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.

[middleagednurse]

Overland1...You made me choke on my popcorn. LOL

[HikingEDRN, BSN, RN]

I refuse to recite scripts. I just WILL NOT do it. As someone who values sincerity, it feels very wrong. Luckily, management in my department does not push it. Then again, my manager was a bedside nurse for over 20 years :)

[Shinnichi, ADN, RN]

Every one of those scripted lines I read, I read the words "very good" with a sarcasm tone or weird inflection! "We want to give you 'very good' service. *wink wink*"

If I were a patient with my nurse saying those things: Do you really even care, you robot? Is English not your first language?

(But now after being on allnurses and learning what crap many floor nurses are subjected to...) What the hell is wrong with your management? Are they Daleks?! "You are making good progress. You would make a good Dalek-- I mean, thank you for choosing ABC Hospital and I wish you well."

[ckm2]

Well said. A hospital I was working at 5 years ago kept on harping on "very good care" Having a degree in statistics, very good is associated with a B grade which is 80%. 80% reliability is also when chaos starts because it means 1/5 times you screw up. So I asked admin why dont we make excellent

care our goal they said thats too hard to achieve! OMG these people do make me laugh.

PS If I am having surgery, Im going some where that does it right 100% of the time.

[meanmaryjean, DNP, RN]

I admit I read the title of the thread and it's completely different from something I've been trying to push at work.

Here's my thought: Why can't we use scripting to actually accomplish something? Case in point- I work PICU. Families are supposed to 'foam in/ foam out' each and every time they pass through the doorway. Few do. My thought was that each nurse would recite the script about hand hygiene with each first encounter of the shift. Then MAYBE we might get somewhere with compliance.

All that fluffy customer service crap? No thanks!

[vampiregirl, BSN, 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.

When scripts are inserted at inappropriate times it makes it seem as though the employee didn't listen to a word the customer is saying. I'm sure that doesn't help customer service scores...

[jadelpn, LPN, EMT-B]

I admit I read the title of the thread and it's completely different from something I've been trying to push at work.

Here's my thought: Why can't we use scripting to actually accomplish something? Case in point- I work PICU. Families are supposed to 'foam in/ foam out' each and every time they pass through the doorway. Few do. My thought was that each nurse would recite the script about hand hygiene with each first encounter of the shift. Then MAYBE we might get somewhere with compliance.

All that fluffy customer service crap? No thanks!

Foaming in and foaming out sounds scandalous!

Bottom line, we are dumbing down nursing with the "I strive to provide you with very good care" stuff--as most would assume we do not strive to kill them before shift end.....

And heaven forbid that nurse following you is not attempting to give "mediocre at best" care--then you could blow bubbles out your butt and your patient will not believe one thing that comes out of your mouth from then on out....

[canoehead, BSN, RN]

This reminds me of those clothing stores where they force some poor soul to stand at the front of the store and refold the same 500 shirts with the folding board and say "HI!" to every single person that walks in. They lose major points by Secret Shoppers if they don't. And don't think hospitals won't be utilizing them soon as well!!

I was a secret shopper at one point. The companies decide what items they want us to check for. Sooo, my point is that the hospital can make their own standards...but they choose to regurgitate what everyone else is doing.

[Kipahni, RN]

At my hospital they do enforce the scripting. The doctors script as well. We have gone to management and expressed our concern and they basically said "this is part of your job description, perhaps you should look for different employment if you find you can not accomplish this hospitals goals"

With 600 new grads a year and I am the primary bread winner in my family I play by their rules and realize that this is a trend like any other nursing trend. Some stay (computer charting) some go (wearing buttons on your scrubs that say "I have time for you")

[txredheadnurse, BSN, RN]

Every time I read one of these threads about scripting I am so dang grateful I am not in bedside nursing anymore. I couldn't force myself to say thank you for allowing me to care for you or so and so is an excellent nurse and has yada yada degrees and experience. I wouldn't say those things because I was trained in an era when doing all you could with everything available to you was the norm and it wasn't required to tell people that you did your job because it wasn't a popularity contest. It was about getting the care one needs to recover and return to life outside the hospital. It was about saving lives and functionality and working as a team and not a bunch of logo/catchphrase/marketing hook spewing folks. It was about understanding that being admitted to the hospital was focused on health and not fluff and nonsense.

I challenge all those administrative people who say the patient has a choice of which hospital they choose so we must be more appealing. I don't know about anyone else but I have to go to whichever hospital is in my insurance network and it will be the one closest to me. Giving me cookies, and bugging me every hour by mouthing meaningless phrases does not make for very good care IMO. I do feel for those nurses who must do this but I wish that some of you would help start a mini revolution among the patients and suggest that if the patients find scripting insincere and irritating that they mention that on the surveys. The practice is degrading to both the doers and the receivers. We should focus on the job at hand and clear transparent meaningful communication and not fill our time with meaningless drivel.

OK off soapbox now.

[Overland1, RN]

Overland1...You made me choke on my popcorn. LOL

Sorry about that.

One nearby hospital received poor PressWhiney scores on its ER doctors, so the next batch of surveys was reportedly modified. The results of those were even worse. I will bet they hated when that happend.

[Catzilla]

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.

My schtick is eerily similar. I think that it makes the patient feel more secure and confident in the care they are receiving. Also gives a brief outline on how the next 12hrs are going to go down. A secure patient pushes the call button less IMO.