When I'm a patient, nothing makes me feel more like I, the patient, am on an assembly line, than when my nurse comes across as an Autobot.
You know, you send a portal message to the office nurse, and the reply sounds like it's composed of drop down box choices. "I'm so sorry that you are having this problem, the doctor will be back in the office on Thursday to address your concerns". "We care about our patients, your pain is important to us". They may as well label the message 'donotreply'.
You're an inpatient and Autobot RN enters the room with a fake smile with a scripted speech "What can I do for you, I have the time. On a scale from 1-10, 1 being barely any pain, and 10 being the worst pain imaginable, how would you rate your pain?".
At least try to be a little real, genuine, creative, HUMAN! Our modern approach to medicine, and many other fields, has taken the human touch out of so many of our interactions. No wonder we often feel empty and uncared for.
You're an inpatient and Autobot RN enters the room with a fake smile with a scripted speech "What can I do for you, I have the time. On a scale from 1-10, 1 being barely any pain, and 10 being the worst pain imaginable, how would you rate your pain?".
At least try to be a little real, genuine, creative, HUMAN! Our modern approach to medicine, and many other fields, has taken the human touch out of so many of our interactions. No wonder we often feel empty and uncared for.
The pain scale and many other assessment data are standardized and the best way to promote accurate and informed responses is to ask in a standardized way. I am a nurse, not an entertainer or therapist. I have no interest in deriving interesting and spontaneous methods to inquire about standardized scales. I am also not a drone. Management wants scripting with verbatim phrases that mimic the Press Ganey survey, it is insulting and undermines our professionalism and autonomy.
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
Yes, it is a thing. I've not first-hand seen it in full-blown use at the bedside in any hospital setting, but have directly seen its strong encouragement by my own leadership. We are directed to use specific keywords in our speech that directly mirror keywords in the surveys given to pts post-discharge. One example, for use bedside report, nurse A is to manage up nurse B by using "This is blah blah, she's been a nurse for 10 years, and blah blah...I know she will *give you very good care*" where the same phrase will show up later when the patient comples the Press-Ganey survey.
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I did not previously make this connection. I'm familiar with the lame scripting and the deference to Press-Ganey. I did not realize the patient was being indoctrinated to answer correctly on the survey.
The pain scale and many other assessment data are standardized and the best way to promote accurate and informed responses is to ask in a standardized way. I am a nurse, not an entertainer or therapist. I have no interest in deriving interesting and spontaneous methods to inquire about standardized scales.
But you are interested in interpreting standard scales correctly, don't you? Do you think that just blindly writing down the responce and acting according to that responce is the right way to do it?
Yes, I was told, just like you, that "pain is whatever the patient said", innumerable times. Now I work with some of such patients who were dutifully given all the Dilaudid they want within those 15 min from the time their 10/10 pain was discovered and were lucky to finally get their insurance paying for 30 days in LTAC to do what is, really, medically complex detox. Those who were not so lucky are dying from overdoses. And I feel that quite a number of these deaths are ultimately stemming from what we as health care providers were doing for the last 10 years.
I did not previously make this connection. I'm familiar with the lame scripting and the deference to Press-Ganey. I did not realize the patient was being indoctrinated to answer correctly on the survey.
I never made this connection either, until my facility flat out told up to start telling patients we were doing certain things "for your safety" as we were not raking as high as they would like in the "I felt safe when I was at ********" areas of the PG surveys.
So "I'm going to make sure you can reach your call bell for your safety, but never mind the 300 lb man in the room next door trying to flip over his stretcher and bite the nurses." (We don't have a separate area from psych patients in my old ER, just a special room which is next door to the gyn room and steps from the trauma bays.)
I don't have ANY scripting in school nursing, just sayin'...
I did not previously make this connection. I'm familiar with the lame scripting and the deference to Press-Ganey. I did not realize the patient was being indoctrinated to answer correctly on the survey.
Yep, we all are, to certain degree. "Do to others what you want to be done toward yourself" works the other way too: I was treated well by them, so now I got to treat them well, too .
You can name it indoctrination if you like, but in reality it is just one of the un-written rules any civilized society lives by. The ethical side of linking common rules of societal life with medical outcomes and monetary compensations is entirely another question.
Before I left the hospital setting we were made to use scripting. At one point they actually said that we needed to start using the word "always" when talking to the patient since it was the word used in surveys.
"I'm so glad you 'always' get your pain medicine in a timely manner."
"Press your call light if you need anything and I will 'always' be here to help."
"If you have any questions for your doctor, let me know and I will 'always' get you an answer."
Specializes in Healthcare risk management and liability.
And of course, one of the major reasons that Press Ganey is so important is the ties to reimbursement. The better the scores, the greater the reimbursement or the hospital is not incurring financial penalties from the Feds or the healthcare insurance companies. In many cases, the salary or bonus of the facility CEO is tied directly to the satisfaction scores. I was at a facility in which the hospital CEO earned a $ 125,000 bonus that year for the Press Ganey scores. As far as I know, that bonus was not shared with the people who actually did the work.
I did not previously make this connection. I'm familiar with the lame scripting and the deference to Press-Ganey. I did not realize the patient was being indoctrinated to answer correctly on the survey.
Our patients are surveyed, from a different entity contracted by Medicare but with same type of questions.
Regardless of staffing, it has been evident that those care issues, both a focus in the survey as well as being important aspects of healthcare, is not resonating with a significant percentage of patients. My response to my staff then isn't assigning scripting (style over substance) but to ask them why don't their patients realize that their pain, for example (substitute safety, disease mgmt etc), was addressed? Was it actually addressed? I can see that it was written in the plan of care and that it was documented as addressed but if they didn't leave with an impression that the pain was addressed what actally transpired that the patients missed it? Keep in mind we are small enough and we have the names of those surveyed that it's easy to determine if the patient had been otherwise reasonable and articulate.
The answer is often that pain mgmt wasn't actually *addressed*. They might have been told the age old generic "stay on top of your pain" (talk about scripting) but were they asked if their pain was managed well enough that they could sleep, perform their usual or progressive activities and their therapy? Were adjustments needed and made in either direction? Were they instructed how to taper down as their post op pain decreased so that they wouldn't experience withdrawal symptoms? Was genuine eye contact made during these discussions?
Those questions could be asked in less time than it took me to type them out and with my extensive experience with this sort of thing (we've been getting surveyed for years prior to star ratings becoming a reality) the patients likely would have remembered. "Yeah, my nurse Libby talked to me about my pain..."
Star ratings came about due to a lack of making this impression, whether due to it not resonating with the patient or it truely not having been addressed. Hospital nurses may not have ever have had the time to take the few minutes to give these issues adequate attention but I can say that we in HH usually have at minimum 3 undivided 30 minute visits with our patients and it still wasn't happening or sticking. THAT's why we have this pressure from Medicare, not because of a direct concern for the patient but because the focus of all of the survey questions are related to the most common reasons for readmission which of course equals $$$$.
So what do I advise, or *indoctrinate* my staff to do? "Make sure your patients don't miss your efforts." No script needed, make sure they realize it in your own words, your own style. Because there is too much riding on it to ignore, money and patient care, and before someone comes along and enforces scripting.
I honestly didn't know this was a thing. Where is this? This is common? You have a script?
My mind is blown. Please clarify.
This, and a few other things I've read on here (re: patient satisfaction surveys, for example) make me less resentful that I didn't get hired by a hospital. The world is going utterly mad...
Well EXCUUUUUSE me! Next time I ask you if you need anything, I will utilize interpretive dance and/or haiku. When I chart your pain scale, I will use a code of my own devising based upon your astrological sign (sun sign only, duh). On days of the month that are prime numbers, I will use hand puppets and hand puppets ONLY.
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Specializes in Healthcare risk management and liability.
Your opinion is important to us, thank you for sharing. We will use this feedback to improve our practice. We rely on you, the viewing public, to help us to provide the best threads possible. We care about you!
mystory, BSN, RN
177 Posts
The pain scale and many other assessment data are standardized and the best way to promote accurate and informed responses is to ask in a standardized way. I am a nurse, not an entertainer or therapist. I have no interest in deriving interesting and spontaneous methods to inquire about standardized scales. I am also not a drone. Management wants scripting with verbatim phrases that mimic the Press Ganey survey, it is insulting and undermines our professionalism and autonomy.