Relationship based care/Playing the game

sharlynn · Nov 21, 2007

The three P's? You have time to do this hourly? I think I'm in the wrong job!

Hellllllo Nurse, BSN, RN · Nov 21, 2007

My hospital is trying to obtain magnate status. They have hired the Studor Group as a consultant. At the same time another consultant is teaching us relationship based care. Some of the things they have us doing are wonderful, but the projects as a whole leave us with odd feelings. It feels like a game we are being forced to play. They are trying to improve patient satisfactions scores by scripting everything that we do. It all feels very fake. To increase patient satisfaction scores, patients must give us an "Excellent" rating. If they use any other word except "Excellent" our satisfaction scores drop. We are taught to throw the word around throughout our daily routines. It almost seems like we are brainwashing the patients. We do things like hourly rounding when you ask the patient the 3 P's. Do they need something for pain. Do they need pottied or positioned? It all sounds good on paper, but I'm not sure it really gets done. There are numerous other scripted things that they have us doing. We recently started our Primary Care Nursing project. It does not seem to be working very well. They just keep telling us "it works, because other hospitals are doing it." Is anyone else familiar with these concepts and is it really working in other hospitals.

Oh, I don't think I could deal with having to do that stuff. Being real and authentic is very important to me. It makes me feel a litttle physically ill just imaging having to recite all that to pts.

It's a sad day in health care when survey results are more important than pt outcomes. It sounds like this is what is happeneing in this situation.

When you ask the three p's , if a pt says yes, they want something for pain and they need help to go to the bathroom, that's 15 mins right there. If just one person says yes, that screws up the hourly rounding schedule. Does someone else take over your hourly rounding, then? :uhoh3:

luvschoolnursing, LPN · Nov 21, 2007

Would you like some of our EXCELLENT pain medication?

Would you like to use our EXCELLENT potty?

Could I help you get into an EXCELLENT position?

I need you to sign this EXCELLENT advance directive.

Don't you think this is an EXCELLENT place to spend Thanksgiving?

:uhoh3:

Sorry, I just woke up and this stupid idea just tickled me. :lol2:

Forgive my sarcasm.

dekatn · Nov 21, 2007

We started the same thing a couple of months ago. Supposed to cut down on call light use etc. Yeah, sure. We do our best to do the hourly rounding, I work nights, at ten we start every two hour rounds. Pt. complain about being woke up every two hours when we enter the room as we are disturbing thier "excellent" sleep. As far as the scripting, I never was one for letting other people put words in my mouth. I loved the one about, " is there anything else I can do for you, I have the time". We have to sign a paper hanging up in the room every time we go in there, funny, none of the other staff has to, resp, is in and out all night long, have yet to see them sign the paper. They told us the same thing about the scores dropping if we didn't get an excellent on customer service. All I can say, is so be it, you can't please all the people all the time and some of them never. So, I just keep on keeping on and doing the best I can, which is what I have always done, and if we get an excellent score fine and if we don't fine. The public expects too much from health care, they come in very sick, because we all know only the sickest people are hospitalized now, they expect to have surgery and be 100% pain free, expect to be "fixed instantly of any thing that is wrong" and get po'd if magic doesn't happen. Expect infections to "disappear" after one dose of ABT. Same ole same ole. This Studor thing isn't going to change people, it's just going to make us look bad again.

EmmaG, RN · Nov 21, 2007

Would you like some of our EXCELLENT pain medication?
Would you like to use our EXCELLENT potty?
Could I help you get into an EXCELLENT position?
I need you to sign this EXCELLENT advance directive.
Don't you think this is an EXCELLENT place to spend Thanksgiving?
Sorry, I just woke up and this stupid idea just tickled me.
Forgive my sarcasm.

Post one of these in each room LOL

FireStarterRN, BSN, RN · Nov 21, 2007

My hospital is trying to obtain magnate status. They have hired the Studor Group as a consultant. At the same time another consultant is teaching us relationship based care. Some of the things they have us doing are wonderful, but the projects as a whole leave us with odd feelings. It feels like a game we are being forced to play. They are trying to improve patient satisfactions scores by scripting everything that we do. It all feels very fake. To increase patient satisfaction scores, patients must give us an "Excellent" rating. If they use any other word except "Excellent" our satisfaction scores drop. We are taught to throw the word around throughout our daily routines. It almost seems like we are brainwashing the patients. We do things like hourly rounding when you ask the patient the 3 P's. Do they need something for pain. Do they need pottied or positioned? It all sounds good on paper, but I'm not sure it really gets done. There are numerous other scripted things that they have us doing. We recently started our Primary Care Nursing project. It does not seem to be working very well. They just keep telling us "it works, because other hospitals are doing it." Is anyone else familiar with these concepts and is it really working in other hospitals.

I thought magnet hospitals were supposed to be places where nurses WANTED to work? This sounds like working at Safeway... :rolleyes:

happydays352 · Nov 21, 2007

Post one of these in each room LOL

I love it! You just made my day:lol2:

llg, PhD, RN · Nov 21, 2007

If one more check-out person at the grocery store asks me, "Did you find everything you needed today?" I think I'll scream. It's obviously a scripted line they are forced to say to every customer. PI am tempted to give them smart-a**** comments back, but I know it's not their fault that they are forced to ask the exact same question every time.

Really, this whole "scripting" idea is ridiculous. It's a good idea to suggest some possible lines that people can use when they check on a patient, etc. -- but the nurse should always be allowed to personalize it and/or use a little judgment to be sure that what he/she says is appropriate for the specific circumstances. Some people are shy and can use a few suggestions to get them started. But that's a far cry from forcing a specific script.

One more thing to drive good people out of nursing.... another "excellent" idea mutilated beyond its usefulness.

funinsun · Nov 21, 2007

I agree with everyone's sentiments regarding this push for 'excellent' care.. This particular push has not helped nurses at all but just provides the hospitals with more ground to put increased burdens on their hourly workers. I have to give the children (even 5 years old!) and childrens' parents discharge surveys that rate from "Excellent to Poor" and we are too given a script where we repeat "Excellent" at least 5 times before handing it to them. If they don't give us an 'Excellent' on one of the areas we have specific staff meetings regarding why that didn't happen with that patient, etc. This is at a children's psych facility where on any given day where they can be involuntary and they may have not liked the food, felt upset about having to go to groups, having a bedtime, :uhoh3: etc. and our answers can be pretty bad! I view it as comedy now..

They post the results of the surveys (by the month) on the back of the bathroom stalls-you can't get away from it!haha

BBFRN, BSN, PhD · Nov 21, 2007

you think it's bad now...wait til you have to start making all those 'excellent' calls to your patients a few days after they are discharged home. That's another Studer Group brain child.

Health care just continues to get dumber and dumber. Try making the docs do these things, and see how that would pan out.

EmmaG, RN · Nov 21, 2007

you think it's bad now...wait til you have to start making all those 'excellent' calls to your patients a few days after they are discharged home. That's another Studer Group brain child.

Yup, been there, done that. It didn't last, however. The nurses pretty much revolted--- expected to make follow-up calls on every patient they discharged (even those who had died) with no allowance made to accommodate this re: their workload. Uh uh.

So they contracted it out to a some survey company. They called me after my daughter had emergency surgery to repair a completely ruptured patellar tendon. Asked me about the room and food and whatnot. Then asked if I was happy with my decision for her to have surgery and in hindsight, given my experiences in the hospital, would I still have consented. My answer was that considering it wasn't exactly an elective surgery and she wouldn't have been able to walk again without it, yeah I suppose it made me "happy" :trout: