What is the dumbest most degrading, most unprofessional thing...

Nurses Relations

Published

that you have heard of a hospital requiring nurses to do?

I was in a meeting with a group of nurses yesterday - most of us with more than 25 years as RNs - and was hearing about the lovely new practice of "scripting". What is that? It means giving you - a professional nurse with all of your experience and skills and knowledge - a cute little "customer relations script" that you are supposed to say to patients when in various patient interaction situations.

For example: before leaving the room at one hospital, you are supposed to say " Is there anything else you need? I have the time." (whether you have time or not)

I understand basic sense about being pleasant to patients. I understand courtesy. I even know that a few nurses can use a little work in these areas. but the indignity of giving a professional RN a script to use when we talk to our patients? All because some consultant has told them it will improve the patient satisfaction scores. Cartain of our chains seem to be stars at this sort of thing - part of the corporate mind set I guess.

Anyway, I wanted hear how wide spread is this and what other stupid ways of degrading our practice are you seeing out there?

Oh, I almost forgot...here the administrators go again, trying to chip away at the nurse's credibility as patient advocates. Anyone else feel insulted by this poster/button campaign?

"It's O.K. to ask if I've WASHED MY HANDS."

Not only is it 'ok', but our posters say "PLEASE ask me if I've washed my hands"! I think I'd keel over backwards, dead and stiff, if I ever saw a doctor wash his hands before entering a room, after entering a room, upon leaving a room....or, frankly, EVER.

I don't do buttons. Ever.

It's not so fun when its mandated. I would have told them to shove their paper hats.

Or, being the PITA that I am, I would have drawn little pictures on them and passed them out to patients!

How about writing "I'M WITH STUPID" across it, and an arrow pointing to the left....and then cutely standing next to the nearest suit? ;)

I think administration feels the important stuff is tidy rooms and public relations. I, on the other hand, am thinking the important stuff is meds, procedures, titrating drips to keep the patient alive--could be wrong though!

Ah, but if the patient dies, they're pretty sure the family will be MOST interested in finding out if the COUNTERTOPS were dusted that shift....right? Priorities, after all.

Here's my issue with scripting (aside from the obvious that I am a highly trained and skilled medical professional and the English language was a pretty much a prerequisite to my program) When our NM introduced the idea, she actually had the gall to use her recent to trip to a drive thru resteraunt as an analogy. "Would you care for any condiments? How many napkins would you like? Will you need any silverware?"

This ol girl almost fell out of her chair!! I stood up and said, "Are you actually comparing an overworked, understaffed, underpaid ER to Denny's???:banghead:

My theory is I know I don't "have time", NM knows I don't have time, the patient I just told "I have the time", doesn't know any better in most cases. So when I promise the moon and then don't return for an extended period of time because I've been pulled into a code, an acute MI or a crashing kid, the patient is simply left to believe that I

A: Don't Care

B: Am incompetent

C: Am lazy

Because after all, I told them "I had time" to attend to their every (trivial) need.

I out and out refuse to set myself up for that. If hospitals want us so desperately to deny that we are busy and insist on us lying to patients, then they need to make it so we aren't busy by hiring and paying for more of us.:twocents:

Ok, I totally agree with everyone....but here's my question.

What are we going to do about it?

We talk about quitting all the time because of stuff like this. It's usually my first response also, but seriously, that isn't going to help. When are we going to stand up for ourselves!!!

Just REALLY needed to get that out. :banghead:

I had a hard time paring down my list but to summarize:

I was asked to do the following as an Nurse Practitioner under managed care planning:

1) Don't sit down in the exam room during a patient visit. It gives the patient the expectation that you have unlimited time to spend with them to get to the reason of theand don't ask open ended questions.

2) Went to a "efficiency/improved team work" seminar that wanted me to

wear a headset during the patient exam to listen to staff in charge of clinic flow to keep the clinic flow going. I said I couldn't listen to the patient and they got mad at me. I eventually got tossed out of the seminar due to my attitude that seemed to want to pick and chose their program. One of my best ideas was to throw out eligibility altogether and just have one, single-payer instead of multiple insurance plans to pay for the visit. That is where a lot of clinic time is wasted in my current job in public health.

3) Same seminar session would have a "scribe" take my charting notes while I am examing the patient, write my note and do my plan for me with my dictation to speed up the thru-put time.

4) Answer to a "Dr. Black calling" signal that was proposed if a clinician was in a room with a patient too long (longer than 20 minutes). It was a way of getting the clinician out of the room to answer a fictitious call and end the visit.

5) Buy my own clinic equipment. If you can't get your management team to buy you clinic equipment (like a simple weight scale) to save time buy it yourself at WALMART.

6) If a patient can't pay for their visit to save time and the clinic money and save your job, send the patient to the neareast VERSATELER and have them withdraw the money needed to pay for your fee before you treat them.

7) Don't write a letter to an MD regarding a patient clinically mis-mangaged by the said Doctor that you are refering the patient to a specialist (to diagnose the damage done) and then send it and chart you are sending it to the said doctor. NP's are not suppose to write letters to doctors.

8) Asking me to use the new "ATM" card reader installed in my homeless clinic to charge some homeless patients a fee. They don't have credit cards in addition to not having a home. That's why they are called "homeless"

Just a short list of some of the dumbest and most un-ethical ideas from management who bought into "damaged care" theory of increasing revenue at the expense of quality care and nursing ethics.

Nancy Lewis, RN FNP

Specializes in ICU/Critical Care.

Good grief. That's awful.

This is a follow up to my most degrading moments as a nurse practitioner.

What I (we)did about some of the most degrading things we were being asked to do by management as nurses and NP's:

Generally Revolted and :

Started an "underground Clinic" where we just skipped the billing altogether and treated the patients the way we say fit and wrote management up.

Got written up ourselves for writing letters but sent letters anyway to incompetent MD's with other MD's co-signing with us.

Got tossed out of the management seminar but called our bosses who wrote a letter of complaint to the higher ups not to waste the public's money on seminars like this for our system and allowed us (the staff) to re-design our selves. My supervising physician stated "she wasn't into TQM nor scientific management since it reminded her of vodoo economic theory of trickle down.

Support SB 840/HR 676 and joined CNA/NNOC.

Regularly lobby for the above.

Specializes in ICU/Critical Care.

Here is another degrading thing I was put through at my former job: Your evaluation being based on the unit's press ganey scores and the budget. And we were always over budget because we were short-staffed most of the time and people would pick up overtime to fill in the spaces and it put us over budget. Our evals sucked and it was pay for performance and it never really evaluated you on your bedside skills.

And we were always over budget because we were short-staffed most of the time and people would pick up overtime to fill in the spaces and it put us over budget. Our evals sucked and it was pay for performance and it never really evaluated you on your bedside skills.

We were told we could fix that by working extra shifts for straight time when possible or plain overtime when we should be getting incentive pay. Oh, and of course, if we worked short that ALWAYS helped the budget and thus would help our raises.:rolleyes:

Specializes in ICU/Critical Care.

manipulation at it's best.

Unfortunately my hospital has come up with scripting. Really hard some days to slow down and say everything they want to say when your flying around crazy trying to get work done.. They keep on making things harder and harder

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