The Customer is NEVER Right - A Nurse Practitioner's Perspective
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The Well Written Nurse (Not me. It's a class!)

drove 400 miles to attend a one-day storytelling course to try to improve my storytelling during podium presentations. The class’s title was “The Well Written Nurse: Storytelling for Health Care Professionals” taught by Ersilia Pompilio, a freelance writer and author who also happens to be a Pediatric Nurse Practitioner, Nurse Consultant, and Nurse Professor/Educator. A NURSE! Ersilia was GREAT and the course was AWESOME! The other three persons attending the class were NURSES as well and they were GREAT storytellers.
The class had the following objectives:
1.     Explain and understand the basic composition used in storytelling structure.
2.     Construct a compelling personal true life story.
3.     Perform a 5-7 minute story in front of an audience.
4.     Understand the basic concept for submitting an article, essay, or opinion editorial to a journal/book for publication.
Prior to the class, we were given the following homework instructions:
HomeWork: Yup ... There's Homework before class! But I assure you ... It's Fun! 
Writing Prompt #1
-What's In A Name: A person's name tells a magical story. Have you ever met someone and right away they jump into a story about their NAME!
That's what this assignment is about: Write 3-4 sentences (about a paragraph) on your name. It can be your first name, last name, or a nickname.
For Example: My name is Ersilia but my Starbucks name is "Lola." Sometimes I'm lucky and I get a song and dance with my latte. The barista will belt out "Her name was Lola, she was a showgirl, at the Copa, Copacabana..." 
Bring the story to class and we will read them out loud to introduce ourselves!
I CANNOT STAND HOMEWORK. But that is another story. Anyhow, I sat down and this is what I came up with,
My name is spelled J-O-S-E, Jose. Simple and very common. Yet, some spell it H-O-S-E. When I ask them to read what they just spelled they say, “Hose.” When I ask them, “Is that what I said?” They reply, “No.” And why I am not shocked when asked if I am Hose-A or Hose-B.
During the class, we had to read out loud stories written by others. Another one of my disinterest, of many, reading and reading out loud my least favorite. Anyhow, I was not in charge and the reading was a requirement so I did my best. We also had timed writing prompts that focused on the just learned lesson. Once the time expired, it was pens down and we took turns reading out loud what we had written, finished or not. Again, reading out loud not my favorite but I already moaned about that at least twice already, if anyone is counting. Interestingly, one of the things we were taught in the class was “Non c’è due senza tre” which is Italian for “The rules of three” and an example of how humans process information through repetition, three being the smallest number for that. Thus, to ALL those who say my writings are repetitious it is ONLY because you DIDN’T get it the first and second times it was mentioned, or the third time, the fourth, the fifth...
It wasn’t too long into the class before the first writing prompt and ice breaker gave us just 10 minutes to craft a compelling opening to our story. The theme for this exercise was about our personal journey after waking up that morning. This is what I came up with:
The alarm went off at 3am for me to wake up. Knowing that if I can reach the snooze button I will hit it and go back to sleep I purposely put the phone down the hall. Now I have to walk down the hall to turn it off. Now down the hall Abby and Duke, our two Boxers, have followed me. Sometimes I take them out to use the bathroom first and sometimes I have to go first. This morning they went out first. I didn’t have to go I guess because I only been to bed two hours prior.
My three classmates in the course all had really good and attention getting stories right out of the blocks. WOW! Although NOT intentional the bar was set pretty high I thought. GOOD! I am in the right place.
The second writing prompt allowed us a whopping 15 minutes, sarcasm intended, to write about one of the following:
1.     Best day of our life/Worse day of our life
2.     Worst job ever/Best job ever
Despite all the crap I go through with unhappy customers at work I am grateful I CANNOT ever single out a single day or job that has ever been the WORSE. NOT one, as I find the WORSE to be a far extreme knowing someone, somewhere on any given moment has a worse day or job than I thus I DO NOT complain. On the other hand, I have had MANY best days in my life. Thus, I thought picking any of those BEST days would either diminish the other BEST days or I might unintentionally leave one of them out. Thus, I wrote about my BEST job and that was, as I documented in the book, my time in the U.S. Army. Like Bu La’ia used to say in Hawaii, “Da BEST of the BESTEST!” Of my ten-plus year in the U.S. Army my greatest achievement was taking eleven Joes (soldiers) to war and bringing them ALL back in the same manner I started out with them, at least physically. Here is what I wrote for the second writing prompt.
The squad is supposed to have twelve of us. We been either three to four short for the last two years and somehow made with what we had. Now there is a war. How am I supposed to maintain four ambulances with eight of us. Each ambulance takes a driver, a commander, and a medic in the back for up to four litter patients or who knows how many walking wounded patients. Finally, four nonmedical persons are assigned. I assign the four of them to be drivers so that each ambulance has at least a medic in the back providing care. We have a mission and I have to send two females forward of the FEBA, forward edge of the battle area. Not something that has ever been done before. I did not know and it did not matter to me. The two females are soldiers assigned to my squad and their vehicles are the best choice for the mission. Can I change them for males? Of course. But why? It’s their vehicle and no one knows it and their equipment better than them. The time comes to move forward. One is hesitant to go. I send the other. The unit they are with receives a barrage of indirect fire. They have casualties. They leave their place of safety to move forward to attend casualties. At the end of it all, five dead, some fifteen wounded. Unknown to me, they are submitted for awards. Of the six, four bronze stars for valor. Of the four bronze stars one is a woman. Never before I am told. Never before has there been a female forward of the FEBA with an infantry company. But the one time there was she earned a bronze star for valor.
In comparison to my classmates, who I am guessing belted their composition impromptu, I somewhat cheated on this assignment as I have already written this story in the book and have told it many more times before. Because of that, with minimal recollection I was able to rewrite it without much effort. That said, reading the story out loud is a different topic as this story is very emotional for me for many reasons. And no matter how many times I have told it my voice cracks every time, sometimes more than others and sometimes with tears. This time no different. And despite the pauses and the clearing of my throat it took quite the effort. But with Ersilia’s and of my classmates’ patience I got through it. The irony, if permitted, all of this writing, the book, the blog, Facebook and Twitter, were supposed to be therapy in some manner. However, and where the irony is, ALL of this much-needed therapy has NEVER been for my time in the military or because of war. Instead, ALL of this much-needed therapy has been and continues to be for my time as a healthcare worker where I must constantly prove my desire to help others and my belonging as a nurse. That said, I am not sure any of this writing or speaking on the topic has been or has not been therapeutic in any manner or for any reason. Regardless, I will continue to write and speak about customer service in healthcare and ALL the collateral damage it has left behind. Because, if NOT me, who?
The third writing prompt exercise focused on writing about a time when a failure turned into success where we had come full circle. We were allowed 15minutes to write. Below is what I wrote:
At age 15 I began a Licensed Practical Nurse (LPN) program at the vocational high school I attended. I went to school just like everyone else except three afternoons a week I attended the nursing course which included one of those afternoons taking care of patients in the hospital. Not a candy stripe nurse and not a volunteer but a student nurse, which is how I signed my name in the patient’s chart. The second year of the program was the same except the nursing classes and the hospital care was in the morning.
This school was part of my high school diploma except when I graduated I could sit for the LPN boards. I wanted to be a nurse. But no one in my family had gone to college and I had no idea how that got done. I know I needed money to go to college and the only place I could earn it was to join the military and at 17, with my parents’ consent, I did.
That fall I got into trouble with the law and at 17 charged like an adult with a felon. I recall waking to my mother scratching my head while I slept in the jail cell. Awake I said, “I am sorry.” “Don’t worry,” she said. The next morning after released on bail my father drove me home where my mother waited at the bottom of the steps and to who I kneeled in front of crying, “I am sorry.”
Because of that [felony] the state of NY would not give me a nursing license. Off to the Army I went. After 10yr, 3months and 20 days I left the service to earn a BSN. 2 years later I earned my MSN and a Post-Masters. Both my parents at the graduation where I gave the commencement speech and opened with these words, I AM A NURSE! The auditorium jumping to a standing ovation. My father as well, except he was yelling, “That’s my son!”
Again, this was another story in the book thus I rewrote it with minimal recollection and without much effort. As before, my voice cracking, this time tears welling in my eyes which I struggled to keep from running down my cheeks. Because, as mentioned already, these stories, whether reading them out loud or rethinking them while alone they are a different matter for me. By no means are these post-traumatic stories, not even close. But nonetheless they are very emotional to me, each of them for many reasons, and how they found themselves in a book about customer service in healthcare. Not because any of them have anything to do with customer service or healthcare. But because of how I must justify being a nurse and my desire to help others against those who tell me I should find another profession, to include colleagues. Nonetheless and once again with Ersilia’s and my classmates’ patience I got through it.
The fourth writing prompt asked us to close our eyes and imagine one of our favorite places. For this exercise, we were given 15 minutes to describe this place while also asking the deeper questions—what does each detail really mean to us? This I thought was the most challenging exercise of the class as I have the hardest of times describing ANY the five senses, seeing, taste, smell, touch and sound. And that is during conversation but even more so during writing. Nonetheless, I gave it my best shot, noticeable by the low word count in comparison to the other compositions, and this is what I came up with:
It’s an extra wide hammock where my three loves, my Life, Abby, Duke, and I can lay. The wind struggling to move the four of us cuddling next to each other. The hammock’s rustic grayed wooden frame softly crackling as we slightly sway. My Life concerned the soft crackling is from the old wooden frame or from the weight of the four of us. The same wind gently moving the almost lime-green Palo Verde canopy above us through which bright sun rays peer. The same wind moving the sweet fragrance of the bright yellow flowers of that canopy.
Lastly, the fifth writing prompt and the overall objective of the class. This time we were given a whooping thirty minutes, again, being sarcastic. During those thirty minute we were to construct a compelling personal true life story we would perform within 5-7 minutes in front of an audience. For this exercise, the theme was that we had fifteen minutes to live and within those final minutes we would share our story with someone else who would relay it to others as our final words. The caveat, we likely would tell parts of our story that were important to us and leave out those that were not from a story that could span a lifetime to just those last seconds.
However, we were also given the option to free-write whatever we wanted to write. And I chose the latter as I found the first alternative a bit more demanding and I did not believe I could belt out such a compelling 5-7 minute story within the allotted thirty minutes. Not to mention, despite my interest and appreciation for the class, after a long morning and a late lunch/early dinner just before the last exercise I was fading fast. And although I began to put something together with the first life story option the neurons in my brain just weren’t firing fast enough. Thus, I stopped what I was composing from scratch and looked for something I had already written. I know, I cheated again but I was really tired and not sure what I started writing made any sense to me and would make less sense to the audience. Nonetheless, for this exercise I pulled up something from my last podium presentation and edited to fit this exercise instead of writing something from scratch, like my classmates did. Thus, some might recognize the words below:
I have worked for more than 30 employers as a nurse practitioner in the last 15 years. NOT because of incompetence, breach of duty, or negligence. Not because of injury, disability, or death to a patient. Not because of inappropriate behavior, prejudice, or addiction to drugs or alcohol. Not because I am unreliable, cannot be trusted or undermine those I work with. And not because I do not care or lack compassion.
I have worked for so many because I will NOT bow to EXAGGERATED UNREALISTIC EMOTIONAL EXPECTATIONS. And despite warned and given an explanation. I PERSIST!
I am not a bellboy at your favorite resort looking for a tip. I am not a cashier at Chick-fil-A whose script it is, “My pleasure.” I am not a hospital’s CEO chasing satisfaction scores. And most DEFINITE I am NOT anyone’s punching bag, not to patients, not to families and not to administrators either.
Like you, I am a patient advocate and 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. It is our responsibility, NOT anyone else’s, to cultivate our profession and steer it in the right direction without compromising healthcare workers or patients.
Healthcare’s best-kept secret is NOT how much does the hospital CEO get paid but that customer satisfaction scores are NOT about healthcare and instead about customer retention FOR profits. As studies show there is no correlation between satisfaction scores and good healthcare. Yet, satisfaction scores are the driving force of healthcare.
A driving force without accomplishment I must add. Because despite all the money, time and effort invested satisfaction scores have not added anything to healthcare other than leaving behind an overwhelming amount of collateral damage.
Healthcare is genuinely dedicated to helping others and OBLIGATED with saving lives and stomping out disease. Despite that heritage and DUTY healthcare has been cheapened, by any means necessary and at the cost of so much, into just another customer-driven service.
However, healthcare is like no other industry, NONE, and:
-the only industry with patients
-the only industry with our waiting room
-the only industry in which services are sought during some of the worse moments of our lives and during inconvenient times, for uncertain, unpredictable and volatile choices in places that are unknown, unpleasant and unforgiving
-the only industry where regardless of disposable income or time services are sought after and rendered
-the only industry whose workers maintain the public’s confidence year after year as the public has recognized us as the most honest profession and with the greatest ethical standard of any industry
-most significant, healthcare is the only industry where workers go to battle for every “so-called customer” and when “so-called customers” succumbs—we cry for them as well…
…as the overwhelming number of patient experiences are rewarding for both healthcare workers and patients.
Yet, the melodramas of the complaining minority are permanently etched in our memories, some physically scarred. It is that misery and frustration which drags us down, as we must navigate, ALONE, that exhausting minefield just to stay safe and/or keep our jobs. Reason enough as to why so many leave healthcare and not fatigue as no one fatigues from helping others.
The presentation was received well. One of my classmates stating, “No one is saying that.” Which I interpreted as my words were unique. Which they are and what I been told by many at different conferences. However, no one else is saying them. NOT because they DO NOT agree, but because so many shy away from the premise of my words and their intent and my intent, to push back and push back hard. That said, they ONLY shy away because the risk is too high for them to take. And I understand.
Yes, I drove 400 miles there and 400 miles back. That is NOT a typo! That is 800 miles. For what? To read out loud, which I HATE (“Non c’è due senza tre” or third time is the charm), and to write five, ten to thirty minute, writing exercises and present one of them to an audience with a mic in hand and all. However, for me, the driving is NO big deal. For what? An AMAZING learning experience. Not only an AMAZING EXPERIENCE but to spend the time with such AWSOME storytellers! Ersilia and my classmates. WOW! @nurseshypochond THANK YOU for the useable wealth of information and your COACHING! Not only do I see myself improving at the podium but I also see myself rewriting and republishing the book. Not sure when or where I will find the time to do so but that is the MOTIVATION, DIRECTION AND PURPOSE I got out of the class. Thank you!

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