I hate what's happening to nursing...

ZippyGBR, BSN, RN · Mar 24, 2011

the fundamental issue with scripting interactions is that when how closely you adhere to the script becomes part of the metric it's a broken idea.

yes Doctors use scripts but it's not the sum total of all interactions , pilots use scripts - there's a fixed call and response checklist for most if not all affects the aircraft actions once the wheels are moving and several before the wheels are moving

CRM based OR checks and time outs use a script ....

there's a place for scripts and call and response but it as a guideline like SBAR not as a call centre phone drone metric

Guest717236 · Mar 24, 2011

Scripting is one more erosion of the control that nurses have of their practice.

Being assertive, a patient advocate, using critical thinking, nursing rationales,

and continuing to grow as a nurse by taking CEUs or advanced courses are some of the many vehicles to allow a nurse to gain autonomy in practice.

We are allowing anyone to dictate our professional practice, meanwhile

demanding increased levels of nursing education. Safety is compromised as we yield to the constant pressures of other individuals dictating our job.

Nurses need to take back their professional practice-, competent,caring

professional nurses do not need a script, period.

What they need is a full complement of other professional nurses and staff

and the respect to practice autonomous without interference from business or marketing. They will provide excellent care to the patients, that will exceed any automated script presentation results.

Patients want and need nurses who are compassionate and caring with

a love for what they do, and the experience and education to help navigate

them safely through their health challenge.

PMFB-RN, RN · Mar 24, 2011

the fundamental issue with scripting interactions is that when how closely you adhere to the script becomes part of the metric it's a broken idea.
yes Doctors use scripts but it's not the sum total of all interactions , pilots use scripts - there's a fixed call and response checklist for most if not all affects the aircraft actions once the wheels are moving and several before the wheels are moving
CRM based OR checks and time outs use a script ....
there's a place for scripts and call and response but it as a guideline like SBAR not as a call centre phone drone metric

*** I don't find your examples of scripts used between professionals to be at all comparable to what we are talking about.

There must be some other examples of college educated, licensed, professionals who are required by their employers to use scripts with their CLIENTS?

cosmicsun · Mar 24, 2011

alaine - you sound like someone in management. I don't care if I say my own thing or what the hospital wants me to say. BUT - if I was lying in bed and nurse after nurse, shift after shift, came in and said the same thing to me - I would have HIGH DOUBTS they think for themselves and have a brain. It would make me uncomfortable that I already know what the nurse is going to say before he/she walks into my room.

The hourly rounding and management asking patients how their care is, is undermining care. Of course, we are doing our best to care for our patients. I am in their rooms MORE THEN ONCE AN HOUR, but the fact that I have to write down what time I'm in every room has taken a toll on my stress level - and I HAVE FOUND I am spending LESS QUALITY time with the patients because I'm worried about what time I write down on the logs. I am now the HURRIED NURSE that management doesn't want but HAS CREATED. And, the other day I was in a patient's room with dementia. He was asking me what the cheapest ticket was for Florida, and how much was this going to cost, etc. Then management comes in and is interrogating this person on their care, asking all these logical questions and writing down the answers. It was bizarre. (The previous night this patient had been in restraints with an Enclosure Bed ordered - clueless.)

The nurses are stressed out. We do more than hourly rounds. Having to bounce constantly between rooms and write down the times a minimum of 60 times per shift is exhausting. I'm now going into their room like 4 times per hour because I can't remember exactly what time I was in there before. That would be bouncing from room to room about 200 times per shift... I spend more time worrying about writing on the rounding log than anything else.... If there is a problem, they will check it against the rounding log. They are being proactive to blame the nurse for anything - and the nurses have to defend themselves. That's the respect we get and that is what is passed onto the patient - LIKE IT OR NOT. The rules have consequences and what you are doing to your nurses is negatively affecting patient care. You should be more concerned about the patient to treat your staff better. How the nurse FEELS will be picked up by the patient.

(I like the cop out for the Doctors..... epic)

tntrn, ASN, RN · Mar 24, 2011

yes Doctors use scripts but it's not the sum total of all interactions , pilots use scripts - there's a fixed call and response checklist for most if not all affects the aircraft actions once the wheels are moving and several before the wheels are moving

Having been married to a professional commercial airline pilot for 25 years, I can tell you that a checklist and a script are not the same thing. Pilots use checklists that apply to things that occur in the cockpit and to the aircraft: takeoffs, landing, emergencies. They do not use scripts when dealing with their passengers. Every pilot has his own way of welcoming passengers to the flight once the aircraft is above 10,000 feet. And if you want to see client dissatisfaction go away, just try forcing the Southwest Airlines crews to start doing their announcements just like every other airline in the world does theirs.

RNAM1965 · Mar 24, 2011

sorry, not in management but am charge, have patient assignments and preceptor for 20 years.

I guess the scripting thing is being carried out differently where most of you work. I really wouldn't imagine anyone would be expected to just say the same thing over and over no matter what the situation is. Really, no one could expect that. That is stupid. I'm seeing scripting used to give guidelines to people to make sure they remember to introduce, address certain issues, to be proactive and organized. Because I personally have worked with people for years and a good number of them have to be told to do basic stuff like this. Nurse and Nurse's Aides. It's not just about nurses. Our Respiratory Therapists, Physical and Occ. Therapists, etc., Phlebotomists, everyone signs patient's rounding logs and checks on the same things the nursing staff does.

We are not expected to play games with patients or make cookies or whatever eles people are saying on here to do customer service. Or being expected to stick to a strict script even with a patient who is basically dead. Just to ask what else we can do (that's related to patient care) while in the room, because like we all can agree on, we are all in their rooms all the time anyway, why not check on the same things every time , or almost every time, we are in there. Lots of other people are in the rooms treating patients too and they do it to. I dont' think any of them have been insulted to do it. The OTs and the PTs and RTs haven't been complaining, but sometimes they do have to ask us to come do some of what the patient asked for , just like the aides have to do with pain medicine or whatever.

Is that what is really expected out of all of you who are posting this? It has been explained to us to use as a guideline to check on important patient indicators consistently, explain things more to patients while we are already in the room, because a lot of people do not. I really do not think there is anything wrong with any of that. And our doctors have to meet with us to talk about what we all have to do for the patients because they are graded on the patient satisfaction too. We have a peer review process for doctors who are rude to patients or nurses or anyone. It is not perfect but our patients are happier when we tell them that someone will be checking on them every hour and we have had less falls and pressure ulcers and PCA issues since we have been doing this stuff. The residents check on our patients more --round on them more during the evening--because the patients told the attendings that was what they wanted in the surveys. We have lots of examples like that. We nurses are not the only ones who are changing how we do things based on this concept. But I don't know if a lot of our younger and newer nurses even realize this sometimes to tell you the truth. I know this because I go to meetings. I started going because I didn't agree with any of this at first either. I guess I felt like posting because we have had to try it where I work for years now and it works for us most of the time. Not all the time. Nothing works ALL the time in a busy hospital. But it is has been better for the patients and I think that is what makes me feel good about how hard I work shift after shift, . And I've seen nurses become more efficient and better with their time management once we started doing this. Two weeks ago an hourly rounding in the middle of the night saved one of our patients' lives. She is 30 years old and thank God she is alilve right now.

But I do not think we are doing it the way some of you are talking about. So forgive my ignorance, if you feel you all are being treated like a robot who cannot think and are told to just say the same thing over and over, because that is not how I think it is intended to be. Or how it should be. My job is hard. Nursing is hard. Being a patient is hard. I just think since we started doing a lot of this stuff and once everyone started doing it all (well, most) of the time, things have gotten better and that maybe it would help other people if they just give it a chance.

ZippyGBR, BSN, RN · Mar 24, 2011

a lot of people seem to have missed the point i was making

'scripts' in the broadest sense do have their place in healthcare - as do Call and Response checklists etc. what does not have a place in fixed call centre scripts and discipline for failing to follow the script to the letter ...

there was reference to erosion of professional practice - thisis a vlaid concern when it comes from lay managers as a diktat rather than coming from within the profession in response to evidence base and /or learning from incidents - as the CRM and call response stuff in surgery has come from .

PMFB-RN, RN · Mar 24, 2011

i really wouldn't imagine anyone would be expected to just say the same thing over and over no matter what the situation is. really, no one could expect that. that is stupid.

*** of course that is what is expected, that's why they call it "scripting", as in read from a script. we were given 3x5 cards and told we were to repeat the words on the card to each patient each hour. no exceptions were made for patients who might be intubated and sedated or dead. fortunately the whole scripting thing was squashed in it's initial stages by mass refusal of the nurses to play along.

often fads like scripting are not implemented to sole a real or perceived problem, they are implemented because somebody in management reads and article or attends a conference and brings home these "keeping up with the joneses" hair brained ideas without considering whether there is a problem that needs addressing in the first place.

i'm seeing scripting used to give guidelines to people to make sure they remember to introduce, address certain issues, to be proactive and organized. because i personally have worked with people for years and a good number of them have to be told to do basic stuff like this. nurse and nurse's aides.

*** you said people who refused to use scripting should be fired. i suggest that if you fired the staff, like those you describe above, who are failing to do basic nursing care you might not have to provide them with scripts. no patient in an acute care setting should ever go more than an hour without staff seeing them, more often is better. this is standard for acute care. nurses who are failing to provide the standard of care should be worked with to help them do better. those who are simply refusing to provide the standard of care need to be dealt with. maybe if your hospital concentrated on those things there would be no need for scripting. of course in my unit the rn very often spends the entire shift in the room running crrt, titrating gtts and doing other patient care. can you imagine having to interrupt a discussion with a patient so that you can read a 3x5 card verbatim each hour? it makes us look like idiots.

OCNRN63, RN · Mar 24, 2011

Scripting is one more erosion of the control that nurses have of their practice.
Being assertive, a patient advocate, using critical thinking, nursing rationales,
and continuing to grow as a nurse by taking CEUs or advanced courses are some of the many vehicles to allow a nurse to gain autonomy in practice.
We are allowing anyone to dictate our professional practice, meanwhile
demanding increased levels of nursing education. Safety is compromised as we yield to the constant pressures of other individuals dictating our job.
Nurses need to take back their professional practice-, competent,caring
professional nurses do not need a script, period.
What they need is a full complement of other professional nurses and staff
and the respect to practice autonomous without interference from business or marketing. They will provide excellent care to the patients, that will exceed any automated script presentation results.
Patients want and need nurses who are compassionate and caring with
a love for what they do, and the experience and education to help navigate
them safely through their health challenge.

Exactly this. It's more about control than quality. It astounds how nursing has been dumbed down since I graduated, and I'll bet the nurses here who are more experienced than me are even more horrified at what they see.

I never was much of a fan of Kool-Aid, and I'm not drinking this stuff, for sure.

Riseupandnurse · Mar 25, 2011

When scripting was introduced in our hospital we were told that yes, we definitely would say what was written on the cards each and every opportunity that arose. There are scripts for admission, for rounding, for the nurse at the end of discharge teaching directing the patients filling out the survey to say that they got VERY GOOD CARE (say it several times, were the directions, so that the patient would spit out the words on the surveys) and when the patient was getting into the car. One of the transporters got into serious trouble because he let the president of the hospital get into the car on discharge without saying, "We have really enjoyed having you as a patient here at Robots R Us Hospital and we hope you will choose to use our services again for all your medical needs." Where was she supposed to go for hospital care????? The competition? Just plain dumb, degrading, and ridiculous. Those nurses who resisted got sent to Employee Assistance Counseling because we were obviously showing signs of being mentally unstable. You got to love it.

tahoe77 · Mar 28, 2011

I totally hate scripting too. It implies that I can't be trusted to

communicate on a basic human level. For the most part,

I was already saying the gist of what the script says....except

"i have the time" what a total croc! I don't have the time to

pee in 8hrs or drink a sip of water!

The sad thing about scripting is that apparently some

nurses are so bad at talking to people that they ruined it

for everyone and now all nurses are being asked to script.

Thanks dbags for ruining it for everyone!

Is health care really so bad and the workload so great for nurses

that we have forgotten how to talk to our patients on a basic

human level and now require a script?

its disgusting.

tahoe77 · Mar 28, 2011

Another element of this is that soon medicare, the biggest

payer for healthcare in the US, will be paying hospitals based

on customer satisfaction NOT on services rendered/procedures, etc.

You could be a top hospital with cutting edge technology

but if granny doesn't get her hamburger despite being

ordered a low fat diet and decides to give us low customer

service marks then we are not reimbursed the way another

hospital is. Its terrible!

I really hate this because when people are sick and

in the hospital they are necessarily unhappy. Sometimes no

matter how nice you are pts are going to be miserable

and mean to you because that's what happens when

people are sick! This isn't a damn SPA!

Sometimes being in the hospital means we have to do unpleasant things

like place an NG or foley or start an IV, to save

your life, or wake the pt up

at 4am to weigh and bath them, (i personally hate that).

I love when people come to the hospital wanting to be

a full code and then refuse any simple interventions we

try to put in place to take care of them like start an IV.

The patients are spoiled. They treat their bodies like

++++ for years and years and expect to come to the

hospital one time and be completely fixed and have their back

rubbed to boot.

Its not a spa!