Is this reasonable or just over the top?

[Lakeshore18]

Recently our Nurse Manager informed the nursing staff that we were now to conduct our shift report using certain "scripted" parameters. Basically, we are to wake patients up, conduct shift report at the bedside, include he patient in the process by giving him/her the opportunity to ask questions and add to the information we pass on to the oncoming shift, check all patient orders on the computer and then conduct a brief"physical exam" of the patient with the oncoming nurse. There are certain scripted things we are to say as well. For example the nurse going off shift is supposed to say:

"Good morning, Mr. Jones. I will be leaving shortly to go home to my family. This is Sally and she will be your nurse for the next shift. I have known Sally for 4 years and she is a fabulous nurse with excellent clinical skills. I feel confident I will be leaving you in good hands wth Sally as your nurse!"

After this, we are to continue on with the above outlined report, conduct the mini physical exam, check the orders in the computer and give the patient the opportunity to give feedback during our report. Generally we each have 5-6 patients on our very busy cardiac monitoring unit and our shift report is 30 minutes long!! My colleagues and I are at a loss to figure out how we will accomplish all of this in 30 minutes! I am all for including the patient and allowing them to give feedback, but I fear shift report will now take so long we won't be able to get all our work done! And what about visiting hours? Shift report takes place right in the middle of them at 7pm. Now there will be visitors for both patients adding their comments as well.

In addition, I am uncomfortable giving my opinion about the skills and expertise of the oncoming nursing staff. We are expected to stick to the script and give positive reinforcement about the capabilities of the next nurse coming on shift. What if he/she isn't a very good nurse or has poor clinical skills? Am I supposed to lie to the patient? And if I do, won't I be undermining my own credibility? Does anyone else think this is a little over the top?

[mushyrn, BSN, RN]

I would never do this. It is completely disrespectful to both patients and nurses. Tell those managers to go ______.

[calivianya, BSN, RN]

So the shift to improving satisfaction has a scientific basis for improving outcomes.

This is very, very situational. I know there's research on it, but I can't help but wonder if the research was done on mostly educated people and not the blatantly ignorant general public.

The most recent complaints I've heard have been:

1. "I'm a retaining a lawyer because you're trying to suffocate my husband!" - Husband was recently extubated, couldn't breathe without BiPAP, said the BiPAP was "suffocating" him... and the wife took that literally. She bodily threw herself in front of the patient to keep us from putting the BiPAP on, and he ended up having to be reintubated. I fail to see how going back on the ventilator when a less invasive treatment would work is improving outcomes.

2. "I'm suing because you're not feeding my mother!" Mother was NPO from belly surgery. Family detached the vent tubing from the ETT and tried to stuff a cheeseburger down her ETT. Fortunately, respiratory caught them and we called security and had them escorted out of the room. I don't see how aspiration pneumonia, or possibly a code, from a cheeseburger being stuff down a breathing tube is improving outcomes. Later on, family kept sneaking her food while she was off the ventilator even though she had no bowel sounds, and her bowels dehisced and she needed emergent surgery. I fail to see how dehiscing bowels is an improved outcome.

3. We had a family who refused to obey the two at a time visitor rule, and complained very loudly about that. They had six people in the room. At one point, the respiratory therapist couldn't get to the ventilator while the patient was desatting because all six were swarming around the bedside refusing to move out of the way. I fail to see how patient hypoxia due to family interference with care improves outcomes.

4. Related to the last... recently had a patient who wanted to lie down, but was satting 86% on nonrebreather while she was laying down. She was satting 92% sitting up. Family refused to let us sit her up because she was more comfortable lying down. How does desaturation improve outcomes?

I could give a million more. I really want to see exactly what sort of people those studies use... because in my experience, 9/10 times what will satisfy my patient and their family members will also result in my patients' deaths or at least a massive complication, and while I really do believe death is an improved outcome for most of my patients, I don't think the government or the people doing these sorts of idiot research studies will agree.

[klone, MSN, RN]

You cannot accurately assess all aspects of the patient without waking them up and yes, some places expect you to wake everyone up for assessments. Its beyond stupid.

You think it's stupid to wake them, if waking them is the only way to accurately assess them?

[klone, MSN, RN]

Then we do it all over again when we are out of the room with the additional information the patient does not want to hear!

This is why we do a 10-minute group report first. All the really important stuff, and stuff that can't be shared at bedside.

[Jodell77]

My hospital had had an expectation of bedside report for over a year now. In most cases, we just don't do it. Pretty much every nurse thinks it's ridiculous so we don't do it, we keep doing what we've always done that has worked well. We do go in after we've given report and introduce the oncoming nurse. In meetings management discusses the importance of bedside report and expectations and we may go through the motions for a few days because they're watching but it always disappears because it's just not realistic. We definitely don't have any scripting though, that's just crazy!! What if you're not going home to your family?? What if the nurse coming on is super green do they want you to tell the patient "sally just finished training yesterday, today is her first night on her own." Bwahahaha! That's just crazy!

[PacoUSA, BSN, RN]

Quit. Quit now.

Your manager is an out-of-touch idiot.

Watch your HCAHPS scores plummet.

If I were a patient, I would forbid you from waking me up for this nonsense and I would refuse this while I had visitors.

Geez!

[JadeEclypse]

We do a bedside report, it's a new JCAHO standard so it's pretty much being phased into most hospitals. But thus far they haven't been so bold as to give us an actual script of what to say, only the highlights of what we're to go over and give the patient time to respond and ask questions.

And actually, no, the shift to improving satisfaction does not have direct link to improving outcome.

Majority of recent studies conducted are showing exactly the opposite. They're showing that the higher the patient satisfaction the higher the overall mortality rates. Why?

We're giving patients what they want, not necessarily, what they need.

We're letting that stroke patient have their turkey sandwich that they pitched a fit about not being allowed to have because they're not safe to swallow but because they refused to abide by our order sets and are demanding it and getting verbally abusive over it we're caving and giving it to them only for them to aspirate and choke.

True story, almost had to call security on a stroke patient once because he was threatening to kick my teeth in if I didn't let him eat, despite him being COMPLETELY unsafe. I call the doc, the doc tells me to feed him, despite him being COMPLETELY unsafe. I made a note about noncompliance and against medical advice, but that doesn't change the fact that a fresh stroke patient pitched such a fit over a sandwich, that he got what he wanted, not what he needed.

UC Davis Health System: 4

[Jasel, BSN, RN]

That sucks. Have to admit though I laughed so hard when I read all of that I nearly chocked on my recess peanut butter cup.

[MicsterRN]

Satisfaction is a function of expectations. To attempt to impact the satisfaction (survey results) without managing expectations is utterly baffling to me, as this is a no brainer. The hospital is NOT a hotel, but hotel marketing Could be a great benchmark for managing expectations! Imagine "Hilton TV" that is the default channel when you flip on the hotel TV.

Tell patients exactly what to expect (these aspects will be congruent with survey question verbiage).

For example, a common sensical approach (to me), is a Patient & Family Channel on the hospital TV, which is a default channel. Short video clips, sort of like commercials, that play on a loop. Channel can be changed, of course, but watchers will probably stay 4-6 minutes before flipping. Examples:

"Being away from home in the hospital is stressful, so here is how we are going to support your healing:

-All health care providers will perform hand hygiene before giving you care. It is important that ALL of your visitors wash their hands, too!

-You, the patient, are the center of you treatment plan. You can expect your provider to tell you what changes are being made as well as anticipated discharge, including post-discharge plan.

-Family support is an important aspect of healing. For the convenience of your visitors, they can get snacks in the cafeteria from 7am to 8pm or get a soft drink in the vending machine in the lobby.

(It's a huge pet peeve of mine when VISITORS utilize nursing time requesting a soft drink for themselves, and more time is spent re-directing to where they need to go to get their needs met.

Once upon a time, the Patient Orientation booklet/binder may have been effective, but that was preceding Press Ganey and preceding a TV at every bed.

When "customers" are allowed to invent their own expectations, there is likely little chance of of achieving the lofty, unrealistic, or mis-aligned expectations.

Tell patients, family, visitors what to expect. As those execrations are met, the stated satisfaction will align. I don't see where hospitals are uniformly communicating to patients what expectations they should have - satisfaction scores will always fall short until expectations are first managed.

[WKShadowNP, DNP, APRN]

Satisfaction is a function of expectations. To attempt to impact the satisfaction (survey results) without managing expectations is utterly baffling to me, as this is a no brainer. The hospital is NOT a hotel, but hotel marketing Could be a great benchmark for managing expectations! Imagine "Hilton TV" that is the default channel when you flip on the hotel TV.

Tell patients exactly what to expect (these aspects will be congruent with survey question verbiage).

For example, a common sensical approach (to me), is a Patient & Family Channel on the hospital TV, which is a default channel. Short video clips, sort of like commercials, that play on a loop. Channel can be changed, of course, but watchers will probably stay 4-6 minutes before flipping. Examples:

"Being away from home in the hospital is stressful, so here is how we are going to support your healing:

-All health care providers will perform hand hygiene before giving you care. It is important that ALL of your visitors wash their hands, too!

-You, the patient, are the center of you treatment plan. You can expect your provider to tell you what changes are being made as well as anticipated discharge, including post-discharge plan.

-Family support is an important aspect of healing. For the convenience of your visitors, they can get snacks in the cafeteria from 7am to 8pm or get a soft drink in the vending machine in the lobby.

(It's a huge pet peeve of mine when VISITORS utilize nursing time requesting a soft drink for themselves, and more time is spent re-directing to where they need to go to get their needs met.

Once upon a time, the Patient Orientation booklet/binder may have been effective, but that was preceding Press Ganey and preceding a TV at every bed.

When "customers" are allowed to invent their own expectations, there is likely little chance of of achieving the lofty, unrealistic, or mis-aligned expectations.

Tell patients, family, visitors what to expect. As those execrations are met, the stated satisfaction will align. I don't see where hospitals are uniformly communicating to patients what expectations they should have - satisfaction scores will always fall short until expectations are first managed.

I brought a similar idea because we had so many teaching requirements on admission that real nursing was eschewed for something anyone could do. (And I'm not talking about health education matters. Really just setting expectations and orienting to the environment.) It fell on deaf ears.

[SouthpawRN]

Well I'm not going to lie for anyone, and where I go and what I do in my off time is none of the patient's business. My mantra is if you can't say something nice, don't say anything at all. This is one benefit of unions. Personally, I'd probably file an incident report stating that the hospital insisted I lie to patents and disclose my personal off work activities to them as well, and I refused to do it. I wonder how the joint commission and BON feel about RN's lying to patients on the order of their employer?

[Medic/Nurse, BSN, RN]

I wonder what suit thought this up?

A consultant that was paid way too much money to solve a "problem" they knew way too little about.

Basic nursing quality & healthcare improvement lackey.