"When you get those rare moments of clarity, those flashes when the universe makes sense, you try desperately to hold on to them. They are the life boats for the darker times, when the vastness of it all, the incomprehensible nature of life is completely illusive. So the question becomes, or should have been all a long... What would you do if you knew you only had one day, or one week, or one month to live. What life boat would you grab on to? What secret would you tell? What band would you see? What person would you declare your love to? What wish would you fulfill? What exotic locale would you fly to for coffee? What book would you write?"

Wednesday, May 8, 2013

Impossible Customer Service for All

Hey everyone! I want to thank you for the astounding amount of view counts on the last two blog posts I received. WNB in back with a bang! Thank you everyone!

Anyway, todays post is a nursing post, a somewhat controversial one and I even debated awhile even posting it at all. But, here goes...

So I worked Friday through Sunday this past weekend. What started as a slow-ish weekend quickly turned extremely busy (who woulda thought for early May? Weird.) Anyway, Saturday night I thought I had a pretty easy assignment. Most of my patients were in their 50's, the easiest and very nicest age range group in my opinion. This is not to say that they don't have potential to be very sick because by all means- any patient in any age group has potential to be critically sick. But it just so happened that that night my patients were very nice and had what I thought to be easy diagnoses to take care of.

Now, when it comes to customer service in the hospital- patient satisfaction means everything. It's how hospitals get reimbursed from huge insurance companies. It's how we get more patients. You've all heard the term, one patients good experience- they tell one person but if they have a bad experience they tell ten. When something good happens to a patient in the hospital, it makes them smile. But they still feel yucky. They just want to feel better and go home. They *might* go home and remember that they had a good nurse, but probably won't remember your name. But, they may tell other people that your hospital has "good nurses".  But all it takes is one bad experience mixed with one grumpy or really sick patient to create a chaotic mess of unhappiness. Suddenly that patient feels wronged, that what has been done to them is unjust- even if all it was was that they had to wait 40 minutes for you to remember to bring a soda back they asked for. What they don't know is that when you leave their room, maybe you had to suddenly help a coworker in a dire situation, or another one of your own patients needed you, or whatever! Patients don't think about that. Realistically, patients do know that they obviously aren't the only patient there on your floor. They know that. But they don't like to think about it.

Think about how you would feel or have felt if you were a patient. You are bored. You're thirsty and all you want is a coke. You ask the aide to bring you some when she comes in for vitals- and she says yes but then keeps going along with vitals and when she's done she forgets. Thirty minutes go by and you ring your call bell and the nurse comes in-  you ask her. She says no problem but then gets pulled into another patients room and forgets about your soda. The nurse doesn't even realize how big of an issue to you this is because in our eyes, the nurses, its just a soda in the whole scheme of things. We are worried about your vitals, your health condition, our other patients, etc. But to the patient, they just want the friggen soda and they feel that as if everyone is forgetting about them. Next they go home and tell ten people that your hospital has horrible customer service, even if you provide the best healthcare.

On that note, I always try and do my best possible job when it comes to customer service. I always knock when I enter patient rooms. I always address them properly and then remember how they like to be addressed after that. I smile with them, I listen to everything they have to say and I don't belittle them. I do my best to remember if they asked for something and I get it as soon as I can. I always tell them what shift I'm working and what time they will be under my care until. Before I leave at the end of my shift I make sure to explain that I will be leaving in approximately a half hour and then your next nurse will be in shortly after so that patients know. Patients tend to not like when their nurse just disappears and a new nurse takes over, or when a nurse hasn't been in for over an hour because they were in report or seeing other patients. I always always do my best to explain everything to the patient, even if its just pushing a saline flush into the IV. To us its a simple saline flush, harmless- to them its a large syringe of something that is being pushed into their body.

So despite my best efforts to be attentive to all and provide the best customer service, sometimes its truly impossible. The more patients you have, the harder it gets to be as attentive to all as the patient wants you to be. Take the following story as an example.

I had a young patient, lets call him John Smith. He was in his 50's and his wife was as well, and was staying with him in the hospital, watching and listening to everything. John had just had a heart procedure done with us and was put on a very good blood thinner, now extremely necessary and important for his heart to function. However, John was prone to nosebleeds. In addition to the (very good) blood thinner and the dryness of our hospital, he came down with a nosebleed. When my nurse aide had told me that it had begun, I went in right away to check it out. I told him exactly what to do and told him I'd be back in ten minutes. At that exact same time an admission had just arrived under my care. Now, small blip- patients just admitted to the floor require a lot  of customer service. They are scared, probably tired, hungry, they don't know whats going on, they need a lot of answers. They don't like rolling up to your floor on a stretcher and then being left there for 90 minutes before the first person comes in to see them. I always try to greet admissions within ten minutes of their arrival and do my whole admission shebang.  So anyway, I told John I'd be back, and I went to go say Hi to my admission. I gave her the downlow on what was going on and completed a quick assessment. I told her the aide would be in soon and we should be able to get her to be able to sleep shortly, as it was 12:30 at night. So back I went to see John, and suddenly realized it wasn't just a nosebleed, it was a water fountain. I tried a couple more tricks and then quickly got my nursing supervisor.

To make a LONG story short, I was basically in that room from 12:30 to 7:00 am, with maybe a 45 minute break (in which I quickly went to the bathroom, got something to eat, and charted like my life depended on it). The nosebleed was so severe that it required my constant attention, constant manual pressure to the nose, and a STAT consult to the ENT MD team, twice.

Okay so point here- In this case, I was able to provide excellent customer service to John. Him and his wife even said at the end of it all, right as I was saying goodbye, how fantastic I was all night and how excellent this entire hospital has been so far. They were pleased, despite John being in a very uncomfortable clinical situation. However, I had a brand new admission that was probably wondering where I was after I gave her the down-low, and I had 4 other patients that needed me as well. One of those four patients began having chest pain while I was with John, and another was yelling that he couldn't breathe. Because it was necessary for me to stay with John, I had to delegate responsibility to handle these new problems to other nurses on the floor.

Now think about this for a second. While I was doing what I had to do and on my end was taking care of the patient by sending another nurse in- this is what the patient feels:  Its 2am and you wake up with chest pain. You ring for your nurse who you've had for two nights now and knows your story- but in comes the aide. You tell her you have chest pain. She goes and gets me, who unbeknownst to her- sent in another nurse. Now one of my (very good) friends and coworkers handled the chest pain for me by attending to this patient by explaining that I was tied up in another room. But does the patient want to hear that some other patients problem is more important in my eyes than her chest pain? Probably not.

Maybe I over think things. In fact I know I do. But to me, its basic human connection. I've always been extremely aware of peoples emotions around me and I have the extraordinary ability to put myself in others shoes and see how they might be feeling, and then I have the decency to try and fix it. I try to make patients as happy as possible and in situations like that shift, those five other patients probably weren't very happy with me, but John was. So I made one patient happy and sacrificed five.  But let's say I had left John to be on his own for his nosebleed- to provide his own manual pressure to his nose for six hours while I tended to five other patients. Sure- I would have made five happy and sacrificed one, but that one sacrifice would turn into a monstrous story if not even a lawsuit. So although I couldn't obey the law of attending to the greater good, I obeyed the law of excellent nursing. Although I may not have made my patients the happiest, I at least knew about their problems and made sure they were taken care of by at least someone. To me that's the best I could have done.

Well thank you for reading today, as always! I love you all,



1 comment:

Enid Mueller said...

I am not as understanding as the writer of this article.
The assessment is full accurate: Patients want what they want when they want it, and if the nurse or nursemaid does not drop whatever she is doing to meet the patient's demand of the moment, this is a reportable offense.
Patients think only of themselves and not of the needs of the rest of the patients. This is understandable and natural, but hospital administration cannot fault the nurse for not being able to be at the bedside of all her patients at the same time. Nurses allocate their time and attention based on medical need. That is why a "simple" request for a soda from one patient goes unmet so that a nurse can treat another patient who is hemorrhaging. If the reverse happened, that a nurse was busy getting a soda so she could not help a patient who was bleeding, then the nurse could be fired and/or lose her license.
If administration wants every patient demand met immediately by the nurse, then they can hire a lot more nurses to make the staffing level one nurse per patient.