Customer Service

This is in response to some blog posts I've seen recently protesting the use of patient satisfaction surveys to determine reimbursement.

I haven't settled my opinion entirely, but here are some thoughts.

As a hospital, we ARE a customer driven organization. If we don't have patients, we don't have a hospital to run.

I absolutely think we need to focus on being the best hospital we can be, with appropriate technology, properly skilled clinicians, and safe care for all.

But isn't that just the bottom line?

Can't we do better?

We are understaffed and overworked.

We are busy saving lives.

We are balancing the needs of many, twelve hours at a time.

But above all, aren't we people taking care of people?



What do my patients want?

They want excellent care, and they want compassionate providers.

I'm busy with a critical situation in room A, and the patient in room B is asking for pain medication? Certainly my priority is to get Patient A stable, but doesn't Patient B deserve attention? Maybe I can't make it to that room immediately, but I can ask another nurse to pass that pain medication for me, or ask an aide to explain to the patient that I will get to them as soon as possible.

No matter where we work or what patient population we serve, we are a team. We have to work together to provide the best care possible for our patients. We have to look out for each other and recognize when our coworkers need a hand. We have to talk each other up instead of sniping about the shortcomings of another unit or provider. Even though I might not work directly with Dietary or Environmental Services, patients view all of us as a unit: The Hospital. If they hear me grumbling about how Pharmacy never sends my meds on time, or how ER always sends up my patients dirty, or how that night shift nurse always leaves extra work for me, it reflects poorly on ME, and on The Hospital as a whole. What's that cheesy saying? Together Everyone Achieves More.

Let's work together and achieve greatness, shall we?

(And in the meantime, lowering nurse to patient ratios sure wouldn't be a bad thing! Ahem, administrators. Each patient is not my only patient, but they deserve to feel like they are!)

Expecting the Norm

On the type of units where I work, healthy is the norm. My patients may have pre-existing conditions (such as diabetes or high blood pressure), but most of them choose to be in the hospital. Perhaps it is for an elective procedure, or perhaps it is to deliver a child.

When I take care of my patients, I have certain expectations about their course of treatment.

Sometimes, though, complications develop, and it is my job to be aware and proactive.

I have found that my tendency is to assume that everything will be normal, and to shrug off aberrations as just slight deviations from the norm that will resolve themselves.

I have to make a conscious effort to pay close attention to each detail of each assessment, and to give serious weight to any concerns raised by patients or their loved ones, so that the proper steps can be taken to optimize their health.

I recently had a mother tearfully thanking me for being in tune with her child's condition as it developed, and getting him the interventions he needed.

THAT is why I am a nurse.

To provide for my patients' needs, whether they are physical, emotional, or spiritual.

To provide a listening ear and a sympathetic heart.

To answer questions.

To teach.

To enable.

And if necessary, to delegate to someone with a higher level of expertise, so that all needs can still be met.

Teaching an Old(ish) Nurse New Tricks

Over the last few years, I've developed my beginning-of-shift routine. I generally look at my charts first, then go to each room one by one to medicate and assess simultaneously. The drawback to this is that sometimes I don't make it to my last room before 9am, and that's longer than I'd like to go without seeing my patients! This week, I decided to try something new for me. As soon as bedside report was completed (so I had a basic knowledge of what each patient was there for, but hadn't looked up specific orders), I went to each of my rooms and did an assessment. By doing that, I was able to see everyone before 8am, so I knew what their baseline was in case they might have a status change mid-shift. Once the assessments were completed, I looked in the charts to fill in details, then began coming around with the morning medications. I didn't get to start charting any sooner than I would have, but I felt a lot more prepared for the day, and I felt like it went much more efficiently than usual. So, who says you can't teach an old nurse new tricks?

Miscommunication

How's your pain now? Can you rate it on a scale from 0 to 10? "Well, it was at about a 9, but I repositioned my leg better, so now I'm at a 10." ...Wait a minute. Does that mean you have no pain? "Yes, no pain. It's at 10." This is the point where I re-explained the pain scale we use, where 0 is no pain and 10 is the worst possible. (The patient explained that she and her husband used to joke around and rate each other. i.e. You are all dressed up, you're a 10 today! or You've been out working in the yard, you're a 2! In her mind, 10 = good!) Come to think of it, she did look very relaxed when her pain was a "9"!