The Shenanigans Involved With Scripting

[TheCommuter]

Nurses who have the misfortune of working at healthcare facilities that utilize Press Ganey patient satisfaction surveys are probably subjected to the practice of scripting.

For those who are unfamiliar with scripting, here's a brief rundown. Every nurse is supposed to recite the same pre-written scripted phrases to all of their patients with every interaction. The point is to reinforce the phrase 'very good care' in every patient's consciousness so that, upon each discharge, the facility will generate favorable patient satisfaction survey results. 'Very good care' translates into a score of five on the Press Ganey patient satisfaction survey.

A score of five is the highest rating each patient can bestow upon the facility on this particular survey. Likewise, 'very poor care' is the lowest rating any patient can give and would translate into a score of one on the survey.

Here are a few striking examples of the canned, scripted phrases some members of nursing staff are expected to recite to their patients. Be sure to take notice of the prominence of the key words 'very good':

1. "Is there anything I can do to make you more comfortable? I have the time!"
2. "We know you have many choices, so I'd like to thank you for choosing ABC Hospital, which is a very good facility."
3. "Your doctor is very good!"
4. "My goal is to exceed expectations and provide very good care!"
5. "Thank you for choosing ABC Hospital and I wish you well!"
6. "I want to assure you that we will do everything possible to exceed your expectations."
7. "Our goal is to provide you with very good care!"
8. "In 7 to 10 days, you will receive a survey from the hospital regarding your stay."
9. "Please let me know the moment we can do something better!"
10. "Staff recognizes this must be an inconvenience for you, but we strive to provide very good care!"
11. "You are making very good progress!"
12. "I am pulling the curtain to ensure your privacy."
13. "Our team wants to make your stay very good!"
14. "What? You asked for graham crackers 15 minutes ago and haven't received them? I'm sorry! That is far short of the very good service we aim to provide!"
15. "I sure want to ease your pain! I am going to get your pain medication!"

When dealing with scripting, I call shenanigans. I do not use scripting because the canned phrases sound phony and insult the intelligence of the patients. Moreover, repeated use of scripting insults the intelligence of nursing staff because management no longer believes in our human ability to establish connections with patients and families. Does administration truly believe that patients will automatically return surveys with ratings of 'very good care' if staff continually repeats the phrase?

I am wearily cognizant of all the new pressures surrounding the linking of Medicare reimbursement rates to scores received on patient satisfaction surveys, but uttering canned scripts over and over seems robotic and is devoid of any critical thought. Our encounters with patients should be honest and warm, not derived from phony scripts where the primary goal is reinforcement of a particular phrase.

[dudette10, MSN, RN]

But! If I were a patient and heard this, I would immediately down grade my survey comments. But I would tell the personal to stop the spewing that "stuff" firs.t

Im a bit of an actor at work, so I ad lib the general idea and just make sure I throw in the word excellent a couple of times. The contrivance, for me, is remembering to do so. In effect, I script myself to make it sound more natural. "My name is dudette, and I'll be your nurse until 7 pm. I want to provide you excellent care, so don't hesitate to call me at this number or hit the call bell if you need anything at all." When we round at shift change: " I'm going home now, but Ann will be with you until 7 am. She's an excellent nurse. Thanks for choosing X hospital! If you hadn't, I wouldn't have had the pleasure of being your nurse! Have a good night!"

Mind you, all this self-scripting fits my personality. I'm one of those always-smiling nurses that so many regard with disdain.

We must say "exceptional" care.

That's so fing stupid... given that exceptional means, well, the exception... that is, the outlier.

I just scratch my head and wonder who actually makes this crap up... and how much they get paid for so doing... and whether they even know the meanings of the words that they insist on having 'scripted.'

[Mn nurse 22]

Reminds me of waitressing at a popular chain restaurant. "It's a great day at ______ can I offer you a margarita and some mozzerella sticks?" Our fresh fish today is....

[dudette10, MSN, RN]

That's so fing stupid... given that exceptional means, well, the exception... that is, the outlier.

I just scratch my head and wonder who actually makes this crap up... and how much they get paid for so doing... and whether they even know the meanings of the words that they insist on having 'scripted.'

After much thought and reading, I decided to put the blame squarely on the shoulders of the federal government who enacted the ACA of 2010 with the Medicare reimbursement clause tying it to patient satisfaction. I really can no longer fault administration of hospitals for all this.

I was surveyed the other day for my own hospital, where I also happen to be employed. I just said "excellent" to everything, while thinking, "What do any of these questions have to do with whether or not I got better?" The only two remotely tied to outcome were pain control and communication.

[llg, PhD, RN]

My local supermarker used scripting -- for a while. The cashiers always said, "Did you find everything you were looking for today?" I had great fun saying "No, I didn't" once. You should have seen the hubbub that ensured. The poor cashier got all flustered and called her supervisor. I told them I was lookiong for low-carb cake mixes and couldn't find any. He went back to the baking supplies with me and verified that they didn't have any ... and then recommended another store in the area that might carry them. That store still doesn't carry low-carb cake mixes, but at least for a moment, I thought they were trying to meet my needs.

I've noticed lately that they are not using the same script anymore. There is more variety in their remarks now. That's what I hope will happen with this scripting phase in hospitals. I am hoping that it will evolve into something more reasonable.

[mclennan, BSN, RN]

It's not only Press Ganey, it's also Joint Commission. When I worked for a big Magnet/Joint Commission hospital, when the JC survey was happening, management actually distributed little, pocket-sized, mass-printed booklets that had scripted answers to possible surveyor questions, a guide to the 9 color codes, (9!!!!!) fire procedures, management flow charts and blah blah blah. We were expected to study and memorize it cover to cover. And it was chock full of canned, superficial phrases and statements about 'excellence' and 'satisfaction.'

We were even drilled randomly by management, they would suddenly pull one of us off the floor and 'pretend' to be a surveyor, it was called a 'tracer.' We'd get graded on our answers and everything, and when the REAL surveyors showed up, they'd pick the highest scoring employees to interview with the surveyor.

It was effing SICK. EVERY MINUTE of it felt like a disgusting lie. It made people act totally irrational and dramatic. The hospital even set up a computer app the day they arrived, that tracked the location of the surveyors in the hospital in real time. I have never seen, or hope to ever see again, a level of insanity like that.

[bebbercorn]

I blame Press Ganey and not our facilities. Scripting has been proven to work (although most of us see right through it), although I despise using it. What's the difference between saying "I strive to provide you with excellent care?" and "My name is Bebber, if I can do anything to help, please let me know." Imprinting. I think it is less undermining our intelligence as nurses and more a reflection of the intelligence of the pts that are likely to return the survey. The problem is that PG surveys are not a true reflection of the care pts are receiving, but of a bruised mentality of Americans that they need to be waited on hand and foot, and the ones that (perceive that they) aren't are the ones that will fill out those surveys... giving our facilities unfavorable scores. And with the surplus of nurses entering the workforce, whose paychecks do you think will take the cuts from our facility not getting the "always" we deserve???

[LadyFree28, BSN, LPN, RN]

But! If I were a patient and heard this I would immediately down grade my survey comments. But I would tell the personal to stop the spewing that "stuff" firs.t[/quote']

I've heard scripting in "we are very busy with other patients, we are available as much as possible" or something like that; most of the nurses who scripted this phrase were new grads, nursing students, or nurses 1-2 years old, still "baby" nurses. I told them I could tell that they were new by the scripting, and I tilde them to NEVER state that, even if I was a nurse, and to NEVER script AGAIN to pts; I was a patient then...and almost 6 years from hearing that monotone; I'm grateful that I have never had to script, and if I ever hear that I have to script, I will scream!!!

[Been there,done that, ASN, RN]

Well, that's not very good.

[Kipahni, RN]

We have been told that scripting is a way to let the nurses that lack "soft skills" learn customer PR. I have just morphed the scripting to become more natural. I look at scripting like an actor looks at a movie script. How can I make this nursing role look authentic in this "theater" safely and believable while sticking to the key script.

"Good morning, I'm your nurse for today. I will be here till 7 tonight. My name and number are written on the board so that if you feel you need something like meds or any questions you can call me. You can call the aide for water or food or other care issues as well. Me or the ____ the nurse aide are going to hourly check on you to see if you need anything, pain meds, repositioning, anything. You can also use your call light but the response may be slower. Is there anything you need right now that I can help you with before I go and check on my other patient?

And at the end of the shift " I just saw the assignments made for tonight, your nurse is ___. They are great! You will be well taken care of. "

And then I usually make intentional eye contact with them and sometimes squeeze their hand and say something like " Thank you for letting me take care of you. " or "I hope you have a speedy recovery" or "I will see you tomorrow, sleep well"

And then I go home and accept my academy award for being the worlds greatest life time actress and give my thank you speech to the mirror.

[LadyFree28, BSN, LPN, RN]

We have been told that scripting is a way to let the nurses that lack "soft skills" learn customer PR.

Then it should be for those who need the soft skills, leave nurses to their own devices who have what they need.

[PMFB-RN, RN]

We have been told that scripting is a way to let the nurses that lack "soft skills" learn customer PR.

LOL! you didn't buy into that silliness did you? I hope you called a spade a spade. We were lucky to have nipped scripting in the bud at our hospital. There was widespread nurse refusal to be degraded in this manner and management had to give up on it.

I told my manager that when nursing management was able to get the physicians to read a script written by management to every single patient THEN I would consider it.