Who cares for the caregivers? | Letter to the Premier of Ontario

Thank you for being ill, how may I help you today?

Once upon a time, Nurses were taught the importance of providing “Health Care” and nursing services to their patients. Clinical skills, critical thinking, advocacy and communication are key elements of this basic training. Nurses are accountable for their professional practice to a Governing Body – The College of Nurses of Ontario, and must successfully complete several grueling, long examinations before becoming Registered.

Over the years, the profession of nursing has changed – Registered Nurses and Registered Practical Nurses are in more supervisory roles, overseeing care provided by Health Care Aides, Personal Care Attendants, Personal Support Workers, or whatever other names are given to these “unskilled” workers. With the increased responsibility and skills required to be proficient in these roles, basic education programs have become longer and more thorough for both professions. As more and more care is offloaded to the unskilled workers, their education has changed as well, encompassing more knowledge and skill requirements.

Together, Registered Nurses, Registered Practical Nurses, and Health Care Aides (et. al.) have grown into their current roles to provide valuable services to patients.

Over the years, patients have changed roles as well.

Patient:
Function: noun
Definition: a : an individual awaiting or under medical care and treatment b : the recipient of any of various personal services

Today, we know them as Patients (in hospitals), Residents (in residential facilities), and Clients (in the home care sector). The renaming of our patients is understandable, under the different circumstances and care provided. However, the more recent phrase utilized by the administration of various facilities is disconcerting:

Customer:
Function: noun
Definition: one that purchases a commodity or service

Now, perhaps it is just my conservative view of the health care industry, but I do not see how a person receiving medical care, treatment, or personal services related to health are a “customer”, or should be likened to a person who purchases a cup of coffee, a television set, or subscribes to a daily newspaper.

With this new view of Patients as Customers, Health Care Providers have become… Customer Service Representatives. The skills required to provide nursing services – communication, advocacy, clinical skills and critical thinking, are being reduced to, simply, Customer Service. What’s more, our “Customers” include not only our patients and their families, but also our co-workers, colleagues (physicians, pharmacists etc.) and our employers. That’s a lot of Customer Service we have to provide.

The key points of customer service?

Smile!
Say Hello to everyone you meet, and be enthusiastic!
The customer is always right (even when they are confused, or just plain wrong.)
Without our customers, we wouldn’t be needed.

In principle, these points may be quite accurate. In theory, nurses should be everything to everybody, and do everything with a smile. However, in practice, views of the role of nursing often differ.

Nurses are spit on, called names, sworn at, hit, kicked, slapped, punched, bit, scratched, urinated on, defecated on, bled on and much more, everyday. We get upset, we get short tempered. We forget to smile, and often it is replaced by a grimace as we try to hide pain associated with the physically demanding jobs. We are rushed while trying to tend to several patients at a time, answer questions from the family, and the physicians, and the pharmacy. We worry about making medication errors. We work shortstaffed. We are underpaid, underfunded, and underappreciated. And when all this results in less than steller Customer Service, we are reminded by the powers that be that we should Smile!

George Smitherman, our Ontario Minister of Health, recently commented that cleaning a hospital is no different than cleaning a hotel. His opinion of nurses, as publicly stated and demonstrated through his government’s actions, is that we are overpaid. His initiatives are leading to even more layoffs of nurses in a time of an international health care crisis. He believes physicians should be paid more, and nurses are dispensable. Clearly, nurses are no more important to Health Care than a telemarketer is. It is because of this attitude that I attribute the existence of the Ontario Tourism Education Corporation’s “Service Excellence in Healthcare” training.

“(The program) provides Healthcare Professionals with the tools and techniques they need to maximize their performance.”

At least we are still recognized as professionals. For the moment anyway.

I have undergone this one day program which was very skillfully presented, and did contain a lot of useful information, had I not been taught it all before in my nursing education. However, based on the existence of this program, and the fact that it is provided by the Ontario Tourism Education Corporation, I am beginning to suspect that this is just another way to negate the importance of nurses as providers of Health Care, and diminish us to mere Customer Service Representatives. And I just may be right – I may not be needed in the future of health care, where Customers are purchasing a service, and decide that service could be provided by someone cheaper and less skilled, so long as they remember to Smile!

In the meantime, I shall go about my job and my profession as I see it: To promote the health and well being of my patients; to assist them with their basic needs such as bathing, grooming, and eating; to provide medication and treatments necessary to their survival; to be at their bedside when they are dying, and to comfort their family when they are gone. When the day is done, if I can still smile and be enthusiastic, I will. But not because I was taught it is “Good Customer Service”.