NURSING - Hospital pays £1,800 for an agency nurse to work a single shift (that's £163 an hour)

Hospital pays £1,800 for an agency nurse to work a single shift (that's £163 an hour)

• Sum was paid to nurse for 11 hour shift at Maidstone Hospital, Kent
• Believed to be highest figure ever paid for a nursing shift in the NHS
• Maidstone and Tunbridge Wells Trust spent £2.8m on agency nurses in 2013
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By JENNY HOPE

PUBLISHED: 00:24 GMT, 5 April 2014 | UPDATED: 08:23 GMT, 5 April 2014

An NHS hospital paid £1,800  for an agency nurse to work  a single shift at its accident and emergency unit.

The huge amount was for 11 hours work – equivalent to a payment of just over £163 an hour.

The £1,800 total is thought to be the highest figure ever paid for a nursing shift in the NHS, although the gap between rates for NHS staffers and agency locums at every level has been widening in recent years.

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An unidentified nurse was paid £1,800 for one shift at the Maidstone Hospital in Kent

The extraordinary shift payment  was made for a nurse covering the  bank holiday on August 26 last year at the Maidstone and Tunbridge Wells NHS Trust in Kent.

One staff nurse at Maidstone Hospital, who asked not to be named, said:  ‘Most of the nurses here struggle by on £25,000 a year or so.

 

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‘That works out at about £90-£100 a day, so when you see someone coming in and doing the same job as you and getting paid what you take home in a month in just one day it makes you  sick to the stomach.’ 

A Freedom of Information request found the  Maidstone Trust paid out £4.7million to plug staff shortages between January and November last year, including £2.8million on agency nurses.

Other data suggests the total NHS  bill for temporary nurses is set to reach £450million at the end of this financial year – a 21 per cent rise on 2011/12. 

At least one other trust, the Mid Staffordshire Hospitals Foundation Trust, paid almost £1,800 for a specialist nurse to work 13.5 hours in accident & emergency in December 2011.

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The Mid Staffordshire Hospitals Foundation Trust paid almost £1,800 for a specialist nurse to work 13.5 hours in accident & emergency in December 2011

NHS rates for staff filling a  similar permanent post in A&E range between £25,528 and £34,189 a year.

In most cases nurses are  provided by private agencies, which normally take commission of at least 20 per cent.

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David Prior, the chair of the Care Quality Commission, admitted that there are some hospitals in England where you would not want to go as a patient

Such agencies usually pay hourly rates of between £25 and £40 to nursing staff, but have to find more to fill empty positions on bank holidays and meet unexpected surges in demand.

Agencies advertise their willingness to pay at least twice as much as full-timers receive for  nurses doing shifts at short notice, and specialist skills attract higher rates.

Although Maidstone Hospital may have paid £1,800 to get the bank holiday shift covered, it does not mean that 80 per cent of the money automatically went to the nurse.

The Royal College of Nursing said it is up to an agency to decide how much it agrees to pay an individual for working a shift and this may vary according to demand from its customers.

There are now more than 60 private firms providing nursing and medical staff to the NHS. Doctors can earn vast sums for shifts, with one agency doctor at Mid Staffs getting £5,700 for a day’s work in 2010 and many  consultants raking in around £3,200 for a single shift.

Bosses at the Maidstone and Tunbridge Wells NHS Trust  said the amounts being paid were too high, but reflected the rate it had to pay to get workers to come in on public holidays. Other costs at the trust include 21 agency doctors paid in excess of £1,000 per shift during 2013.

A spokesman for the Maidstone Trust said agency workers were drafted in at critical times, such as peaks in A&E use over bank holidays and staff sickness.

A recent report by the Care Quality Commission found that the trust had high use of temporary staff in the past, but that it was improving.

The Trust spokesman said: ‘We thoroughly agree that agency charges are too high and that is why we are proactively addressing this issue and have been totally transparent with the Care Quality Commission.

‘Reducing agency use will involve international recruitment, and we need an adult debate about this while the training of more doctors and nurses nationally takes effect.’

NHS CARE POSTCODE LOTTERY

There are some hospitals in  England where you would not want to go as a patient, the head of the organisation which inspects them said yesterday.

Care Quality Commission chairman David Prior said there  was a postcode lottery in standards of care, adding: ‘The quality of care in one hospital can be very different from the quality of care in another.’

He said England probably  had some of the best-led and best-run hospitals in the world, but added: ‘In those hospitals where you would not wish to go, you have a very poor damaged culture where employees feel they can’t raise concerns, where patients are not listened to.’

He said a number of hospital trusts had been identified as inadequate. ‘Barking, Havering and Redbridge is a good example,’ he told the BBC. ‘Heatherwood and Wexham Park would be another one.’

Mr Prior said many such hospitals were good in parts and added: ‘The critical thing that determines whether a hospital is good, bad or indifferent is the quality of leadership.’

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MEDICAL NURSE - 4 Simple Ways for Nurses to Improve Patient Satisfaction Scores

1. Who Are You Caring For?

Providing nursing care to patients is an intimate process. A process that many times includes removing all modesty and privacy of the patient to perform our very jobs. The irony is that this is the very thing that nurses try to protect and approach in a cautious manner due to the sensitivity of the situation. However, as a patient and a nurse I can assure you that no one has ever felt more vulnerable and at the complete mercy of others when placed completely naked (other than that paper-thin gown) and forced to wait on that cold, hard table awaiting for an ominous figure in the white coat. So, remember who you are providing care for other than that semi-naked person underneath the hospital-issued blue & white speckled gown.

Nurses are at a disadvantage when it comes to "knowing" our patients. We've already spent 10-15 packed minutes of your entire history, diagnoses, medications, previous hospitalizations and surgeries, family members, significant others, occupation, insurance status, social status, laboratory and diagnostic results with the previous nurse that cared for you. We're focused on our tasks at hand that include patient safety, pain medication, antibiotic administration, fluid and electrolyte balance, and the list goes on: Unfortunately, it doesn't allow the time for us to sit down and listen to find out about our patients on a personal level.

So, one small act a nurse can do is simply being interested in your patient; other than treating them as the sick person in a hospital gown. So, take just a minute out of your usual routine and ask your patient about their life. What do they do, or what did they retire from? Do they have children? What are they most proud of? It's likely you'll find something in common with your patients after a couple of simple questions and it will be amazing the sincerity that you'll receive in return.

Source: Leslie Young via Centers for Disease Control & Prevention

2. Give 110%

It's reasonable to say that the typical nurse provides 105% of their effort on any given day. But rare opportunities arise when there is a lull in the day when the nurse has the option to decide between sitting down, taking a deep breath or providing a helping hand. I'm not telling nurses to avoid breaks or to not enjoy those rare moments, but if you see a visitor who looks like they're worn out and lost in the confusing matrix of the hospital, just offer yourself. A simple offer of a wheelchair ride to their car or assistance with directions will be greatly appreciated. One will be surprised how quickly word spreads about these compassionate staff members that take the extra minutes out of their day to help not only patients, but their loved ones as well. Patient satisfaction isn't always about satisfying the actual customer; it's providing genuine compassionate care to every person you meet.

Source: Nasheka Powell via Centers for Disease Control & Prevention

3. Be on their Level

A simple rule that many fail to notice because they're simply too busy trying to keep up with day-to-day necessities of a healthcare job, is recognizing that the patient is an actual human being. Being able to look past the illness in a hospital gown and connecting with the human being underneath is the first step in providing excellent patient care. Remember when talking with patients to meet them at their eye level, listen before speaking, and try to take a "short walk in their shoes." Is this patient a 65 year-old lifelong farmer with a 3rd grade education that requires medical jargon to be broken down in simple, easy-to-understand terms? And does this same patient have macular degeneration that disables his vision; but he signs your consent papers anyways just because of your request? Basic knowledge of a patient's background will provide one with the ability to be an excellent patient advocate and prevents miscommunication that commonly occurs between medical providers and their patients.

Source: Richard Duncan via Centers for Disease Control & Prevention

4. Expect the Expected

Hospitals as well as the patient-admission process can be a mystery to outsiders and non-healthcare workers. Remember to always inform the patient and designated family members about what to expect: Especially concerning common delays that occur in the hospital environment, frequency of laboratory draws, vital signs, explaining the invasive nature of procedures, and to reassure them that they are receiving the best of care. Additionally, inform family members of common complications to expect for their ill family member. For example, if Grandma is admitted with a urinary tract infection, be sure to warn family members about confusion, agitation, forgetfulness and extra precautions needed to ensure her safety. Family members are never happy when they arrive at 7 in the morning the following day to find Grandma asking them why strangers were sleeping in her bed last night. Delirium is a very real complication for these elderly patients and nurses are so busy staying focused on labs, antibiotics, and safety measures, that we often forget to educate their family members. Therefore, every encounter with a patient or family member should involve some type of education: Educate them about their diagnosis, common side effects, medications, reviewed test results (especially if family members weren't present during physician/provider rounding), or a review of the patient's progress. When patients and families are involved in their care, expectations have already been exceeded.

MEDICAL NURSE - How to Avoid the Most Common Nursing Errors Affecting Patient Safety

By Debra Wood, RN, contributor

March 17, 2011 - No one heads to work wanting to make an error, especially nurses, but people are human. Mistakes happen. Nurses and their colleagues must develop a safety mindset and work together to implement evidence-based practices that protect their patients from preventable errors.

“While all disciplines play a role in patient safety and infection prevention, nurses are more of a patient advocate than anyone else,” said J. Renee Watson, RNC, BSN, CPHQ, CIC, manager of infection prevention and epidemiology at Children’s Healthcare of Atlanta. “They spend more hands-on time with the patient and their families, and they have the biggest opportunity to impact patient safety.”

Coordinating care, nurses are gatekeepers of care and are trusted by patients, Watson added. But touching patients all day, they also have more opportunities for infection breeches. In addition, she said, they have a responsibility to monitor other care providers to ensure they follow safe practices. The paybacks are high, while the failures can prove tragic.

“Iatrogenic deaths are an overlooked problem, and yet it is the third leading cause of death in the United States,” said Jason Hwang, M.D., co-founder and executive director of Health Care at the Innosight Institute, a not-for-profit think tank based in Mountain View, Calif. “It results in enormous losses financially and to reputation when these things happen.”

Hwang considers medication administration, infections and patient falls the three adverse events nurses have the greatest role in preventing. Some specific interventions have been shown to help nurses avoid the more common nurse-related safety events.

Christi Zuber, RN, MHA, reports that Kaiser’s new programs for medication administration and bedside shift reporting have been successful in reducing errors.

Medication errors

Kaiser Permanente developed the KPMedrite program to decrease medication errors.

Knowing research shows interruptions are a primary driver of errors, Christi Zuber, RN, MHA, director of the Innovation Consultancy Kaiser Permanente in Oakland, Calif., and a team observed nurses giving medications. They found nurses dealt with multiple questions from colleagues and physicians while pouring and administering drugs. That led to the KPMedrite program, which includes following a standard medication administration process, preparing medications while standing in a special quiet zone, and wearing a sash to signal to colleagues not to ask questions.

“It’s a very visible and well-known signal that medications are being given, and they are not to be interrupted,” Zuber said. “It also triggers a certain behavior in the nurses.”

Consequently, medication errors have dropped by more than half, Zuber reported.

Devices and poor, look-alike labeling can contribute to errors. Nurses must take additional precautions when administering medications that come in bottles that can easily be confused. Ultimately, Hwang said, manufactures need to change labeling to correct the problem. In the meantime, bar-coding medication and confirming the correct dose, route, time and rate for a drug being given to the right patient, can help prevent mistakes.

Falls

Patient falls often occur when patients attempt to get up on their own to use the bathroom or pick up something out of reach. Nurses frequently hear downed patients say, “I didn’t want to bother you.”

The Studer Group, a consulting firm, came up with the idea of hourly rounding and subsequently found that a nurse or aide checking on the patient every hour during the day and every two hours at night, asking if the patient needs to go to the bathroom and making sure items such as tissues and the television remote control are within reach, reduced patient falls by 50 percent.

Subsequently many hospitals have implemented hourly rounding. San Francisco General Hospital and Trauma Center reported at a Center for Nursing Research & Innovation fellows conference in San Francisco a 30 percent decrease in falls within two months of implementing hourly rounding on a medical-surgical/oncology unit. Northeastern Hospital in Philadelphia experienced a 65 percent decrease in its fall rate after starting the rounding.

Kaiser Permanente nurses conduct hourly rounds and that has allowed nurses to more easily conduct a Nurse Knowledge Exchange, giving shift report at the bedside while interacting warmly with the patient.

“Seeing the patient and hearing [report] sets up a different level of understanding, and it gives the patient better comfort about who is taking care of [him or her],” Zuber said.

Infections

Hand hygiene remains incredibly important in preventing infections. In addition, Watson said, nurses must disinfect equipment and other items in the environment to ensure settings are not changed or lines disturbed, and they must wear personal protective equipment.

For a long time, clinicians considered infection an accepted risk, especially in critically ill patients, but now, through initiatives by the Institute for Healthcare Improvement, Johns Hopkins University and the Michigan Health and Hospital Association (MHA) Keystone Center, nurses know they can prevent patients’ infections.

The Institute for Healthcare Improvement packaged bundles of best-practice interventions into handy checklists that have been shown to reduce infection rates. For instance, to prevent central line bloodstream infections, nurses should use appropriate hand hygiene, use chlorhexidine for skin preparation, ensure full barrier precautions are taken and a sterile field maintained during insertion, and ask daily if the line can be removed. To prevent ventilator-associated pneumonia, nurses should keep the head of the bed elevated and perform daily oral care with chlorexidine. The bundle also includes daily sedation holidays and peptic ulcer and deep venous thrombosis prophylaxis.

While following the bundles helped, clinicians found they could achieve even greater success when combining the checklists with the Comprehensive Unit-based Safety Program (CUSP), a team-based approach to learning more about safety, identifying hazards on the unit and addressing those risks.

“When we first looked at CUSP, we thought we had the bundles in place,” said Mary Guaracino, RN, chief nursing officer at Memorial Regional Hospital South in Hollywood, Fla., where infection rates have declined to zero in the most recent reporting quarter. “But if the doctor didn’t have a cap on, before someone would not speak up. Now staff feels comfortable saying, ‘Let me get you a cap.’ Everyone is looking out for the patient, and everyone is participating in every piece.”

Guaracino urged nurses not to become discouraged. Changing a culture takes time.

“It takes tenacity to know the end part—the lives saved by preventing infection,” Guaracino said. “You have to keep working until you get there. You will get there.”

MEDICAL NURSE - The Changing Role of Today's Nurses

Charles Tiffin, PhD

   Senior Core Faculty, Capella University

The nursing role is rapidly evolving as nurses are tasked with an even wider range of health care responsibilities. Caring for the sick has certainly gotten more complicated. Hospitals are understaffed. Budgets are tight.

The graying of our society -- plus growing rates of diabetes, obesity, and other conditions -- means the health care system is dealing with an increasing number of complex illnesses. And with political elections looming, it's unclear what the regulatory landscape might look like in the future.

In hospitals, clinics, and care centers around the US, nurses are rising to meet these challenges. And advanced nursing education is empowering nurses to lead the way.

Today's nurses aren't just caring for the sick; they're changing our very notion of modern medicine and health care delivery. Nurses are giving TED talks, publishing scientific research, developing mobile medical applications, and actively addressing health care policy. They're collaborating with their colleagues, from social workers and oncologists to hospital administrators and public safety personnel. The field is growing, and so are opportunities for nurse practitioners, DNP and PhD nurses, nurse educators, nurse-anesthetists, and nurse researchers.

New health care technology is also creating opportunities for nurses. More and more aspects of the profession are electronic: Test results, X-rays, blood work, and ordering medication. An array of new technologies -- mobile devices, electronic medical records, cloud computing, and teleconferencing -- invite nurses to be digitally ambitious.

It's not just that nursing is becoming a broader field; it's becoming deeper, too. The opportunity to pursue medical specializations -- diabetes, obesity, pharmacology, and more -- is blooming, but the real opportunity is in mastering complex, multifaceted issues that impact our health care system and our nation. It's more than knowing how to perform tasks and procedures; It's about being a more effective member of the health care team and navigating clinical systems.

Soon, nurses won't just consider the symptoms of patients in front of them; they'll look at the health of their communities and beyond. Health information databases -- like the Joint United Nations Program on HIV/AIDS, which uses cloud computing to understand how HIV spreads -- will help nurses see how illnesses fit into national disease trends.

Even basic medical instruments are getting smarter: For example, new bandages for heart patients have built-in sensors to measure vital signs. It will be the nurse's role to track and synthesize multiple sources of comprehensive patient information. In the emerging field of nursing informatics, nurses will connect with technology developers to make these systems more user-friendly.

Nurses will also confront the growing costs of health care in America. For example, a major challenge is how to curb the large expenditures for chronic disease patients in hospitals. One proven way is to treat patients before they need a hospital visit. New at-home monitoring programs, where nurses see patients on live webcasts, will soon play a larger role in patient care. Because these emerging tools are at the forefront of more cost-efficient care delivery, nurses who can adapt and implement technology will become sought-after leaders.

Patient behaviors are also evolving in a digitalized world. Patients are using online resources to research and treat their symptoms. Health and wellness are consistently among the most searched-for topics on Google. Nurses will need to double as health technology librarians, directing patients to trustworthy websites and useful applications.

New technology won't preclude traditional care, but it will open up more creative options to teach patients about their health. Nurses will no longer be limited to one-size-fits-all safety pamphlets. Patient education can become more personalized, with hundreds of new medical apps, from glucose monitors to basal body temperature trackers.

Nurses will still need to be culturally wise too. Hospitals are increasingly diverse, cultural melting-pots where nurses work on the front lines of race, religion, and gender. Doctor time is limited, but nurses deliver hour-to-hour care and interact with the families of patients. It requires the ability to listen and understand people from all walks of life.

Nursing has become more complex in ways that couldn't have been imagined a generation ago. Now there's an imperative to be not just a great caregiver but a great innovator too. The demands of health care are calling for a new generation of thinkers who want to be agents of care innovation. It's a profession for the intellectually curious, lifelong learner.

However, as nursing continues to evolve with new hospital structures, fancier gadgets, and political challenges, the heart of the profession stays the same. Whatever the tools and technologies, the job of the nurse will remain caregiver and advocate for the most sick and vulnerable members of our communities.

Great nurses take what they've learned in their formal education -- the key concepts, the research, the policy and societal considerations -- and apply it to make surprising, difficult, life-or-death decisions every day. And that's why nursing education has such a crucial role to play. Getting an advanced nursing degree means preparing yourself for a changing world of possibility. With the right skills and knowledge, the next generation of nurses can make a bigger difference for patients, communities, and our national health care environment.

MEDICAL NURSE - Customer Service Tips for Nurses

Customer service, or "bedside manner" as it's more commonly referred to in the medical profession, is an important aspect of the job for both physicians and nurses. Nurses who work to establish a positive therapeutic relationship with their patients typically report greater job satisfaction and are less likely to be named in malpractice cases. Whether you're a nurse in training or you have years of experience under your belt, these tips will help you improve your bedside manner.

Observe Other Nurses

• Because bedside manner is not something that can necessarily be taught in the classroom, it's important to gain hands on experience. Observing other nurses who have been in the field for a while can be a valuable tool in learning how to appropriately treat patients. New nurses in particular should spend time watching how more experienced nurses interact with patients. It's one of the best ways to learn what types of behaviors patients respond well to and what makes them the most comfortable.

Speak in Simple Terms

• While observing other nurse-patient interactions can be an invaluable lesson, it's important to remember that not all of these scenarios may be perfect. Even experienced nurses and clinicians can make the mistake of overusing medical terminology when speaking with patients, which often leads to the patient feeling confused or upset. So remember to keep it clear and simple, without coming off as condescending, when explaining a certain type of drug or condition. It may also be helpful to ask the patient if they have questions about anything you have mentioned.

Practice Common Courtesies

• One of the easiest things you can do to maintain good bedside manner is to make eye contact with the patient and refer to her by name. Asking questions about her day and her personal habits will help her to feel comfortable and secure in the fact that you're concerned about her welfare. No matter how difficult of a day you might be having, you should always be polite and positive toward the patient. Discussing your own problems with her is not acceptable at work. Remember that your main priority as a nurse is to take care of your patients first.

Maintain a Professional Image

• Bedside manner is not just about smiling and being friendly (although, those things certainly help) -- it encompasses every aspect of patient care and speaks to your overall professional image as a nurse. The main thing to remember when working with patients is that they want to feel safe and secure. They need to be able to trust you, and in order to build that trust it's important that you show concern for their particular situation.

Express Interest and Concern

• When meeting with a patient, always remember to communicate with the same respect as you would one of your own family members. Try to show empathy through your words and actions, and offer support whenever you can. Even in situations where the patient is not the friendliest, you should maintain a personable tone and keep your defenses down. Answer his questions honestly, and show encouragement especially when his situation is bad.

MEDICAL NURSE - Professionalism Reminders & Tips

We compiled the list below as reminders and tips for nurses to consider on their quest for excellence. Look over the list and see how many of these statements you agree with and how many describe you.

1. A professional nurse takes pride in her work, skills, knowledge, appearance, and reputation.
2. A professional nurse strives for excellence in all aspects of her work and life.
3. A professional nurse does not settle for mediocrity or do just enough to get by; "good enough" never is.
4. A professional nurse always does a little extra, always something postivie that was not expected.
5. A professional nurse understands that being a professional extends beyond work and applies to all aspects of life.
6. A professional nurse does not lie or mislead individuals in any way.
7. A professional nurse does not gossip or spread rumors.
8. A professional nurse does not spend time at work on personal matters.
9. A professional nurse is always polite, kind, and respectful.
10. A professional nurse says please and thank you.
11. A professional nurse does her job and completes her assignments on time and without complaining.
12. A professional nurse offers suggestions and takes steps to improve business and nursing care processes, procedures, and techniques.
13. A professional nurse looks sharp, clean, and well groomed.
14. A professional nurse does not just throw himself together and rush off to work; he takes time for personal grooming and time to press his clothes before going to work.
15. A professional nurse does what is the right thing to do regardless of what others are doing or may say.
16. A professional nurse helps others learn their jobs and do their work.
17. A professional nurse maintains the confidentiality of patients and their information.
18. A professional nurse is a good listener and pays attention when others are speaking.
19. A professional nurse is compassionate.
20. A professional nurse is dependable; he does what he says he will do or is asked to do.
21. A professional nurse does not swear or use foul language.
22. A professional nurse learns how to be effective and manage her time well.
23. A professional nurse is a positive 'can-do' individual.
24. A professional nurse does not complain, gripe, or whine about challenges, setbacks, and other obstacles that may come his way.
25. A professional nurse is a team player and does what she can to improve team performance and help others succeed.
26. A professional nurse does not lose his temper and speak or act in an angry or violent manner.
27. A professional nurse knows and abides by the nursing and other codes of conduct and ethical rules and guidelines that have been established.
28. A professional nurse arrives for work on time and is usually a little early.
29. A professional nurse is a continual learner and is always taking steps to learn more and develop additional skills.
30. A professional nurse is forthright; she does not exaggerate or conceal facts and she does not mislead others in any way.
31. A professional nurse admits his mistakes and learns from them; he does not blame others or make excuses.
32. A professional nurse keeps her word.
33. A professional nurse understands that his image matters and reflects his personal pride and the pride and brand of the organization he represents.
34. A professional nurse dresses appropriately, complies with a dress code if one exists, and avoids clothing or adornments that would be considered in poor or questionable taste.
35. A professional nurse does not wear excessive cologne or makeup.
36. A professional nurse seeks out new responsibilities and personal growth opportunities.
37. A professional nurse does not try to bully or intimidate.
38. A professional nurse does not talk negatively about others or the organization that employs him.
39. A professional nurse acknowledges people and respects their views and opinions.
40. A professional nurse understands that the needs of patients are not an interruption to her work; rather the needs of patients are the core of what nursing is all about.
41. A professional nurse is always aware of her responsibilities to the family members of     the patient.  Often, just like the patient, family members are scared and confused, and look to the professional nurse as a source of both information and comfort.

Source : http://www.goalsinstitute.com

MEDICAL NURSE - Patient Care And Customer Service Are Not The Same!

Customer service and patient care are two totally different concepts. Unfortunately, the great divide between the two is only going to clash as we enter this difficult era of reimbursement rates that depend on subjective patient satisfaction surveys. The purpose of this article is to illustrate the differences between patient care and customer service.

by TheCommuter Asst. Admin Aug 22, '12

Patient care and customer service might seem interchangeable to healthcare administrators and members of the public, but they are most certainly not the same. If nurses ignore the differences between the two practices, the outcome could be downright disastrous.

Dorland's Medical Dictionary (2008) defines patient care as the services rendered by members of the health profession and non-professionals under their supervision for the benefit of the patient. On the other hand, customer service is the capability of a business or entity to meet the wants and needs of its customers. While some elements of customer service should be incorporated into patient care, the healthcare industry would be wise to avoid jumping too deeply into the customer service bandwagon. Keep reading to see my point.

Healthcare facilities are expressly designed for patient care; however, they are not made for customer service, regardless of what the powers that be would like the public to believe. Keep in mind that good customer service involves consistently meeting the needs and wants of the people who patronize the business. Conversely, patients often want things that counteract the effects of good patient care. The nurse who gives patients whatever they want (cigarettes, donuts, etc.) is providing great customer service while delivering poor patient care.

The fry cook at McDonald's provides good customer service when he smiles while preparing a Double Quarter Pounder cheeseburger and super sized fries for the patient diagnosed with coronary heart disease. The friendly people at the bakery display great customer service by making an entire dozen of sugary cinnamon rolls per request for the noncompliant type I diabetic patient. The courtesy clerk at the Holiday Inn delivers outstanding customer service when she escorts the oxygen-dependent COPD patient outside to smoke. 

Employees in the service industry do these things to ensure a certain level of service because they want those paying clients to return. Who cares if good customer service might be bad for one's health? Health promotion is not the concern of workers in the hotel, restaurant, and hospitality industry. They want the customer's money in exchange for all services rendered, even if the service will lead to patient demise in a few years. 

I totally agree that some aspects of customer service belong in healthcare because patients are external customers of the facility, and will refer others to the hospital if they are satisfied with their care. However, what about the patient who refuses to have any vital signs taken during the duration of his or her stay due to not wanting to be bothered? The nurses who honor this request are excelling at customer service for giving the patient what they want, but are practicing poor patient care by not performing a complete assessment.

Customer service and patient care are not synonymous. Unfortunately, the great divide between the two concepts is only going to clash more as we enter this era of reimbursement rates that depend on subjective patient satisfaction surveys. As always, we cannot go wrong with the Golden Rule to treat others in the same manner that we would want to be treated. When faced with the choice between customer service and patient care, I hope that patient care lives on.