The Customer is NEVER Right - A Nurse Practitioner's Perspective
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Obviously, NO ONE is thinking!

 
In Dec 2016, while walking the dogs, off-leash of course, we came across this sign near a pond within the grounds of a public park in Florida. Being in Florida the sign caught my attention for a number of reasons but primarily that we were in Florida. The sign looked like it had been in place for some time and not likely due to the alligator incident that occurred in Disney earlier that year. That said, the sign made no mention of alligators or did it state, “No swimming”. The sign simply read, “Swim at own risk”. Regardless, if “at own risk” referred to alligators or no lifeguard on duty or whatever else one could easily extrapolate from the signage. Regardless, the sign’s message, the park’s administration was okay with loss of life of anyone who dared to swim in this pond. Yes, loss of life. Regardless if, by drowning or by alligator or whatever else.
 
All of that to point out the following, shortly after the dogs and I reached the pond’s edge out of nowhere a golf cart with two young men showed up. Interestingly, I thought the young men were going to inform me there were alligators in the pond and I should stay away. NOPE! Instead, one of them said to me, “Do you have a leash for the dogs?” What? Really? A leash.
 
“Yes,” I replied.
 
“You need to put them [the dogs] on the leash,” the same young man instructed me.
 
“We are leaving,” I replied.
 
“You need to put them on the leash,” the same young man fired back. I just kept walking with the dogs towards the car. All three of us got in the car and we left the park.
 
Why the drama? Here is a public park, its administration and community, I thought to myself, that is okay with loss of human life, as noted on their sign. But they are NOT okay with two dogs being off-leash. I cannot make this stuff up.
 
Here is the point of all this, as a society we have become so consumed with the themes of special interest groups or the squeak wheels that we are unable to see the bigger picture. How can we be okay with loss of human life from swimming in a pond yet we are not okay with two dogs being off-leash? How or why does that happen?
 
Somehow all of these non-work related experiences ALWAYS comeback to being related to work for me. In the same month of December, just before coming across the mentioned sign and all the drama, I was let go from a job where I had been working for three years. In the past I was asked to resign because of patient complaints. This time I am NOT sure why I was let go although likely because of the same, patient complaints, given my history.
 
However, this time I have no idea as I was NOT told at the end of my shift one morning. Instead what I was told was that the night before had been my last shift and it was ALL I needed to be told before I walked out NOT to look back. Again, I was NOT told why but then I did not ask and I did NOT and DO NOT care.
 
If I did NOT and DO NOT care what does it matter. This time, again, NOT that it matters, it could have been because a healthcare worker thought I was a bully (which is another outrage, actually, as bullying seems to be the latest vogue rave and likely a future post). But then it could have been because I was NOT wearing the influenza mask of shame after I declined the influenza vaccine.
 
With that in mind this, a physician I worked with in Texas, an antidote mentioned in the book, advocated the following viewpoint, “If I don’t toot my horn no one will.” Meaning, no one will promote you unless you promote yourself. Fine. Based on that viewpoint I wrote the following ad for myself in the book,
 
“I am a nurse! A member of a time-honored profession, responsible to care for the sick, promote health, prevent illness and injury, and maintain levels of health for others. Deeds and not words define my practice. I am a quiet professional who conducts himself in a legal, ethical, and moral manner based on principles of honesty and integrity. An asset to any organization and never a burden to any or anyone. I continually demonstrate a work ethic that is unmatchable, an uncompromising integrity, a loyalty that is absolute, and a proven record of doing the right thing simply because it makes sense and not for the purpose of securing a place in Heaven. As a nurse it is my responsibility to cultivate my profession and place patients’ reasonable interest ahead of personal convenience, pleasure, profit, and safety without bias, stereotype, or prejudicial compromise. I realize I am not able to be everything for everyone as my personal and professional pride, projected self-confidence, authority, and command for respect spoils my ability to satisfy the demands of a minority.” –The Knitted Brow
 
That said, in tooting my own horn, I would think I would be a catch for any organization. Yet, because of my tainted record regarding patient complaints, I have difficulty finding work. And although colleagues in other emergency departments verbalize interest hospital administrators are not as welcoming. That said, I am grateful my inability of keeping a job or finding one has never been because of failure to provide adequate healthcare—incompetence, breach of duty, negligence; injury, disability or death to a patient; prejudice, alcohol or drug addiction; I am unreliable, cannot be trusted or undermine others; or because I do not care or lack compassion.
 
Instead, organizations are willing to let me go because I am “too serious”, as so many have commented.
 
“Too serious” must be my candid demeanor, self-confidence, professional conscientiousness, authority and command for respect which spoil my ability to satisfy the demands of the vocal minority. A minority who, in EVERY case, has convinced administrators that my competency, proven record of being an asset to any organization, who never shies away from work, and, more importantly, provides the best care for patients without prejudice, stereotype or preference were irrelevant to the baseless EXAGGERATED UNREALISTIC EMOTIONAL EXPECTATIONS of complaining minorities. WHATEVER!
 
That said, the same organizations that dismiss talent, like myself (pardon I tooted my own horn, again, but no one will do it for me), because of complaints are willing to coddle those with stained clinical records. NO BUENO! (NOT GOOD!) Myth? I do not know. What I do know is that several medical directors have shared with me stories we have all heard of, healthcare worker who has caused injury and even death but because adored those persons are kept. Yet, when I asked those directors as to why they kept individuals who have cause harm, more common than not, those same directors revealed that those with sentinel events, such as harm and/or death, are never on anyone’s complaint radar.
 
Thus, healthcare administrators and pundits are so focused on (dogs being on leashes) customer service they overlook, miss, ignore and/or allow the overwhelming collateral damage (loss of life from swimming in a pond) that is:

-Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) undermining those with less-than-stellar scores by withholding payment and causing those organizations to close their doors resulting in decreased overall access to healthcare.

-Those patients having to go elsewhere, where they overwhelm other organizations, which leads to deplorable circumstances and catastrophic outcomes, i.e. increasing medical errors, wait times, treatment delays and nursing workloads.

-Perverse incentives that NOT only lead to improper admissions, diagnostics, procedures, opioid prescriptions and indirectly their abuse, and other improper prescriptions as well.

-Studies have shown the most satisfied patients not only spend the most on healthcare and prescriptions but they are also most likely to be admitted and most likely to die.

-In 2011, the Centers for Medicare and Medicaid Services (CMS) spent $226 BILLION on overtreatments that did not benefit anyone. How much of that wasted just to avoid complaints from patients?

-That $226 billion wasted does not include the BILLIONS lost because of healthcare directed violence. A violence that has become more frequent, more brazen and more violent and those statistics skewed, as we fear losing our jobs and why negative incidents are underreported.

Those are but a few of the collateral damages and the true reasons as to why so many have left healthcare rather the proposed “compassion fatigue”, as NO one fatigues from helping others.

Plagiarizing Albert Einstein, “[Healthcare] will not be destroyed by those who [take us down the wrong tracks] but by those who watch them without doing anything.”
Healthcare has become so complacent with the status quo. And those who struggle with being complacent ONLY do so because they fear the backlash from pushing back. Thus, no one dares to ask for the much-needed change. But I AM! NOT only am I pushing back but I am asking for the much-needed change as well as the time of small thinking must end.
 
ALL of that said, NOT to keep anyone from swimming in the pond, have at it if that is your desire, but we shouldn’t get too upset when dogs are off leash either.

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