I hate what's happening to nursing...

northbynorthwest · Mar 24, 2011

Right on. If I hear someone wants to go into nursing, I tell them they are NUTS. I tell them everything you and I know. I want to give advice to the young nurses here and lend a hand. But in the long run, it isn't worth it. Maybe at the MSN level - good nurse practioners have some great jobs that I have seen, especially in cardiology.

PMFB-RN, RN · Mar 24, 2011

I don't understand why most nurses sit around and complain and hop from job to job!

*** I agree with you on the complaining. The ironic thing is that hospital ENCOURAGE job hoping by providing financial incentives to do so. In most hospitals a nurse who is hire with 5 years of experience will be paid more than a nurse who started as a new grad in that hospital and has been there 5 years. My hospital does this and I have often wondered why.

The message they send to their staff when they do this is one of a lack of appreciation to those who have devoted so much of their working life to them.

Riseupandnurse · Mar 24, 2011

I don't understand why despising scripting makes a nurse a "hater." Nobody has to tell me what to say to a patient. Sorry, but yes I do think that is derogatory to my years of education and experience with therapeutic communication. I love nursing and I loved my patients. I wanted an authentic relationship with them and telling them "I have the time" when I don't is nothing but a lie that people should be able to see through. Oh, yes, I tried it one night. One patient wanted me to play cards with him, one wanted me to make him a grilled cheese sandwich and one said, "It must be great to have such an easy job." All while there were much, much more important things to be doing.

I wouldn't share my problems or my other concerns with a patient, and I would always try to make each one feel valued and special but people are different and nope, the fact that some nurses shouldn't be allowed near a patient does not justify making us all script. It reminds me when "the powers that be" once decided we needed to explore every single patient's sexual concerns. No matter why they were in the hospital. We had to ask PRIESTS if they had satisfying sexual relationships. What we were supposed to do about it if they said no was never explained. Some of the patients also interpreted these questions to mean we were soliciting them and would respond with a leer and a grope. Nobody can "script" their way to an authentic and meaningful relationship with a patient. If you don't believe that, try scripting your spouse and see how far it gets you.

helicoptergal, BSN, RN · Mar 24, 2011

I am new to nursing, I am 2 years into my adventure. And I thank god that I am lucky enough to work around the "old nurses" (not intended to offend) I am speaking of the ones who know what it was like in the old days. Thank you to the ones who setting the stage for us newbies.

Ayvah, RN · Mar 24, 2011

alaine,

I am curious, are you management or do you actually work on the floor, and how long?

As Jan mentioned, there are many reasons that people are upset at scripting. A big reason is that a common script pushed onto staff is "I have time", which is a lie the majority of the time. I'd like to know your rationale as to why being asked to lie to my patients shouldn't be insulting?

The other reason is because many times, more emphasis seems to be placed on hourly rounding, scripting, and other customer service "fluff" than on the patient's actual health. You don't have to travel far on this form to find the examples. I don't need to round on a 25 year old walkie talkie appy and ask him if he has all his P's taken care of every single hour. That's time away from my unstable patients who really need me at the bedside. I also shouldn't have to be fearful of a write up because I'm coding someone and miss my hourly round on that appy.

Making cookies or toast :rolleyes: for patients takes me away from contacting the doctor about lab results that are trending towards dangerous, keeping tight control on my patient's pain, or a myriad of other interventions that actually mean something to the patient's health and well being which there's barely time to do in the first place.

Another example is that my hospital stopped paying for ACLS for med-surg and instead started paying for staff to go to a customer service retreat. When you have customer service meaning more to management than actual patient health, that's when the nurses get up in arms.

martymoose, BSN, RN · Mar 24, 2011

As Jan mentioned, there are many reasons that people are upset at scripting. A big reason is that a common script pushed onto staff is "I have time", which is a lie the majority of the time. I'd like to know your rationale as to why being asked to lie to my patients shouldn't be insulting?
The other reason is because many times, more emphasis seems to be placed on hourly rounding, scripting, and other customer service "fluff" than on the patient's actual health. You don't have to travel far on this form to find the examples. I don't need to round on a 25 year old walkie talkie appy and ask him if he has all his P's taken care of every single hour. That's time away from my unstable patients who really need me at the bedside. I also shouldn't have to be fearful of a write up because I'm coding someone and miss my hourly round on that appy.
Making cookies or toast for patients takes me away from contacting the doctor about lab results that are trending towards dangerous, keeping tight control on my patient's pain, or a myriad of other interventions that actually mean something to the patient's health and well being which there's barely time to do in the first place.
Another example is that my hospital stopped paying for ACLS for med-surg and instead started paying for staff to go to a customer service retreat. When you have customer service meaning more to management than actual patient health, that's when the nurses get up in arms.

OMG THIS THIS AND THIS!!!!!!!!

What part of these examples do some of you not get? This why I get so upset. And now that floors have high acuity(what used to be ICU patients) mixed in with the walkie-talkies, how on earth can this be done effectively? It's a no win situation.

Again, I state- I want to do a good job, I want to provide the best service I can, but when I am in a pt room for 2 or three hours straight because they are unstable and the docs don't want to move then,how am I supposed to round?And Lie and say I have the time when I clearly DON"T. That is where the problem lies.

PMFB-RN, RN · Mar 24, 2011

alaine,
I am curious, are you management or do you actually work on the floor, and how long?
As Jan mentioned, there are many reasons that people are upset at scripting. A big reason is that a common script pushed onto staff is "I have time", which is a lie the majority of the time. I'd like to know your rationale as to why being asked to lie to my patients shouldn't be insulting?.

*** A couple weeks ago O took care of a guy who had shot himself in the head. His family decided to donate his organs. The brain death tests were done and my patient was declared legally dead. My job was to keep his organs perfused until suitable recipients were located. During much of this time his family was in the room..

Later it occurred to me just how stupid and insulting it would look to my deceased patients family had my hospital insisted on scripting. Can you imagine how it would look for a nurse to say the exact words every hour on the script to a patient who was DEAD? What would the family think?

tntrn, ASN, RN · Mar 24, 2011

Scripting: What a bunch of hooie. Even where I work (and the average IQ is not that high) our patients GET TIRED of hearing the same thing, said in the same way, ad nauseum. I had a patient ask me NOT to tell them AGAIN blah, blah, blah.

Two days I had to call my own health care insurance company, and in the process spokw with three different people, all of whom asked me the following: May I ask you a few questions? then Thank you for letting me ask them...then Thank you for answering them.......in exactly the same words, tone of voice, etc. I wanted to scream.

It hardly sounds sincere when we becomes clones of each other.

For 34 years, I have never left a patient's room without asking if there's anything else before I go.....but with scripting it would be insincere and believe me, even the not so bright ones catch on to that.

pedicurn, LPN, RN · Mar 24, 2011

Wow, all these posts are so sad, Everyone is really missing the point. What I am about to type is going to sound harsh but there is no other way to say it.
People in healthcare are given scripts because the truth is most healthcare workers don't communicate appropriately. Pt satisfaction, Press Ganey, etc are here to stay and I think angry, miserable nurses who think "management" and "administration" are clueless and are the enemy really need to stop and educate themselves on what is going on with healthcare, the gov't, the payors, Medicaid, Medicare, CMS, etc.
Pay for Performance rating periods begin in July this year and guess what? Medicaid/Medicare will base their reimbursement not on services rendered, but on quality of care (the quality indicators like CHF discharge teaching) and patient's perceptions of their care. 70% of reimbursement from the "core measures"--there's 17 of them--if your facility hasn't taught them to you , shame on them. If you haven't listened, shame on you. 30% of reimbursement will be based on patient's perception of their care (HCAHPS). Private payors always follow suit.
You want to know why CMS and others are concerned about patient's perceptions of their care? Numerous research will tell you (NE Journal of Medicine for one) that when you focus on improving patient's perceptions, the quality of care follows. Facilities that have high customer service ratings also have better quality outcomes for their patients. Isn't that why we do what we do? To improve patient outcomes?
"Scripting" and other measures are implemented by facilities because they are evidence-based techniques that have been proven to reduce patient anxiety. Studies prove over and over that when you manage patient anxiety you increase their compliance with their treatment regimen and you have better patient outcomes.
"Hourly Rounding": love it or hate it, but this is a technique all of us old, and good, nurses have practiced for years. It is proactive and efficient. When it is done properly, again the evidence confirms less decubitus, less falls, and other quality indicators that are influenced by nursing. Also, less failure to rescue.
I came into the nursing profession from a prior professional career and I can tell you, I was appalled at the way most healthcare workers communicate with patients and the unprofessional attitudes. People don't introduce themselves to patients or explain what they are doing so now it has to be mandated. Put yourself in the patient's place, would you want that? Would you want the miserable, frumpy, complaining nurse who runs in and out your room quickly without explaining anything caring for you? Or your family members? Would that make you feel safe? Would that inspire confidence in you that you are receiving good care? Wouldn't you want someone who came in to care for you, to introduce themselves, check on you regularly, and act like competent, efficient, and skilled professionals?
What REALLY is the problem with a script? They are everywhere now. Wanna know why? Because when used correctly they work. They get desired results when used consistently. Really, what is insulting about a script? Is it because you don't understand the purpose of it? It really doesn't take more time to say those key things that are so important to most of our patients. I sincerely think a lot of nurses need to get over themselves and stop feeling insulted when given tools to use that are proven to decrease patient anxiety and increase outcomes. Really, give it a try. In any other profession if you refused to do it, you would be fired and you should be fired. Give it an honest chance and use it to your advantage. My heart breaks for the nursing profession; I see so many of my colleagues ***** and moan and complain and they don't really know what they are talking about. Not being mean, but it is a professional responsibility to keep up with the evidence and research out there. And the research supports the actions your facilities are rolling out to you. People don't have time to just sit around and make this stuff up. Stop being miserable for the sake of being miserable and educate yourself and constantly look for ways to improve your practice and your outcomes.
But guess what, so many nurses aren't capable of that because it is easier to "be insulted as a professional" than it is to act like one! Nursing is a hard job, always has been and always will be. If you compare what we are doing to fast food work, now THAT is insulting. And if much simpler jobs need scripting to consistently get whatever the desired outcome is, why shouldn't a job as difficult and complex as ours need scripts too? They really are no different than following a clinical practice pathway, clinical policy or guideline.
Scripting is good for patients and that should matter to any nurse. When we are at work, it is not about us, it's about the patient. If talking from a script isn't comfortable, just get over it and do it, and it will get more comfortable with time--just like anything else in life. Positive communication is good for patients and in turn, is good for you. Being positive is better for everyone's morale. I think that if most nurses could feel good about what they're doing, they wouldn't be so miserable. And scripting, rounding, etc is about making things better for the patient and improving their outcomes. If everyone would just do these things MOST of the time, all of us could be more efficient. But when half the staff are stamping their feet and whining about the professional "insults", refusing to do things and just throwing up roadblocks to any changes, how can any of us be successful? We will always have problems as a profession if we can't ever work together for the common goal of the patient? Nurses could be taken more seriously by all if they would stop acting unprofessional and just give things a try--seriously try, not being passive-aggressive or self-sabotaging.

I think you make many excellent points.

However ....for many of us ...scripting would be professional insult.

When they make us script in Australia - well that will be the year I leave nursing

Many of us have manners / social skills and adopt a positive/proactive pleasant manner with our p'ts

Here we go again ...paying the price for our coworkers who are not up to scratch

Darknights · Mar 24, 2011

My worst scripting experience was dealing with a telecommunications company lately. The call centre personnel were totally unable to deviate from their script and actually stumbled if I tried to divert them straight to my issue. It took me 5 1/2 hours of going through the same series of questions and answers with every person I was put through to, until I finally got someone who had no script and within five minutes she had identified my issue and promised to correct it herself personally. I will not forget her because she was such a welcome contrast to all those robot voices I'd been unable to get any sense from previously.

Some of their scripted responses to what I'd say were so ridiculous and completely out of context that I felt like I was trapped in some sort of call centre hell.

allnurses Guide · Mar 24, 2011

*** A couple weeks ago O took care of a guy who had shot himself in the head. His family decided to donate his organs. The brain death tests were done and my patient was declared legally dead. My job was to keep his organs perfused until suitable recipients were located. During much of this time his family was in the room..
Later it occurred to me just how stupid and insulting it would look to my deceased patients family had my hospital insisted on scripting. Can you imagine how it would look for a nurse to say the exact words every hour on the script to a patient who was DEAD? What would the family think?

Exactly! Trying to reconcile in my mind all the reasons we should raise the minimum bar for entry into nursing (which stresses such qualities as adaptability, "critical thinking" and considering the whole bodymind of the patient), and then hands them a canned phrase to say. :confused:

:banghead:

allnurses Guide · Mar 24, 2011

Wow, all these posts are so sad, Everyone is really missing the point. What I am about to type is going to sound harsh but there is no other way to say it.

Don't worry, you are far from the first person to come down from the mountain.

People in healthcare are given scripts because the truth is most healthcare workers don't communicate appropriately.

Wouldn't it be more effective to take that up with our educators? They would probably be interested in knowing that they were wasting countless hours of time teaching communication strategies and assessment of nonverbal cues, and cross-cultural understanding and active listening and therapeutic communication, when a 3x5 card would work just as well.

Pt satisfaction, Press Ganey, etc are here to stay and I think angry, miserable nurses who think "management" and "administration" are clueless and are the enemy really need to stop and educate themselves on what is going on with healthcare, the gov't, the payors, Medicaid, Medicare, CMS, etc.

Nobody has said they are the enemy but it's curious that you would present the solution as a zero-sum. Just as you did with the communication issue. You have it so if the people we are caring for don't have a satisfactory experience, it's the nurse's fault (information out) and also if we are unhappy with management above, (information in) that is also the nurse's fault. Is anything really not our fault?

Pay for Performance rating periods begin in July this year and guess what? Medicaid/Medicare will base their reimbursement not on services rendered, but on quality of care (the quality indicators like CHF discharge teaching) and patient's perceptions of their care. 70% of reimbursement from the "core measures"--there's 17 of them--if your facility hasn't taught them to you , shame on them. If you haven't listened, shame on you. 30% of reimbursement will be based on patient's perception of their care (HCAHPS). Private payors always follow suit

.

How long do you think it will take for there to be statistical evidence that the kind of things thought to represent good care by patients and what actually is good care from a medical standpoint is actually increasing healthcare costs? We already know that nurse managers side with patients over things like ambulation after surgery or sneaking a cupcake to grandpa or a snack to an NPO patient. We know that narcotics are written for in the ED despite the doctor's solid medical opinion that narcotic is not medically indicated and likely harms the patient in the long run. Be careful what you wish for.

You want to know why CMS and others are concerned about patient's perceptions of their care? Numerous research will tell you (NE Journal of Medicine for one) that when you focus on improving patient's perceptions, the quality of care follows.

That's magical! But on the other hand, I wouldn't want my patient's negative perception of me to reduce the quality of my care.

"Scripting" and other measures are implemented by facilities because they are evidence-based techniques that have been proven to reduce patient anxiety. Studies prove over and over that when you manage patient anxiety you increase their compliance with their treatment regimen and you have better patient outcomes.

If only thinking made it so. Outcomes when? On their way out the door thinking about that nice nurse who didn't make them get out of bed and walk? I think most nurses can recognize an anxious patient. An anxious patient needs someone to talk to them. If I was anxious and my nurse told me "is there anything I can do for you? I have the time" while all hell is breaking loose behind him or her I don't think I would be reassured. I'd probably start hearing the theme from "Twilight Zone" playing and want to check out of the place.

I came into the nursing profession from a prior professional career and I can tell you, I was appalled at the way most healthcare workers communicate with patients and the unprofessional attitudes. People don't introduce themselves to patients or explain what they are doing so now it has to be mandated. Put yourself in the patient's place, would you want that? Would you want the miserable, frumpy, complaining nurse who runs in and out your room quickly without explaining anything caring for you? Or your family members? Would that make you feel safe? Would that inspire confidence in you that you are receiving good care? Wouldn't you want someone who came in to care for you, to introduce themselves, check on you regularly, and act like competent, efficient, and skilled professionals?

Most nurses are about as friendly as they can be while being dumped on from all sides. If nurses are as horrible as you describe above (not my experience as a patient or a nurse) no corporate wallpaper will cover such basic deficiencies.

Scripting is good for patients and that should matter to any nurse. When we are at work, it is not about us, it's about the patient. If talking from a script isn't comfortable, just get over it and do it, and it will get more comfortable with time--just like anything else in life.

I find that statement disturbing.