"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]

Again, Tweety, that's not customer service, that is good pt care.

Maybe you and I have the same definition, just different terms.

O.K.

Sometimes there's a way to provide a more patient centered care that provides greater satisfaction. When nurses say things like "you're not my only patient you know", when the go into the room hang an antibiodic and walk out, when they run into a room "I'm so horribly busy, we're so short staffed, I hate this place", "it's change of shift, you have to wait",

I just walked out of here, why did you call me back!" these are the issues that need to be addressed. Call them patient care issues, customer service issues, whatever you want. Bottom line if people aren't happy and there are things we can address to improve.

Of course administration has a place to because if your nurses aren't happy, the patients aren't going to be happy.

[LilPeanut, MSN, RN, NP]

That is exactly what I'm talking about tweety!

[flashpoint]

What is being effectively communicated is that "wants" are just as important as "needs." Our patients need air to breathe, a beating heart and enough blood volume to adequate supply oxygen to vital organs, nourishment to replenish and rebuild their bodies, education to help them help themselves, etc. They may want a coke or warm soup, but they will not perish nor will it compromise their condition if that want is not met in a timely manner.

:yeahthat:

[JennieO]

Frankly, customer service is important to attract future pts., but it can certainly distract from the "real" pt. getting the best care. I do not want to have you hinting that YOU, the visitor, have not had their BP checked for months while I am doing an assessment, etc, etc. My priority is the pt. and that is what I want to focus on. I am not your secretary. Ask the doctor these questions when he/she comes in, instead of sitting there being polite and smiling, especially after you just unloaded on ME your frustrations with the medical end of business. Visit, go home, call later. And how about those huge families that live at the hospital--obviously someone needs a job.

[TrudyRN]

I agree with DusktilDawn. 'Customer service' is not about giving good quality nursing care, its about keeping the patients and their families happy ---no matter what. IMO, the way management is now attempting to define 'customer service' in terms of quality nursing care is both silly and impractical. Nurses nowadays are working with more and sicker patients, our scope of practice is broader so we have more responsibilities, and we are under increased pressure because of higher Joint Commission standards and our own concerns for patient safety and potential liability issues. So, its likely that there's always going to be that angry patient or family member who files a complaint because we didn't bring the extra blanket they asked for fast enough, or because we didn't come back at exactly the time we said we would. In an acute care environment we must constantly rearrange our priorities, and, in any case, one patient's satisfaction should never have a higher priority over another patient's safety.

I've been written up before because a family member was upset that I didn't come back to warm up her husband's soup and he "couldn't enjoy his dinner." According to my then manager, I seemed to have an issue with communicating with patients and their families because I should have gone back to the room and explained why I didn't come back at the time I said I would. Sorry, but if I'm juggling a bunch of patients on a busy med surg floor with no PCA to help me, and one of my post-ops suddenly starts bleeding, I'm not going to leave that bleeding patient to go warm up a bowl of soup. The manager was well aware of the circumstances but she still wrote me up for it anyway.

The way I see it, if management is really serious about giving patients hotel-type 'customer service' then they need to hire more nurses and supportive staff and give us fewer patients, but that probably never going happen, so...

Please tell me you wrote down your side of the picture in your response to being written up. Please tell me you protested the write-up all the way to the Board of Directors if no one lower listened to you and tore the #&** thing up. If you didn't, do it now. Your manager has her cerebrum up her rectum and deserves to be horsewhipped.:angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire

[TrudyRN]

True customer service story:

I had six patients on a step down unit.

In room with MD removing staples on post op pt. Pt dehisces in front of shocked family onlooking. Running back and forth, getting saline, dressings, hollering for the UC to order cooling blanket, stat IV ABTs, getting stat pain meds, etc, etc, calming family, doing everything that minute to get this pt stable and keep freaking out family from freaking out further. MD freaking out, cursing, hollering.

Pt in next room, their family member stops me in the hall as I am rushing to the unstable pt's side with meds and bandages, "Grandma needs a coke." Told family member as pleasantly as possible, "I am in the middle of an emergency situation with another patient, I will be a while, can you please go to the desk and ask someone else."

I got called to NM's office next day and yes she understood the situation entirely but I still got written up because the Grandma-needs-a-coke person had complained that I told them I was too busy to get Grandma a coke. That was "poor customer service." Told NM I don't have customers, I have patients, the one with her guts lying all over the bed came before grandma and her coke, and he could jolly well have walked his big butt down the hall and got Grandma the coke himself.

Customer service, my eye.

I was on the other side of the bed last month, had kidney surgery. Other than asking for pain meds the first day as often as they could give them to me (and morphine sucks! God only knows why they give it, I hate it!!!) and going to the desk the last day and asking for ice cream (throat hurt d/t being intubated twice), I never asked for a darn thing. I KNEW my nurses woud help me as soon as they could and didn't make a pest of myself.

Customer service is what I expect in Penney's or Sears when I am looking for a green size 18 sweater they advertised in the Sunday paper and can't find it. (Oh here it is in lavendar ma'am, or would you like a rain check?)

Patient care is what I give at work and what I expect while I am in the hospital or in the doctor's office. I expect them to get me better, not find bubble gum for my grandchildren or feed my husband.

Hospital customer service has evolved into meeting EVERY NEED OF EVERYONE WHO VOICES ONE NO MATTER HOW MINOR OR HOW MUCH NEED SOMEONE ELSE HAS WHO REALLY TRULY NEEDS IT. Then we are understaffed and berated on a nearly daily basis when we cannot perform the impossible.

Like I said, customer service, my eye.

Please, please, please forward this to your Senators and Representatives, both in your state and in DC. They need to know the truth from the trenches.

And your manager - it's good I don't work there. He sounds like a total jackass. :angryfire :smackingf And I now toast you for saving a life. :cheers: :cheers: :cheers:

[TrudyRN]

To use your example - your manager told you that after the other pt. was stabilized, you should have gone back to the first pt. and explained what happened. Why is that an unreasonable expectation?

I have worked in retail and as a waitress, perhaps that's why I have a different perspective? Or maybe it's because I've been a long-term pt. in a hospital and know what it is like to be that pt. who is totally dependent?

I'm sure the L&D nurses who floated to my unit hated me. I looked perfectly healthy, I was just on bedrest. But if I wanted a ho-ho or cupcake out of my "goody box", I needed someone to get it for me. I wasn't supposed to be doing any sort of exertion. And I needed the goodies and sweets - I was chronically underweight for an unknown reason, and I was actually following the nutritionist's recommendations, but most float nurses wouldn't have that in-depth of an understanding into my case.

I think too many people forget what it is like to be on the other side of the bed.

Granted, we need to remember what it is like to be dependent upon strangers. I pray every day that my loved ones and I never, ever wind up in that worse-than-death state.

Just curious - why didn't your HoHo box get put where you could reach it?

Also, maybe she didnt' go back because there was still paperwork to do, there were other patients in dire need of her care, maybe she needed time to clear her mind, maybe she thought the request had been taken care of. Maybe she just plain forgot, being weak from hunger and dehydration, and in agony from no pee break all day. Not sure, I wasn't there, just speculating.

Also, it is not the norm in retail or waitressing to deal with life and death, mortality and morbidity, getting sued for one misstep. Please don't compare these lines of work to Nursing.

[justavolunteer]

It sems that hospital administrators have tried to make the hospital stay into more of a hotel experience. I am certainly willing to do what I can to make any patient's stay more comfortable. That's a big part of my job of being 'justavolunteer'.

HOWEVER, there are times when a patient will have to be NPO or on a restricted diet, Pitching a fit with me after the nurse has already said 'NPO' isn't going to change the fact.

I have had pts. threaten to file a complaint about me because I wouldn't take them out before they were discharged or because I wouldn't give them something that wasn't on their diet. Usually when someone gives me grief, their nurse has already gotten an earful about the same thing.

Patients are often told "you have the right to be treated decently, to be informed about your care", etc. I don't have any problem with basic courtesy. However, I think some people need to be told "This is a hospital, you may have restrictions on your diet, being allowed to go out to smoke, etc. You also have the RESPONSIBILITY to be cooperative with your caregivers, not rude & obnoxious to everyone within range".

[TrudyRN]

This is not what the customer service movement is about. Sounds like your faclity has got it all wrong. It's not about being someone's servent. If I worked for a such a facility I would have to quit. Seriously, I can't imagine being written up for such a thing and the minute I signed the write up they would get my resignation on the spot.

But, Tweety, we can't run around quitting q time something goes wrong.

[TrudyRN]

I am a nursing student and a recent family member (my father died after a 3 week ICU hospitalization). I am very apalled at the responses I have read! It seems that most of the nurses here could care less about their patients or their families, but are more concerned with their own status and the "Cardiac in Bed 6." As a Nurse or Student Nurse, we have no way of knowing what the family is experiencing or how that radiates/transcends to the client/patient/customer. In NS 101 we were all taught to care for the "Whole Patient"- which includes the family/support mechanism in place.

As an expert in Customer Service (22 yrs and an MBA), EVERY Business, including hospitals must recognize and cater to their customers- or lose them to competition- and most areas have competition even in Health Care.

When we as Nurses, Doctors, Lawyers, Politicans, or even Students forget who signs our paycheck- The Customer/Client, then we are doomed as an Economy, Hospital, or Profession.

I'm sorry about your Dad, Snickett. Your concept is not wrong about customer service. It's just that you do not have real life nursing experience yet. I think you'll understand better once you've worked some mandatory OT, had to take more pts than was safe, been in the middle of a super emergency and had to deal with comfort requests by visitors (for THEIR comfort, not the pt's), and been written up for taking time to pee, nourish or hydrate yourself, and care for your patients first.

[TrudyRN]

This is amusing, but totally untrue. Yes, we have mom. baby-daddy mom's boyfriend. Mom's mom. Mom's dad. Mom's sisters and brothers. Baby's sisters and brothers. Auntie from out of state, cousin who just flew in, dad's step-dad and mom, dad's dad and girlfriend. Mom's friends. Parents and grandparents have open visitation, and everyone else visits from 8-8. Even just with parents and g-parents, that can get very crowded.

I've never had a pt or family complain when I've explained that there was an emergency with another pt.

The way the rooms were set up, there wasn't a good place for that to happen, plus my fridge was on the other side of the room. There's only so much you can have in arm's reach.

The nurse doesn't have to warm up the soup, but taking three seconds to say there was an emergency goes a long way to making a person not feel neglected and abandoned.

The point is that even though he explained that there was an emergency, the person still complained. And the idiot manager still wrote him up.

[TrudyRN]

I don't think you get the picture. It doesn't matter who is on what side of the bed. Priorities are priorities. Going back to warm up a bowl of soup for a stable patient is not a nursing priority when you have an emergency bleed going on and you're on the phone with the surgeon and trying to keep the families updated, and rushing around to prep and take your patient back to the OR, plus documenting the incident.

I don't neglect any of my patients on purpose, but I am not going to run around like a crazy trying to be super nurse and end up making serious mistakes and burning myself out. I try to work in an organized way, and I always prioritize care from the most important thing to least. I don't mind warming up food for my patients, but, again, warming up food is not a nursing priority when you've got other more important issues going on. I wouldn't even have mentioned the soup incident, except for the fact that the patient's wife could also just as easily have walked to the microwave down the hall and warmed up the soup herself. It wasn't like she couldn't see us rushing into the other room to try to stabilize the bleeding patient, and it wasn't that I DIDN'T go back to explain why I did not come back earlier to warm up the soup. It was her attitude that got me, as if I was supposed to stop everything else and warm up her husband's soup. Well, well, well... maybe I'm a terrible nurse but I will not EVER prioritize one patient's satisfaction over another patient's safety.

OK, now I do have to ask - did the person know she was free to use the microwave? Did she know the location?