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.

[PMFB-RN, 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.

Your experience is pretty standard for Magnet hospitals, at least in the 4 different Magnet hospitals I have worked in. Its all fake and is why the better hospitals are dropping Magnet.

[Overland1, RN]

Where I worked in an ER many years ago, they wanted us to use the hospital's slogan as part of the scripting as often as possible (i.e., "I am closing the curtain so you can have some privacy...because we care", or " do you want something to eat or drink while you are waiting... because we care"). One night, a security officer and I had to restrain a a very agitated patient onto the stretcher; he took one side and I took the other. As we placed the person (supine) on the stretcher, I informed the person, "we need to restrain you now...because we care."

The rest of the staff dang near lost it.

[2015]

Number 1 takes the trophy. It insults everyone involved's intelligence. I am looking for a home care job because I never have time to provide the care I believe my pts pay for and deserve. Seven pts, two discharges, two admissions totals to 9 patients. That's almost a nursing home ratio.

[2015]

Most of this scripted crap comes from nursing research....where study xyz found out that there was high patient satisfaction when nurses did or said xyz. So much for evidence based practice.

[TheCommuter, BSN, RN]

Okay. . . I did some digging into Allnurses.com cyberspace and found a scripting thread from 2001 (13 years ago!). Apparently the practice of scripting has been going on for many years.

https://allnurses.com/nurse-colleague-patient/verbal-scripts-424.html

[GeneralJinjur]

I know a Colorado hospital was doing it in 1998, when I had my first baby. I hung out on bedrest, with the phrase, "I have the time" ringing in my ears. It was always the newer nurses using the phrases, not the experienced ones.

[Guttercat, ASN, RN]

The day of her surgery, I informed my mom that she'd be receiving a "scripted" follow-up phone call, and why.

It was an outpatient procedure, but it was an all day event, and relatively invasive. She was exhausted.

She received the phone call at 7 AM the next morning. She was sound asleep.

Really???

[martymoose, BSN, RN]

I think we should customize our script then. As in very good = top notch, awesome , supreme , tiptop,superb,fabulous.

Haha- Hi Im JR- I am proud to be able to provide you with fabulous care. We hope your stay at joschmoe hospital provides you with a supreme experience in medical care.We pride ourselves on being awesome!

:roflmao:

might as well have fun with it....

[Bortaz, MSN, RN]

True story follows.

Me: I'd like a # 3 with fries, and an order of mozzarella sticks.

Drive Thru Chick: Ok, sir. Would you like to add fries or maybe an order of mozzarella sticks to your order??

Me: Are you f'ing kidding me?

Her: I'm sorry, sir. We're required to say it!

Me: Well, tell your manager I said it was stupid.

Same way I feel about scripted nursing. Are you f'ing kidding me?

How about GIVING excellent care, and allowing your nurses to give excellent care by not overwhelming them with 8-9 sick patients in order to save a buck? How about stop instituting stupid policies and procedures that sap all the time and energy from your staff? How about stop taking staff away from the bedside and making them sit through 2-3 hour mandatory meetings 2-3 times a month? How about you quit managing to the lowest common denominator, get rid of slackers and let the nurses that are competent and willing to work...let them do their jobs without an idiot hovering and micromanaging?

[amygarside]

So true! This repeated scripting makes me sick. Why say something good out of the situation you are in. There's nothing wrong about being honest. It also establish a strong connection between the nurse-patient relationship. Nice read.

[PMFB-RN, RN]

True story follows.

Me: I'd like a # 3 with fries, and an order of mozzarella sticks.

Drive Thru Chick: Ok, sir. Would you like to add fries or maybe an order of mozzarella sticks to your order??

Me: Are you f'ing kidding me?

Her: I'm sorry, sir. We're required to say it!

Me: Well, tell your manager I said it was stupid.

Same way I feel about scripted nursing. Are you f'ing kidding me?

How about GIVING excellent care, and allowing your nurses to give excellent care by not overwhelming them with 8-9 sick patients in order to save a buck? How about stop instituting stupid policies and procedures that sap all the time and energy from your staff? How about stop taking staff away from the bedside and making them sit through 2-3 hour mandatory meetings 2-3 times a month? How about you quit managing to the lowest common denominator, get rid of slackers and let the nurses that are competent and willing to work...let them do their jobs without an idiot hovering and micromanaging?

Wow! Well said! I wish I could "like" this 100 times.

[PMFB-RN, RN]

What would be GREAT is if in the surveys patients complained mostly about the demeaning manner their nurse repeated the same phrase over and over to them.