.

then her father was in our icu. she hand picked the nurses to care for him, and who did she pick? cathy and me. "i knew you guys would keep him safe and help him get better," she said. "i guess you guys were right about the other stuff -- it's different when it's your father in the hospital!"

(unfortunately, once susie got it, she got promoted, and we got another manager who emphasized "customer service" over patient safety.

while i agree with most of what you say, somehow i don't think this visitor was looking for change for his dollar. i suspect he wanted the nurse to dig into petty cash (or her own wallet) to give him money for the vending machine. and i do mind that! i draw the line at spending my own money to placate patients or their visitors. yet this was the expectation in one hospital in which i worked. "our patient population is mostly poor and minority," i was told. "we help them out where we can." yes, the population was poor and minority, but none of them had jobs, either.

it happens all too often that patients and families are allowed to disrupt the unit in this fashion. setting limits is a wonderful thing, but it has to come with the backing of administration, and all too often, administration just doesn't get it.

many people equate stating facts with being "rude", notwithstanding if you sugar coat it and put a stick in it. management knows this but they don't care because they are being led around by the press-ganey nosering because all the "cool kids" are doing it. i swear, it's like a bully on the playground.

on the diabetic diet comment above, this is exactly what i was talking about in another thread. and largely, responses there stated that patients have the right to eat whatever they want and whenever they wanted it.

the fact is, if you want good nursing care, you can't have it both ways. press-ganey doesn't rate the efficacy of nursing care, it's just another madison avenue red herring.

[darrell]

I work as a tech while finishing the RN program. I've been complimented for the comments and reactions I get from my patients. Basically, I treat them as guests and I often think back to the way I've been treated on cruises when I am deciding what to do and say while on the job.

I don't cater to anyone, but my general attitude toward the treatment of a guest goes back to somewhere in the dim reaches of my childhood and comes quite naturally to me. I will tell folks when they have to wait because I'm busy, but I do so in a manner that indicates I care that they have to wait.

The flip side of this approach is that my peeps are almost always very understanding of delays and my shifts are chock-fulla positive interaction, laughter and good old-fashioned smiles.

[flashpoint]

I think I have said this before, but I think that some managers forget what it is like in the real world. Sometimes they expect things that are way above and beyond the call of duty and they feel the need to discipline staff for even the most trivial complaint. I have seen nurses written up for not sharing their lunch with patients. I have seen nurses written up for not letting patient's families in front of them in the grocery line. I have seen nurses written up for not running to the local diner to pick up burgers and fries for patients when their shift is over.

I think I should be written up for being openly rude to anyone...I should be written up for gross negligence...I should be written up for failing to do my job out of laziness...for most other things, I would like to be told, just so I know that a complaint was made, but unless it is a valid complaint, it shouldn't be much more than an FYI.

[darrell]

I have seen nurses written up for not sharing their lunch with patients. I have seen nurses written up for not letting patient's families in front of them in the grocery line. I have seen nurses written up for not running to the local diner to pick up burgers and fries for patients when their shift is over.

Let's not get silly. That's not customer service at all. Even that fact that such measures would be needed says something ugly. That they might be tolerated in a profession marked by shortages is beyond my comprehension.

Customer service is not about nasty enforcements. It's a pleasant, even fun experience that is mostly comprised of reciprocal common courtesy.

[banditrn]

Let's not get silly. That's not customer service at all. Even that fact that such measures would be needed says something ugly. That they might be tolerated in a profession marked by shortages is beyond my comprehension.

Customer service is not about nasty enforcements. It's a pleasant, even fun experience that is mostly comprised of reciprocal common courtesy.

Darrell - I don't believe she's trying to be 'silly' at all!! Just truthful about what some people's expectations were.

I NEVER had a complaint about my 'customer service', but I also didn't let people run all over me either. My expectation was, that while they were under my care, that we were going to follow the rules, and do what the doctor ordered - if they had a problem with that, I took the time to explain why 'diabetic grandpa' shouldn't have a milkshake. If they still had a problem, then it was time for the Dr. to spend a little time with them.

I've had visitors try to hit me up for money for food - I pointed them to where we kept the soda crackers. I had a patient once who was on Title 19, throw a fit because I wouldn't pay the $2 for his co-pay for his pain meds. He didn't know WHAT he would do if he had to go home in pain! I suggested that he borrow it from whoever was taking him home - and next time plan to have his money with him.

I have no doubt that there were plenty of 'nice' nurses in our department who would have forked over cash for some of these people. And there are certain folks I fixed food for, too - not because they asked, but because maybe it was the little old wife of a little old man, and I was sure she was afraid to leave the bedside.

But these nice nurses put a burden on all of the rest of us - I remember one night this nurse who was FAMOUS for being a patient floormat, left the department to take a patient to her car. And didn't come back for 45 minutes - now, we were busy, patients coming out of anesthesia right and left, and all our other patients to take care of.

Found out the patient and her husband had asked to be taken to another part of the hospital to visit another family member - so she took them! You betcha she got 'brownie points' from this family - but she won no awards from her co-workers.:angryfire

[pie123]

I don't know that anyone would refuse to show good bedside manners to a patient or their family.

The issue I have with customer service is that it has taken priority over patient care. It's more important that the nurse learn the cute, robotic phrases, than know what is current in the literature and how to provide good nursing care.

People have become so used to fast service in every aspect of their life, they also expect it when they come into the hospital. They no longer understand if their procedure gets pushed back a couple of hours because their doc has an emergency. Or, they feel it's ok to move four of their family members into the hospital with them, and demand free food and drink for all, and become angry when you say no. They also do not understand if the nurse has an emergency with another patient and can't get to them as quick as they want- everyone has become very egocentric, and it doesn't matter if you explain you had an emergency.

My favorite is when they let their kids run loose around the nurses station, screaming, and playing with the elevators. If you ask them to please corral their kids, and explain they could get hurt, you get the evil eyeball.

It's not that nurses don't want to provide customer service. But the public has to understand that they are here for medical care. I am here to take care of the patient first, the family second.

Educating them about what we can and cannot provide does not always work, because when the satisfaction scores drop, everyone wants to know why. I can't help it if the the public has forgotten what the hospital is for.

Very well said. Our hospital has recently put dry erase boards in every patients' room. The following information is provided to the patient on this board: the date, who the nurse is, who the doctor is, then each hour is listed in columns and the idea is that the nurse is to enter the patients' room each hour and then initial next to each time, to show that she has been in to see the patient, at least once an hour. There is another area that says: today's plan, a section that says questions for my doctor, and then a section that says something about pain. In this part, we are to write what the pain medication is, what time it was given, when it is next due, and then write the patient's pain tolerance level, and circle it, so that those who enter the room know what level of pain the patient can tolerate. The last section is about what's important to the patient. In the past, on this particular section, I put safety and comfort. I have since been told by administration that this section is actually for what's important to the patient. One patient said it was important for her to have applejuice instead of cranberry juice, and that she liked to do crossword puzzles, so the administrator said that I had to put that on the board. At the very bottom of this board, there is a blurb in quotations that says something about us being there to provide the best patient satisfaction. In orientation for this particular business, we were told that we are to reiterate this blurb to each patient.

[pie123]

I absolutely agree that customer service and satisfaction survey results have become the priority over patient care.

I love critical care nursing. I love working with very sick unstable patients.

I do not enjoy doing all of the above while also being expected to entertain their families because of 24/7 open visitation. I do not enjoy that I must work harder and have more interruptions to caring for critically ill patientes because of families/visitors being present.

The number one cause of medication errors is distraction. I have found myself on occasion searching for a polite way to tell a family member not to distract me and that their incessant interruption is causing me to be unable to care for any of my patients properly, including thier family member.

If I sound burnt out.. I am. That's why I'm actively trying to find a job in an area that involves much less customer service.

You know what, I have been a nurse for almost a year and a half, and everything you have mentioned here is exactly how I feel. My charge nurse recently told me that I am burnt out because I try to do too much, and that I needed to learn to say no. I have no problem asking a family member (s) to leave so that their critically ill loved one, as well as his/her roommate can rest. I have no problem telling a family member that I have given them 2 cups of coffee, and that I cannot keep fetching coffee for them, I have no problem asking the 4 kids running in the hall, sitting on the floor, to please stop running, etc. But, how do you say no to a patient who is requesting a bath when they haven't had one in 4 days? One time I asked a patient about shaving. I offered it to him, he did not ask me about it first. But I got too busy, and was unable to do it. When the nightshift nurse came in and asked how his day was, his response was, "horrible." When she asked why, he said it was because I told him that I would try to shave him, and I never did. I guess the lesson is never to offer such things unless I can do it right then. Nevermind that I have 3 other critical patients.

[mshultz]

Very well said. Our hospital has recently put dry erase boards in every patients' room. The following information is provided to the patient on this board: the date, who the nurse is, who the doctor is, then each hour is listed in columns and the idea is that the nurse is to enter the patients' room each hour and then initial next to each time, to show that she has been in to see the patient, at least once an hour. There is another area that says: today's plan, a section that says questions for my doctor, and then a section that says something about pain. In this part, we are to write what the pain medication is, what time it was given, when it is next due, and then write the patient's pain tolerance level, and circle it, so that those who enter the room know what level of pain the patient can tolerate. The last section is about what's important to the patient. In the past, on this particular section, I put safety and comfort. I have since been told by administration that this section is actually for what's important to the patient. One patient said it was important for her to have applejuice instead of cranberry juice, and that she liked to do crossword puzzles, so the administrator said that I had to put that on the board. At the very bottom of this board, there is a blurb in quotations that says something about us being there to provide the best patient satisfaction. In orientation for this particular business, we were told that we are to reiterate this blurb to each patient.

I'm not a healthcare worker, but I was a patient in the ICU back in 2003. If someone had asked me what was important to me, I would have said "being a good little patient". These posts are enlightening, in terms of learning about how the "other half" lives (or thinks).

My room had a white board, but the nurse was unable to find any markers. Since I had neither pen nor paper, this effectively eliminated written communication.

[Mulan]

Very well said. Our hospital has recently put dry erase boards in every patients' room. The following information is provided to the patient on this board: the date, who the nurse is, who the doctor is, then each hour is listed in columns and the idea is that the nurse is to enter the patients' room each hour and then initial next to each time, to show that she has been in to see the patient, at least once an hour. There is another area that says: today's plan, a section that says questions for my doctor, and then a section that says something about pain. In this part, we are to write what the pain medication is, what time it was given, when it is next due, and then write the patient's pain tolerance level, and circle it, so that those who enter the room know what level of pain the patient can tolerate. The last section is about what's important to the patient. In the past, on this particular section, I put safety and comfort. I have since been told by administration that this section is actually for what's important to the patient. One patient said it was important for her to have applejuice instead of cranberry juice, and that she liked to do crossword puzzles, so the administrator said that I had to put that on the board. At the very bottom of this board, there is a blurb in quotations that says something about us being there to provide the best patient satisfaction. In orientation for this particular business, we were told that we are to reiterate this blurb to each patient.

so are you expected to provide crossword puzzles? :rotfl:

the problem with those boards is you can never find a pen to use with them, and the time it takes to erase the previous name and put your's down cuts into what little time you do have to get the work done in

[rnin02]

Very well said. Our hospital has recently put dry erase boards in every patients' room. The following information is provided to the patient on this board: the date, who the nurse is, who the doctor is, then each hour is listed in columns and the idea is that the nurse is to enter the patients' room each hour and then initial next to each time, to show that she has been in to see the patient, at least once an hour. There is another area that says: today's plan, a section that says questions for my doctor, and then a section that says something about pain. In this part, we are to write what the pain medication is, what time it was given, when it is next due, and then write the patient's pain tolerance level, and circle it, so that those who enter the room know what level of pain the patient can tolerate. The last section is about what's important to the patient. In the past, on this particular section, I put safety and comfort. I have since been told by administration that this section is actually for what's important to the patient. One patient said it was important for her to have applejuice instead of cranberry juice, and that she liked to do crossword puzzles, so the administrator said that I had to put that on the board. At the very bottom of this board, there is a blurb in quotations that says something about us being there to provide the best patient satisfaction. In orientation for this particular business, we were told that we are to reiterate this blurb to each patient.

I like the idea of this board. It may take a little bit of time in the beginning, but it seems worth it. It seems like it would cut down on a lot of questions and confusion for the patient. We have dry erase boards in our rooms, but they are fairly small, usually just enough room for the date, room number, phone numbers, and nurses names (post partum nurse and nursery nurse). After that we don't have anything left.

[pie123]

so are you expected to provide crossword puzzles? :rotfl:

the problem with those boards is you can never find a pen to use with them, and the time it takes to erase the previous name and put your's down cuts into what little time you do have to get the work done in

B=No, I didn't have to provide the puzzles, but in her whole stay, she never did one crossword puzzle. One of my co-workers was reprimanded by administration regarding her "boards". She got taken into the office and came out crying uncontrollably. They had dinged her twice about her boards. There was something that she did in the past that did not sit well with administration.

So, I think rather than address that, they used this instead.

In our orientation for these boards, we were told that if a patient says fly-fishing is important to him, then we need to put that on the board, and that this would be an example of conversation starters when we're making rounds on the patient.

We have also implemented patient call backs. It's similar to what is done on an outpatient surgery unit. It's basically a satisfaction survey done over the phone. We have to do it for every patient that is discharged.

[crissrn27, RN]

We don't do "customer satisfaction" call-backs, but we do patient care call-backs to make sure mom and baby are alright;)