April 16, 2012

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Nurses and customer service: A new annoyance or an old standard?

By Donna Cardillo, RN, MA

I recently overheard a nurse bitterly complaining about the staff on her unit being asked by their manager to address patients by name each time they enter the patient’s room and asking them, while there, if they needed anything else. This nurse was irate about the request and proclaimed it was yet one more example of how nurse managers “do not care” about the staff nurses providing good clinical care to patients but that they only care about patient satisfaction scores. I’m not sure that analogy holds water. But this is not the first time I have heard a nurse bristle at any hint of what could be labeled “customer service” strategies. But is it really such a foreign concept to nurses or are we just looking for an excuse to buck the system?

When I was in nursing school we talked at length about developing a therapeutic relationship with patients and family members and making sure that they were as comfortable as possible at all times. We learned how hospitalized patients feel scared, powerless, intimidated and often disoriented. We discussed the importance of acknowledging people, addressing them by name, empowering them by encouraging them to ask questions and so on. Back in the day when nurses had a little more time to spend with patients, we also used to fluff pillows, straighten sheets, give back rubs and even refill water pitchers in addition to all our other nursing duties. All of this was “customer service” even though we didn’t call it that back then. We did realize that these things were a necessary part of empowering patients and their family members to feel safe, calm, comfortable and more in control. It’s something we often referred to as “bedside manner.”

Granted the more personal care tasks are now relegated to unlicensed staff for obvious reasons. But why have some of us become so angry about providing basic patient/customer care services? I’m not talking about adding in extra “tasks” such as fetching juice or ordering extra meals, which can easily be delegated to other staff. I’m talking about a knee-jerk reaction so severe that it could break someone’s jaw at the mere suggestion of the concept.

Let’s be clear on what we’re talking about and not taking about here. The phrase “customer service” is an umbrella term that refers to how a person or entity (healthcare facility, professional association, business, individual practitioner) treats the people they serve. By “serve” I mean, in our case, tending to those who come to us for care, help, advice, healthcare services. The phrase “customer service” is not synonymous with “waiting on people” such as a server in a restaurant or a sales associate in a retail store would do. Nor does it imply that those we serve must be called “customers” rather than “patients.” It’s the concept not the terminology that matters. The phrase is universal.

I’ve heard nurses say that we do these things “only” for patient satisfaction scores. Of course the scores are a measurement tool to assess how well patients perceive their overall care and hospital experience. A patient’s perception does play a role in his/her care because we all know that the happier, safer, and more cared for patients feel, the better their recovery; the fewer times they hit the call button; the less inclined they are to initiate a law suit; and the more inclined they are to have good feelings about the facility and it’s staff overall. These things are all important to any nurse, even the latter, which impacts our livelihood.

I’ve been a patient myself as have many of my family members in the last 10 years. Acknowledging people, calling them by name, taking a few minutes to ask if they need anything, tending to some basic needs, and encouraging questions make a world of difference in care. You can look at it as “something extra” but I see it as part of the therapeutic process. No, it does not trump life-saving skills, critical thinking, and applied nursing science although it does enhance it. So do the two have to be mutually exclusive of each other? I think not. To me, they go hand in hand…and always have.

Donna Wilk Cardillo is the Career Guru for Nurses and “Dear Donna” columnist for Nursing Spectrum, NurseWeek, and www.nurse.com. Donna is also an ‘Expert’ Blogger at DoctorOz.com. She is author of The ULTIMATE Career Guide for Nurses, Your 1st Year as a Nurse, and A Daybook for Beginning Nurses. Ms. Cardillo is creator of the Career Alternatives for Nurses® seminar and home-study program. You can reach her at www.dcardillo.com or www.nurse-power.net/blog.

 

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19 thoughts on “Nurses and customer service: A new annoyance or an old standard?”

  1. Anonymous says:

    The key question was stated in the blog: ” But why have some of us become so angry about providing basic patient/customer care services?”

    Leaders need to start addressing the sources of nurses’ anger — instead of ignoring us and telling us to do better — or telling us what better bedside nurses they were “back in the day.”

    Until the causes of that anger are addressed, the possibilities for improvement are limited.

  2. Anonymous says:

    I would be curious what you think the “cause of anger” might be.

  3. Anonymous says:

    Knowledge is wealth. So when we as nurses give our undivided attention to the patient and state is there anything else we can do before we leave it offers a venue for the patient to speak and ask a question. And as we leave if we state that a you will be back in one hour or that the CNA will be back in an hour and follow thru it allievates the fear of the unknown. It builds trust and a relationship because the consistency is there in the follow thru.

  4. Anonymous says:

    Too frequently the unit is already under staffed. A friend left her hospital job after being told by her supervisior that SHE needed to go empty the trash in a room because the family was unhappy it hadn’t been done as soon as they asked. The acuity of her patients that day didn’t leave time for ’emptying trash.’ Why wasn’t this taken up with the housekeeping supervisor instead? Customer service is great when you have the staffing – otherwise the sickest patients will get the attention first.

  5. Shelly says:

    Times have changed, expectations have risen. We need to change the title”Patient satisfaction scores” manage the reports as a tool to address changes. It is a must in order to get feedback on how we are respectful. It has never been a tool used to determine your clinical strengths or quality. Don’t confuse them. Its an evaluation tool of how the patient perceives their stay, did u smile? were you grumpy? Those who have visited starbucks, the Ritz, you will be greeted with a smile and no less.

  6. NurseEducator says:

    I discovered by myself in practice that “making friends” with my patients made my day more pleasant, and more importantly, it opened the door for conversation and deeper levels of sharing. If your patients are your friends for the day, they trust you, and will confide things that might otherwise remain unspoken about their feelings, pain, beliefs about their condition etc. Thus: treating people with true friendliness begets greater communication leading to more intelligent care

  7. Anonymous says:

    I agree that calling it “customer satisfaction scores” puts the staff off. When you look at it from the point of view that you are caring for someone the way you would want your family to be treated – making people clean & comfortable & listened to & warm & cozy. That’s different. Our techs had no idea what HS care was & preferred to call it tuck in care, but they still didn’t want to do it. Too much trouble. But they do have time. Back rubs? Don’t get me started!!

  8. Anonymous says:

    The author states, “But is it really such a foreign concept to nurses or are we just looking for an excuse to buck the system?” I believe the RN was expressing frustration about her work load…no foreign concept…not trying to buck the system….just overworked, and yes, probably a bit angry. I consider that an important concern.

  9. jaa says:

    I have read several studies thatindicated that hospitals and doctors with the highest patient satisfaction scores also had the highest mortality rates and poorer outcomes. While acknowledging developing a friendly relationship with our patients we must still remember we are responsible for their care, education and treatment while they are patients. Sometimes encouraging them to participate in their care isn’t the most popular treatment. Isn’t that why smoking and weight control are avoided?

  10. Anne says:

    As a patient with a chronic illness, I remember each ER visit based on how I was treated by the staff. There are some ERs that I will do anything to avoid because the staff acts like you are a hindrance to their job. As a clinical nurse for 35 years, I am appalled that any nurse would not treat another human being with at least a civil tone and a basic interest in that person. When my husband was a patient, I had a nurse pretend I wasn’t even in the room! This is just wrong.

  11. 84ocnRN says:

    In our magnet hospital and associated oncology practice the staff is expected on conclusion of a patient’s visit to ask “Is there anything else you need today?” I find it to be an additional way to assess the pt’s needs, because often they do have another issue but perhaps feel the time is not right or they simply need encouragement. I realize the “customer service” term is offensive to some caregivers, but I’m an old nurse (I prefer “seasoned”) and used to give back rubs and all the comforts.

  12. breyan says:

    This was a terribly argued article, but I love that it was written because it adds fuel to the fire of what I believe is wrong inn the minds of those whom push this whole marriage of costumer service and nursing care. First of all has the author done bedside pretty recently? I doubt it. The problem was not that the nurse dreaded using the pt’s name and asking if they needed anything else etc. it’s this movement to force a scripted sterile interaction to our profession like so many other biz cont

  13. breyan says:

    businesses, like I can’t go anywhere without an awkward forced “Welcome to such and such” SUBWAY….geeeez! So regulations have gone crazy. Documentation is so out of hand I think it is institutionalizing lying. Instead of our profession accepting that we are going to have crazy rude people once in a while WE COULD NEVER MAKE HAPPY NO MATTER WHAT, instead of the management evaluating the bedside nurse and supporting him or her if they were in the right and setting bounderies with the patient/fam

  14. dunbr1 says:

    The management is so afraid of those evals they will let nurses be abused. Just burn ’em out and hire new ones is the philosophy of many institutions. I know every new shift I come in with the best attitude because I’m really interested in doing anything, and willing to accelerate my aging and ruin my back in the process. But the underlying frustration is not about resisting a therapeutic nursing process that CAN be nice and a great pt satisfier at times-but it’s forcing us to kowtow to peoples

  15. dunbr1 says:

    whims and egos when: 1.They are wrong; For ex, I have been told not to give my pt morphine by a family member because she didn’t think he was in pain! And there was no way she was right…I discussed it nicely but then I eventually had to say he’s my ICU pt, you are not, and this is not a choice you can make for your 30 son with a neuro status. She complained and it was spun that I could have done SOMETHING differently. No back up at all, but she got movie tickets to make her happy. 2. It is not

  16. breyan says:

    therapeutic. It is BAD nursing to cater to certain personality disorders. It fosters dependence, not independence. We were taught to do ONLY what they can’t do for themselves (basic fundamental theory)!. Families refuse to help because they don’t want to and they decline when nicely asked if they would like to learn how to take care of their parent whom they want full code in spite of no neuro status and stage IV’s because she wasn’t turned at home. Giving my pt’s warm blankets is one of my

  17. dunbr1/breyan says:

    of my fav things to do, but now most of the time I have pt’s families telling me their dad’s cold, even though he, the pt, said nothing, and have me put on a blanket in spite of there being a stack of clean linens/blankets right next to the bed in plain sight. This is one example of the trend of caring by proxy. These poor people love ordering me around b/c they prob have no power in life. I get it. But it is still abusive and it all adds up. We do the Docs job, hear more charting from admin

  18. dunbr1/breyan says:

    Is always being added/needed. We are at the computer instead of doing the pt care we love. And now instead of just encouragement to be happy professionally behaving nurses, we are expected forced to be healers who must put business before the beneficent evidence-based therapeutic nursing process. I have a feeling the evidence will show this will not lead to healthier people, just spoiled chronically ill brats.

  19. kittyk says:

    The people I take care of as a nurse are not my customers, they are my patients. I am not a customer service rep, I am a professional. I am not a whipping boy for pts to take out their power-fulfilment needs on, nor am I there to serve as the focus of relatives temper tantrums which they throw to prove to the pt how much they really love them.
    There are times when boundaries need to be set, e.g. when a pt or relative curses out the nurse.

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