The Shenanigans Involved With Scripting

  1. 19

    Many hospital administrators believe that scripting is useful in formulating great patient encounters and influencing Press Ganey scores in a positive manner. However, scripting insults the intelligence levels of the staff members who must recite the canned phrases and the patients who are forced to repeatedly listen to the same scripted lines.

    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.

    RESOURCES
    http://www.uhnj.org/uhnetweb/custome...SE_Scripts.pdf
    Last edit by TheCommuter on Jan 23, '14
    malamom, hikernurse, AJJKRN, and 16 others like this.

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  2. Visit  TheCommuter profile page

    About TheCommuter , BSN, RN

    TheCommuter is a moderator of allnurses.com and has varied experiences upon which to draw for her articles. She was an LPN/LVN for more than four years prior to becoming a registered nurse.

    TheCommuter has '9' year(s) of experience and specializes in 'acute rehabilitation (CRRN), LTC & psych'. From 'Fort Worth, Texas, USA'; 34 Years Old; Joined Feb '05; Posts: 29,856; Likes: 46,437.

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    66 Comments so far...

  3. Visit  jadelpn profile page
    3
    Amen! Very well written article!! It astounds me that critical thinking has gone way of the "this phrase will get us paid"

    Another "good" one.....(or should I say "very good" one....) "This is RN Xyz, BSN, ACLS, PALS, and one hundred other letters behind the name....here, let me write it on the white board for you! I have worked with RN Xyz for a large amount of time (even if it is hours...) and I KNOW that you will recieve VERY GOOD care!! THANK YOU SOOOOOO much for allowing me to care for you!!"
  4. Visit  jrwest profile page
    5
    Very good article ( lol)
    no, really.

    This scripting stuff is something that undermines us as a professional nurse. How phony we must all sound. I had no idea when I took this on that we had to be actors too, in addition to waitresses, housekeeping, etc.

    I must admit though, on the d/c instructions of a pt, there was a page that had a picture of the MD who took care of the pt, and he had a small schpiel ( however it is spelled) of how he hoped he provided very good care, and that they would be getting a survey in the mail. I thought that was a good thing to have added to the d/c instructions- makes the doc accountable
    Last edit by jrwest on Jan 23, '14 : Reason: computer glitch
  5. Visit  PMFB-RN profile page
    13
    Well said and timely article. Thank you. I have always refused to use is. Scripting, starting wages of less than $20/hour, punching time clocks, and the paternalistic manner in which nurses are treated by management give make mockery of those who proclaim nurses are considered true professionals.
    kabfighter, FransBevy, jadelpn, and 10 others like this.
  6. Visit  Nalon1 RN/EMT-P profile page
    1
    We are a Press Ganey facility but have never been told in 5 1/2 years to use any of these phrases.
    I do say some similar phrases (I talk up other staff all the time, tell them why I pull the curtain/close door and such), but that is just part of my normal self.
    chare likes this.
  7. Visit  DisneyLoveRN profile page
    1
    I am one of those people. Thank you for sharing our pain. I also do discharge call backs. This also involves scripting. This is the one time I do use the "very good" phrasing. This is the last time they hear from the hospital before that survey arrives in the mail.
    bristolrover likes this.
  8. Visit  cardiacfreak profile page
    8
    We must say "exceptional" care. Why not have it piped out of the intercom every 15 minutes?
    hikernurse, brandy1017, jadelpn, and 5 others like this.
  9. Visit  dudette10 profile page
    1
    Scripting with "very good" won't prevent lowered Medicare reimbursement. To steer clear of cut funding, it has to be "excellent."

    I, too, find it contrived to say, but it is a necessary evil. Not enough "excellents" means Medicare cuts in reimbursements, means higher ratios, means reduced patient safety. If all it takes is some careful scripting, then so be it.
    SNJS likes this.
  10. Visit  morte profile page
    8
    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 from dudette10
    Scripting with "very good" won't prevent lowered Medicare reimbursement. To steer clear of cut funding, it has to be "excellent."

    I, too, find it contrived to say, but it is a necessary evil. Not enough "excellents" means Medicare cuts in reimbursements, means higher ratios, means reduced patient safety. If all it takes is some careful scripting, then so be it.
  11. Visit  Savvy20RN profile page
    11
    I used scripting once in the hospital and my patient laughed at me. I never used it again.

    This one: "Is there anything I can do to make you more comfortable? I have the time!" bothered me the most. I NEVER had time and I was lying when I said I did. The patient knew I was lying. They watched me dart up and down the hall for 12 hours nonstop.
    hikernurse, AJJKRN, SoldierNurse22, and 8 others like this.
  12. Visit  neverbethesame profile page
    1
    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 have the time" when that's not the truth at all- how does that square with Veracity – duty to tell the truth? Just sayin'......
    hikernurse likes this.
  13. Visit  NanikRN profile page
    4
    And if you're not telling the truth about having the time, what else might you not me telling me the truth about? ---I think that's how I'd feel as a pt if that were tossed at me.

    Lying or misrepresenting ANYTHING to the patient is an extremely poor way to build a pt/nurse relationship
    hikernurse, SoldierNurse22, PMFB-RN, and 1 other like this.
  14. Visit  dudette10 profile page
    3
    Quote from morte
    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.
    Catzilla, Guttercat, and Kipahni like this.


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