Customer Service VS The Bum Rush

  1. Customer service must by definition be continuous. I am seeing things that go against the theory of good customer service. I must ask if the policy is absolute or one of convenience? If we are to give absolute customer service then we can not forego the simple niceties and good manners just because time becomes a factor in certain instances.

    I was preparing to transfer a patient one day last week. I had already written the orders and called report. I had done this all before breakfast trays arrived. As I was giving report breakfast arrived. I explained to the receiving nurse that I would let the patient eat and give 0900 meds prior to transfer. It was 0830 and trays were already on the other floor etc. I took my patient her tray and explained the next course of action. Good Customer service would dictate that I allow my patient to eat their meal at their own pace and deliver the AM meds and then transfer the patient.

    Suddenly the room is needed STAT! I understand that these things happen and that if someone is crashing they will need a room. If that room is not empty then it can not be given out. Having a room and even having called report does not make the room empty. Yes a patient in dialysis was "crashing" they have stopped dialysis and started dopamine and she is stabilizing. Now though because of this urgency the room is needed and the customer service of the patient eating breakfast is no longer absolute it is a matter of convenience. Is the crashing patient more deserving? Priorities are the issue if the patient is truly crashing and the transfer is ready then explanations should be given and the transfer completed without haste.


    Customer service is a good thing and I think we should all strive to make people comfortable. I also feel that once I have given a patient an explanation about the next course of action, such as being allowed to finish breakfast then that is also good customer service and should not be overlooked or disregarded. I also feel that as nurses we are rushed many times with no actual attempt to circumvent problems.

    Solution: The patient in dialysis is crashing, perhaps the Code Nurse could be sent to dialysis where the patient is already on a monitor and receiving dopamine. The nurse can assess the severity of the situation, and determine if immediate action is required. If this patient is going to code then wouldn't it be better to be in a controlled environment? If the patient is stable enough perhaps they could remain in situ for a short while. The AM meds could be given during the patient's breakfast. The transport could be called and then when the patient finishes breakfast they can be transported. This would be good customer service to both customers and would not rush a nurse that has already devised a plan of action

    Staffing and census are our long-term enemies and we are dealing with them daily. We as staff nurses understand that Charge Nurses and Unit Managers can not control events as they unfold. Perhaps a few simple plans for implementing emergency procedure for emergency situations should be developed.
    Last edit by CCU NRS on May 8, '04
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  2. 10 Comments

  3. by   Tweety
    Don't have any answers. But from a med-surg standpoint nothing is more nerve wracking than having your license on the line with a critical care patient in need of a bed that is non-existent. I've waited as long a 12 hours for a bed once, doing on-on one with a hypotensive patient, being in charge and taking care of a patient waiting for a bed.

    During bed crunches I've had critical care nurses come to the unit to see if they really need to be transferred. "Oh they are breathing and alert, so it will be a while for you to get the bed" or "call the doctor back, they don't need critical care". Obviously there are bogus transfers, but critical care nurses don't realize sometimes that even if a patient is perfusing with a bp of 50/20 and responded well to a bolus, we don't have the manpower or training to monitor the patient for problems and changes frequently.

    But that wasn't what you were talking about, you are talking customer service and I'm off topic. My take is that for the betterment and safety of the crashing patient, move the patient and tell the patient to finish breakfast on the step down floor. Custoemr service is 99% approach and attitude. Sure they will get upset, but if you've had a good rapport with them all along it would work.

    Anyway that's my two cents. Would be nice to have a unit that for everytime the unit is full, it grows an empty bed and a nurse ready and waiting for the next in-house crash.
  4. by   CCU NRS
    Quote from 3rdShiftGuy
    Don't have any answers. But from a med-surg standpoint nothing is more nerve wracking than having your license on the line with a critical care patient in need of a bed that is non-existent. I've waited as long a 12 hours for a bed once, doing on-on one with a hypotensive patient, being in charge and taking care of a patient waiting for a bed.

    During bed crunches I've had critical care nurses come to the unit to see if they really need to be transferred. "Oh they are breathing and alert, so it will be a while for you to get the bed" or "call the doctor back, they don't need critical care". Obviously there are bogus transfers, but critical care nurses don't realize sometimes that even if a patient is perfusing with a bp of 50/20 and responded well to a bolus, we don't have the manpower or training to monitor the patient for problems and changes frequently.

    But that wasn't what you were talking about, you are talking customer service and I'm off topic. My take is that for the betterment and safety of the crashing patient, move the patient and tell the patient to finish breakfast on the step down floor. Custoemr service is 99% approach and attitude. Sure they will get upset, but if you've had a good rapport with them all along it would work.

    Anyway that's my two cents. Would be nice to have a unit that for everytime the unit is full, it grows an empty bed and a nurse ready and waiting for the next in-house crash.
    Actually my point is they have recently been screaming customer service in one ear and get em out in the other. I do understand all of the complications involved but it is just that they seem to want it both ways. I can not be caring and kind one minute then insensitive and brash the next to the same person. I was attempting to point out it would have possibly been an extra 15 minutes which if the pt in dialysis is stabilizing on Dopamine isn't really that much difference.

    I do know where you are coming from about needing a room and not being able to get one as well I have worked all areas, med-surg for several years, our uit used to keep one bed open for a "code bed" 9in case of emergency but we no longer do that and it does cause problems.

    I was just ranting a bit and thanks for your earnest reply Tweety.

    I watched cartoons this AM and saw the oen where Tweety is a messanger for the Confederate army and Sylvester is the spy catcher for the Union. LOL also caught Bugs but no Foghorn leghorn, I say, I say what is wrong with those people leaving out such a handsome figure on their program?
  5. by   Tweety
    You gotta love administrators that scream customer service, but don't want to spend any money on it. Like not having enough staff and resources to provide good customer service is going to help. Or when they provide customer service when it's convenient.

    (Who is Foghorn Leghorn??? )
  6. by   CCU NRS
    I say, Boy, I say you must be joking why Foghorn Leghorn is only the greatest most well loved Giant Rhode Island Red in the world, when it comes to out smarting that bone headed dog or just setting the little chicken hawk straight he is your mahn! a handsome figger of a Rooster too I mahght add!!!!

    for current photo see my avatar
  7. by   Tweety
    LOL. Sorry, it that his name? Mom didn't let us watch cartoons when we were kids, had to go off to catechism (sp?) on Saturday mornings.
  8. by   mattsmom81
    I wouldn't feel badly for too long about rushing granny with her breakfast because a patient was crashing...thats what critical care is for. We can always order her a new hot breakfast tray when we get her to medsurg.

    We still have to prioritize regardless of management's ridiculous expectations of 'customer service'...and we can't possibly make everybody happy all the time.
  9. by   CCU NRS
    Quote from mattsmom81
    I wouldn't feel badly for too long about rushing granny with her breakfast because a patient was crashing...thats what critical care is for. We can always order her a new hot breakfast tray when we get her to medsurg.

    We still have to prioritize regardless of management's ridiculous expectations of 'customer service'...and we can't possibly make everybody happy all the time.
    Ok Maybe I was being a little sensitive. In all honesty though the Pt in dialysis just could not handle dialysis it was dumping her B/P and they stopped dialysis and started dopamine she arrived to me with a 132/68 on 5mcg Dop which I subsequently decrease to 3 three and she was still 120s/60s after an hour I turned it off and baseline B/p was low 100's/50-60 which she had returned to. I just felt that it was not a true crash but more of a dialysis induced problem as was evident after things were turned around it did not seem like a STAT situation in my eyes.
  10. by   plumrn
    But... you didn't know that until sometime later. When it first happens, all you know is she is crashing and you don't know how much worse she will get. You do know, she will need close care, and monitoring for awhile. It would be nice if the administration pushing the "customer service @ all cost" prompts, would be immediately available to explain to pts when that can't be the case.
  11. by   Havin' A Party!
    Quote from mattsmom81
    ... can always order her a new hot breakfast tray when we get her to medsurg... and we can't possibly make everybody happy all the time.
    That's the way I see it.
  12. by   MandyInMS
    Ya ain't gonna please ALL the people ALL the time...never a truer statement was ever made.

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