Is this reasonable or just over the top?

[Lakeshore18]

Recently our Nurse Manager informed the nursing staff that we were now to conduct our shift report using certain "scripted" parameters. Basically, we are to wake patients up, conduct shift report at the bedside, include he patient in the process by giving him/her the opportunity to ask questions and add to the information we pass on to the oncoming shift, check all patient orders on the computer and then conduct a brief"physical exam" of the patient with the oncoming nurse. There are certain scripted things we are to say as well. For example the nurse going off shift is supposed to say:

"Good morning, Mr. Jones. I will be leaving shortly to go home to my family. This is Sally and she will be your nurse for the next shift. I have known Sally for 4 years and she is a fabulous nurse with excellent clinical skills. I feel confident I will be leaving you in good hands wth Sally as your nurse!"

After this, we are to continue on with the above outlined report, conduct the mini physical exam, check the orders in the computer and give the patient the opportunity to give feedback during our report. Generally we each have 5-6 patients on our very busy cardiac monitoring unit and our shift report is 30 minutes long!! My colleagues and I are at a loss to figure out how we will accomplish all of this in 30 minutes! I am all for including the patient and allowing them to give feedback, but I fear shift report will now take so long we won't be able to get all our work done! And what about visiting hours? Shift report takes place right in the middle of them at 7pm. Now there will be visitors for both patients adding their comments as well.

In addition, I am uncomfortable giving my opinion about the skills and expertise of the oncoming nursing staff. We are expected to stick to the script and give positive reinforcement about the capabilities of the next nurse coming on shift. What if he/she isn't a very good nurse or has poor clinical skills? Am I supposed to lie to the patient? And if I do, won't I be undermining my own credibility? Does anyone else think this is a little over the top?

[SmilingBluEyes]

Who came up with this lunacy? Studer and their ilk. See, patients are NOT stupid. They pick up on these silly lines and tactics and I have seen people here tell of them asking "what are you robots or Stepford Nurses-----why do you all say the same silly things"? or something similar. This makes them uncomfortable and insults their intelligence. I just feel lucky that none of the hospital systems in which I worked had this in place because there is no way I could have been able to do it. It demeans us and our patients, all in one stupid silly one-liner.

[Here.I.Stand, BSN, RN]

First of all, scripting is highly insulting to the patient; it assumes that they don't notice hearing the exact same lines BID-TID. All of your staff need to agree that you will not insult pts' intelligence.

1a) it is highly insulting to licensed professional staff. All of your staff need to agree that you will communicate as professionals -- and I don't mean professional ACTORS.

Second, report in any fashion needs to take 30 minutes -- no more. All of your staff need to be VERY protective of that 30 minutes, and refuse to come in early or stay late for the sake of report.

Third, interrupted sleep is a known major contributor to delurium (aka ICU psychosis, aka "brain failure" as a former educator called it.) All of your staff need to agree that pts will only be roused for an important medical reason. Frequent post-tPA neuro assessment is a valid medical reason; shift change is not.

Fourth, sometimes it's just not appropriate. Some pts do not want their ROS to be discussed in front of family or roommates. All of your staff need to agree that you will provide *pt centered* care. Not idiotic management centered care.

[TriciaJ, RN]

Honest to God, you are supposed to, wake the patient up? ������

If I was the poor patient being awakened to listen to Stepford Nurse scripting, that would be reflected on my Press-Ganey survey.

[TriciaJ, RN]

First of all, scripting is highly insulting to the patient; it assumes that they don't notice hearing the exact same lines BID-TID. All of your staff need to agree that you will not insult pts' intelligence.

1a) it is highly insulting to licensed professional staff. All of your staff need to agree that you will communicate as professionals -- and I don't mean professional ACTORS.

Second, report in any fashion needs to take 30 minutes -- no more. All of your staff need to be VERY protective of that 30 minutes, and refuse to come in early or stay late for the sake of report.

Third, interrupted sleep is a known major contributor to delurium (aka ICU psychosis, aka "brain failure" as a former educator called it.) All of your staff need to agree that pts will only be roused for an important medical reason. Frequent post-tPA neuro assessment is a valid medical reason; shift change is not.

Fourth, sometimes it's just not appropriate. Some pts do not want their ROS to be discussed in front of family or roommates. All of your staff need to agree that you will provide *pt centered* care. Not idiotic management centered care.

I can't "like" this enough. Same goes for previous posters. Yes it is over the top. WAY over. Just when you think management can't get any stupider....

[NICU Guy, BSN, RN]

"Good morning, Mr. Jones. I will be leaving shortly to go home to my three lovely daughters. This is Sally and she will be your nurse for the next shift. I have known Sally for 4 years and she is a fabulous nurse with excellent clinical skills. She was also my best friend until she had an affair with my husband. I feel confident I will be leaving you in good hands with Sally as your nurse. Just don't leave her alone with your husband."

or

"Good morning, Mr. Jones. I will be leaving shortly to go home to my family. This is Sally and she will be your nurse for the next shift. I have known Sally for 2 months and she is a incompetent nurse with marginal clinical skills. This is her third nursing job in six months. I feel uneasy leaving you with Sally as your nurse, but my shift is over so I hope you survive the night until I come back tomorrow."

[Susie2310]

See, patients are NOT stupid. They pick up on these silly lines and tactics and I have seen people here tell of them asking "what are you robots or Stepford Nurses-----why do you all say the same silly things"? or something similar. This makes them uncomfortable and insults their intelligence. I just feel lucky that none of the hospital systems in which I worked had this in place because there is no way I could have been able to do it. It demeans us and our patients, all in one stupid silly one-liner.

This is very true, yet I prefer scripted good manners over authentic indifference or rudeness which some nurses exhibit. The scripted good manners is a compromise I can live with if it reduces some of the rudeness/indifference. My guess is that this is the goal of management. I have seen nurses perform the scripted behavior quite well where the patient/family were comfortable with the interactions because the nurses appeared to have naturally good manners outside of the script as they provided care.

[AJJKRN]

I wonder what suit thought this up?

Ours came from the Studer Group in an effort to increase HCAHPS scores. (That's why I included their bedside report link in a previous post ;-).

I can say that after spending more than apparently willing, my company kept the concepts of bedside report and hourly rounding but have since parted ways with Studer.

[Penelope_Pitstop, BSN, RN]

I don't think this is appropriate in most cases on a MedSurg floor. For one, most MedSurg rooms in my area are semi-private. Also, it's nice to SIT for half an hour, goodness! I'm not even going there with the scripted crap.

Now, in the ICU, yes, this was a good idea. Easy way to check drips, vent settings, do a visual once-over and help with a turn. But giving report on two patients was much quicker (I was never late clocking out in the ICU) so these things could be managed must simpler; also, we didn't need to wake the patients. Often times they were sedated or not going to wake up so that element was removed.

Again, ignoring that terrible script, I think for privacy's sake and the nurses' mental health sake, unless the patient has something unusual going on or the oncoming nurse is unfamiliar with something (such as a surgical drain on a medical floor), no need for anymore than perhaps an introduction (if the patient is already awake!)

[jennylee321]

"Hello Mr. Jones, I will be leaving shortly to go home to my 7 cats. This is Sally and she will be your nurse. I have known Sally for about 3 mins because she's a travel nurse and we just met. I assume she's a competent nurse because they let her work here"

Clearly this script doesn't work LOL unless you are going to lie which feels real disingenuous

[ImLovingIt]

Hmmmmm.....waking 5-6 patients up. That means taking 5-6 patients to the bathroom and a couple pain pills. No problem. Then, add the bed alarms, telephone calls, beeping IVs and other interruptions....I see a discussion with your NM in the near future on your lack of time management due to all the OT you are logging.

[NightNerd, MSN, RN]

Wow, I have been asked to do some stupid things on the job, but this is a real winner.

Maybe I'm being naive to hope for this, but, like, is there ANY chance of being able to reason yourselves out of this? Like, "Yeah, okay, we can do a bedside report, do a quick ROS and look at orders together, and introduce the next shift (sans the over-the-top warm fuzzies), but it's not in the patients' best interest to wake them up, so we're not doing that. Also, HIPAA, so no visitors involved, k?" The whole thing sounds so extra and I don't think I'd be able to tackle every point, even if I thought this was at all reasonable. Which I do not.

[Fiona59]

Gag me with a spoon.

Thank Gawd I don't work in the US!