"Do you wanna.......huh...........do you really wanna?"

[eriksoln]

Ever see the movie Lethal Weapon, when Mel Gibson goes on the roof to talk down the guy threatening to jump? The guy insists he is going to do it blah blah blah..............so Mel looks him right in the eye, gets this "I'm not all there" glare in his eye and asks him "Do you wanna..................HUH.........do you really wanna?" Next thing you know, Mel is pulling him off the ledge, forcing him to make the "jump" he was threatening to do. The guy is so scared by the time its over, he is screaming to get away from Mel.

I think the next time someone tries to tell me customer service is the focus of healthcare is going to have a very similar incident with me.

I was talking to some friends who were (yes, the past tense is intentional) big proponents of the push to make the medical field more like the "customer service" industry. I pointed out to them why healthcare can never completely adopt "customer service" policies.

1. Healthcare is and forever will remain a business. In that aspect, yes, we are much like any other retail/food industry establishment. On the other hand, we have more than any other industry taken the role of public servants. We continuously admit people who we know have no ability to pay their bills because it is our duty to do so.

Consider for a moment going into McDonald's with the famous line "I'll gladly pay you tuesday for a burger today." Or simply consider going in and saying.............."I can't pay, but I am hungry and you are service oriented sooooo..........hop too with making my burger and don't forget to hold the onion."

Once the laughter stops, you will quickly find said McDonald's management showing you the door. This is Real Life customer service.

Is this how you really want your local ER operating? We continuously treat people despite their ability to pay. We do not have the option of turning away customers simply because they are low on funds. Ask the guy who, with no health insurance, who falls and breaks his leg if he likes the RL version of "customer service."

2. The healthcare field more than any of our "customer service" counterparts must have the ability to personalize our service. We exemplify "Have it your way" more than any Burger King will. Yes, the grocery store will bag your sale exactly how you wish, yes BK will add/subtract whatever condiments to your liking. But we go much further than this. Timing of medications, treatments given (PT/OT, Social Services etc), everything down to how much your legs should be elevated is personalized for the best results for each individual patient.

Other sevice industries have the luxury of offering a service and placing difinite, concrete parameters on how it can be received. If you don't like their way of offering the service, more than likely they are not the company for you and good luck with your search for someone who does w/e it is (eating out, shampooing carpets) better. Tell me how successful you are in getting the cable guy to come to your home at 11PM becasue "its what I am most comfortable with." Next time you wake up with an urge for a night snack at 2AM and want pizza, tell me how well it goes when you call the pizza joint that closes at 10PM.

Is a hospital that stops admitting between certain hours what you want? What would you think of a physician who writes med orders like the cable company makes appointments.........."Take one tablet daily until somewhere between April 9th and May 5th"?

Point is, "customer service" industries are able to set their own parameters of "service" so they don't over promise.

If you don't agree with their way of doing it, your only real option is to find someone who does it your way, and more than likely it will cost more. This is RL "customer service". In order to cater to many, there are policies in place that allow for a systematic approach to be used. We on the other hand don't have the freedom to go between systematic and personized.

3. Ever been to a restaraunt where you've been to 1000 times before and gotten.........extra special benefits because you're known as a good tipper? or.............Ever been to a restaraunt for the first time and gotten so/so service because the waitress doesn't know you and is busy with their familiar good tipping crowd?........or, Know of anyone who tends to get bad service at the local restaraunt because they are needy or don't tip?

Industries in the service industry put a lot of effort into keeping the "good customers" and freeing themselves of the less desireable ones. If you are one of the "less desireable" types, service industries will tell you to pack it up and take your high demands elsewhere. I used to work in the food service industry and have witnessed more than a few times "clients" being told they should probably seek another place for their next meal because they were too demanding.

Retail and service industries are allowed to draw the line in the sand when someone is out of line. We, as healthcare providers, are not so fortunate. We can be attacked, spit at, verbally abused and all sorts of demands made of our time are needlessly made (often by non-paying patients) but............"Ah well, they are sick so it is their right" is the general opinion of onlookers.

Do you really want a healthcare system that gives better care to the patients who "tip" best? How about a nurse who can't be bothered getting you pain meds because they are too busy fluffing the pillows of the big tipper? How does a nursing manager telling you to take your demands elsewhere because you have no shoes/shirt on when you need cardioverted sound? Thats RL "customer service".

My point is, if you want "customer service" to be a part of healthcare, you have to take the good with the bad. It works for the service industries because they can implement it under their own terms. No government fines because the steak was Medium-rare instead of Medium, no being forced into catering to unrealistic demands, freedome to choose who the "good customers" and "bad customers" are and act accordingly.

The "customer service" approach works for retail and food service because they have liberties that will never be accepted in healthcare. Without said liberties, you can't have the other aspects.......not because I don't think they should be there but because they simply don't work without the balances or ying/yang in place.

So, to end, I will ask all the proponents of customer service out there:

":devil:Do you WANNA................huh................do you really wanna?"

[eriksoln, BSN, RN]

i started nursing about the same time managed care came along. i remember when the pbx operator announced the end of visiting hrs at 8pm, visitors left. imagine what would happen if that was done today! let's face it, healthcare is an industry/business where the #1 priority is the bottom line so that hospital ceo's can collect a 7 figure salary plus bonus for "managing costs", meanwhile the nursing dept has a wage/hiring freeze. the ceos of the largest insurance companies make 8 figures while their "enterprise" policy makers and corporate attorneys create loopholes to deny coverage. the health insurance lobby is one of the most active and powerful groups in dc, hard to believe, right?

The focus on customer satisfaction has had an ever increasing negative effect on the ability of direct pt caregivers to do just that, give care to the pt. how many times have we all seen groups of visitors camped out in a pts room and had to squeeze through to hang fluids, pass meds, tried to assess breath sounds in the middle of the pizza party? Of course not all pts do this, but the ones who do make our jobs harder than necessary. i've even seen this happen in critical care units, which would have been unheard of 20 yrs ago. This type of behavior continues because it is tolerated and encouraged by hospital administration who use press gainey scores as a marketing tool.

Hospitals will continue to recruit customers by building new facilities, that look more and more like hotels, providing VIP suites with flat screens on the wall, mini fridge and microwave, laminate wood flooring, custom art. The brand new hospital in my area also has a grand piano in the lobby.

https://allnurses.com/general-nursing-discussion/lack-attention-primary-570405.html

[Ruthfarmer]

A doctor told me once that if at 5% of the patients aren't angry about something then we are not doing our jobs properly. He went on to explain that all patients want or "need" something. Sometimes what they want or need is contraindicated or just simply not appropriate. Those times are when we must refuse their wants or "needs" because these are NOT medically appropriate or in the patient's best interest. This is just real life.

Whenever we had someone all bent out of shape in the little rural ER over the fact they couldn't get a meal tray at 2 am when their complaint was severe nausea or that they wouldn't receive a morphine shot for a hang nail, we would just wiggle all five fingers of one hand at each other and mouth the words, "The five percent."

Unfortunately the customer service hype does not allow for denying patients things that are inappropriate. And so it goes.

[eriksoln, BSN, RN]

A doctor told me once that if at 5% of the patients aren't angry about something then we are not doing our jobs properly. He went on to explain that all patients want or "need" something. Sometimes what they want or need is contraindicated or just simply not appropriate. Those times are when we must refuse their wants or "needs" because these are NOT medically appropriate or in the patient's best interest. This is just real life.

Whenever we had someone all bent out of shape in the little rural ER over the fact they couldn't get a meal tray at 2 am when their complaint was severe nausea or that they wouldn't receive a morphine shot for a hang nail, we would just wiggle all five fingers of one hand at each other and mouth the words, "The five percent."

Unfortunately the customer service hype does not allow for denying patients things that are inappropriate. And so it goes.

Had a manager who was VERY deep into PG scores tell me something similar. Basically, they said:

There are, unfortunately, a small portion of patients who will give us all 1's and 2's regardless of how good the care is. But that's going to be their loss in the end. If you have someone like this, don't stand there and argue with them (kinda like Ruby's sig. says), that is time wasted on someone whose score won't change. Let'em suffer and wait for their..........w/e they want. Focus on the ones who can be brought from a 3 to a four or five. Then, that small population of patients who can't be satisfied will not matter so much.

And that's what I do now too. If you are impossible to please, you can pretty much expect not to see me unless a medical emergency summons me to your side. I'm busy with the others, sorry, maybe the next nurse can adjust your drapes for the 24th time today. Just like the waitress who can't be bothered with you cause they know you don't tip. This is RL "customer service".

[DLS_PMHNP, MSN, RN, NP]

On the other hand, administration tells nurses to accept the public's deviant behaviors because the 'customers' are sick and not feeling well. Management demands that we coddle to rude visitors because they're 'under stress.' This mentality is wrong on so many levels. .

This type of administrative nonsense bull$#%^ is really degrading to us nurses. I felt more like a waitress than a nurse in the hospital. In fact, I even had a pt (A&O x4) tell her husband, "I like this nurse (meaning me), she is a good waitress."

Ummm... yeah. Where's my tip then?

[lrobinson5]

Oh.

Wonder if I'm allowed to rewrite this and submit it? Hmmmm, does this actually fall into the category of "ethics" though? A little bit of a stretch maybe, but not totally foreign to "ethics" I guess.

I think that treating patients as customers is an ethical issue. In business, the customer is always right, i.e. you do anything and everything to keep them happy. I think that trying to apply this mentality to nursing would be a disaster. There was a guy I was next to in the emergency room that was relentlessly bothering a nurse for food (he had a blood sugar level of over 500). Do we make him happy and get him the KFC that was brought in for the nurses?

[inshallamiami]

eriksoln--when are you going to write a book? Not an article, not a thesis, not a tome, but a book; about you, nursing, whatever. I'd buy it.

[anotherone, BSN, RN]

I'm 90% there with ya. I believe having an assertive and in-control personality/mentality is a big part of nursing these days. The ability to talk down/calm family members and make people who are very afraid feel safe is an attribute one can not ignore if they wish to be a truly effective nurse. In short, charisma separates the avg. nurses from the great nurses often times.

I think though, the person you quoted and myself are talking about conditions that go well beyond what can be expected of........even a great nurse.

I can handle my irritated/agitated patients without a hitch for the most part. What I have a problem with is when I walk onto the unit and pick up an assignment in which EVERY SINGLE patient is verbally abusive and some are close to becoming physical. I've been nursing over 5 years and its worse now that I've ever seen it. Patients are going to new heights with their threats and verbal abuse now that they feel empowered by this new push for "customer service". How good customer service came to be interpreted as allowing ETOH withdraw patients to beat on you or allowing drug seekers to take up all your time so that non-verbal/unable to reposition herself grandma gets ignored.............is beyond me.

And yes, I do, for the most part, blame the new/vogue attitude about customer service for this. As should you actually, according to your post. The new vogue/popular attitude about customer service has robbed powers that be of their will/desire/ability to be assertive. What do you do when a calm voice and assertive approach are not enough? That's when the things I talked about come into play: "If you are so unhappy here, perhaps you should seek your next meal at another establishment." RL "customer service". We can't do that though.

Anyway, my point is, there are more than a few times where even the great nurse's assertiveness is not enough. Patients know we are up against it as far as having to deal with their demands, regardless of how unrealistic they are. If we don't dig the ditch exactly where they want it, as deep as they want it and fast enough to satisfy them..........all "1's" on the survey and you don't get paid.

It is as if, we are a McDonald's that has been told by the powers that be: "You are obligated to satisfy w/e demands are put upon you. If the patient demands prime rib cooked to perfection with all you can eat lobster tails on the side...............you better find a way to serve it or you don't get paid." Now tell me, what McD's would stay open for even one full day under these circumstances.

Awesome posts. This is how I feel but can't express it as well. It is a losing battle and everyday i feel like i am going into a mental battlefield at work. Your nursing judgement is not respected by the customers or managmenet. I try to prioritize my tasks so things get done in a timely fashion leaving time for charting etc. Well the drug seeker wants his meds at exactly 12:00not a min later, the walkie-takie wants her multi vitamin at exactly 12:00 not a min later or earlier. Meanwhile, at 11:55 the 300lb incontinent pt, already at risk for skin break down, needs to be changed and I have to serach far and wide for enough staff to help.Well, the walkie talkie is now writing a e-mail to my manger, and ceo to complain about my poor nursing skills and customer service and I might end up having to attend some customer service seminar. The drug seeker is standing at the station yelling at the unit clerk............................................ Try telling any of these types that you have sicker pts or gasp, they are not your only pt and it is a big scene.

[anotherone, BSN, RN]

I think that treating patients as customers is an ethical issue. In business, the customer is always right, i.e. you do anything and everything to keep them happy. I think that trying to apply this mentality to nursing would be a disaster. There was a guy I was next to in the emergency room that was relentlessly bothering a nurse for food (he had a blood sugar level of over 500). Do we make him happy and get him the KFC that was brought in for the nurses?

In business you do what the customer wants up to the point where it ensures you a profit that is worth that effort. When it is not you have the right and obligation to your shareholders to tell the customers to go find another business. hospitals don't do that. that is the part that angers some people.

[chicookie, BSN, RN]

Great post Eriksoln!!!!!!!!!!! You have a natural ability for nursing issues communication!

Your post has my vote to win! :balloons::balloons::balloons::balloons:

Disclaimer- When Eriksoln wins and starts his own healthcare network,

I am working there!

200% agree with this!

Are these the articles that everyone votes on? If that is the case then please let us know, then your loyal fans can flood the voting button!

[Anna Flaxis, BSN, RN]

Awesome posts. This is how I feel but can't express it as well. It is a losing battle and everyday i feel like i am going into a mental battlefield at work.

I feel this way, too. The amount of psychic and emotional energy it takes to handle this aspect of the job is so incredibly draining, I find that most lay people have no understanding of it, and only fellow nurses can really appreciate the feeling of emotional exhaustion that results.

My partner thinks I have PTSD from some traumatic experiences I had earlier in my life, and that for whatever reason, this job is triggering me. I think that hospitals that emphasize customer service to such a degree that staff members feel that they cannot advocate for themselves lest they upset the customer (heaven forbid!!!) are creating an atmosphere inside their facilities in which staff members feel violated and powerless. I think this is likely a contributing factor behind my own personal struggle.

Eriksoln, I think you could rewrite your post in such a way that it is tied to nursing ethics. I think the customer service model impacts nursing ethics in multiple ways, and all you need to do is connect the dots. Best of luck! Can't wait to see your winning article!

[mama_d, BSN, RN]

It's totally an ethical issue. We choose, every minute of every shift, who and how we're going to spend our time with our patients. How many times have we had to make the decision whether the drug-seeker in room five is going to get her dilaudid to the minute it's due, or are we going to turn and clean up the non-verbal 90 year old that the tech just found wet again?

True stories:

Got reprimanded by old manager b/c I td a pt that they needed to stop screaming about needing to use the BSC b/c we were in the middle of intubating one of my other pt's and she would have to wait. When, after the unstable pt was finally transferred to the unit, I was able to get back into her, she continued to scream at me. I told her calmly that another pt going into respiratory failure and dying took priority over her needing to use the restroom. Her answer: "I don't care what else is going on, as far as I'm concerned I'm the most important patient you have, so I come first." So, I should have left my dead pt that we were coding to put her on the BSC? Really? And my manager thought that I was being the unreasonable one.

We had two sitter patients b/c they were high fall risk. Normally this alone will not qualify, but the families made such a fuss that mgmt relented and took both our techs off the floor to sit. Leaving the nurses to do primary care on five tele pts each. Wonder of wonders, another pt who was high risk but had a family that was sweet as pie and would never make unreasonable demands on the staff fell. There just wasn't enough staff on the floor to get to him in time. So b/c the other two families were the proverbial squeaky wheels, some other poor guy hit the floor. Fair? I don't think so. And you can bet your bottom dollar that the family of the guy who fell was never told that staffing was an issue that night. It was all over the incident report though...not that it'll make a difference.

It's gotten so bad that I had a dream a while ago that there was a Hilton sign right under the hospital name sign at the main entrance to where I work. I'd call it a nightmare but we all already know that it's close to reality.

[eriksoln, BSN, RN]

eriksoln--when are you going to write a book? Not an article, not a thesis, not a tome, but a book; about you, nursing, whatever. I'd buy it.

Only if my nursing book is allowed to have Dark Elves, Hobbits, Dragons, Wizards and a little bit of baseball mixed in with the nursing.

[Having fun pretending he knows some fashion this all ties in so that everyone else gets headaches trying to make the connections]