Scripting Nurses?

Nurses General Nursing

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I am an RN on a telemetry unit where the ratio is 7:1 at all times. We are technically the step down unit also. We get all of the d/c's down from CCU and ICU. Last week in our staff meeting, we were told there are key phrases that we are being required to say to our patients....much like scripting that sales and telemarketers use... Things like "I have the time for you" each time you are in the room with every patient. Does anyone else think this is a joke? I told my manager I refuse to be scripted...I don't have the time for this and I think I provide the best care I can for my patients. But most days each nurse has 3-4 discharges, and gets 3-4 patients back, either direct admit from the MD's office or from the ER. Anyone else having this problem?

The management means well with scripts. However it generally raises more problems then is solves because scripts do not fit all situations with all people.

I think I may have goofed. In my annual performance review I had to do a self evaluation. In it I casually mentioned that I ask a patient, "is there anything else you need before I leave." NOW we are being directed to use that phrase everytime we leave a room. THAT is a major mistake. Mangement aparently liked that I do this. So now they think everyone should do it all the time. I do not do it all the time, is is not appropriate all the time nor with all patients.

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Specializes in Utilization Management.

On a similar note, I got such a lengthy script read to me from someone in another business (I think it was my cable company), that I was waiting for about 3 minutes for her to finish. It went something like, "Good day to you, Mrs. O'Plasty, and welcome to the Local Cable Company call center. We welcome your call and thank you for doing business with our company. And how may I provide excellent service for you today?"

I was so stupefied at that when all I really expected was "Hello, this is Shania, how may I help you?" that I was unable to speak for a couple of seconds, then blurted, "Wow, honey. They make you say ALL that? Incredible!"

She stifled a giggle, so I continued, "Do you guys realize that I'm calling from a cell phone during peak time? So your lengthy little scripting is actually costing me money? Can't you cut to the chase with a simple 'hello, may name is ___ ?"

The next time I called, they didn't have to say all that. Thank goodness. So maybe a few patients need to speak up and tell TPTB what they tell us: "We know you're busy and we see you running your buns off and why don't they have more help?"

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I was taught to provide appropriate, kind, and compassionate nursing care to my patients. This includes prioritization. The reality is, I might not have time to get you a cup of fruit punch right now. I might need to go into the room where I hear grunting and make sure that someone is not ready to deliver their baby unexpectedly. I am not a minimum wage telemarketer. I am a professional. I don't need a script written for me by some PR person who wouldn't touch a patient w/ a ten foot pole to do my job well. Just another example of someone sticking their nose in to manage another dscipline they know nothing about. Healthcare and nusring are stressful enough, let's get admin. to help us by adding some more ridiculous fluff and not fixing the problems by getting some more qualified staff in place.

Give me a break. I have told patients before, "it is very busy tonight. If you need me, please put your light on. If I don't come, especially if it is urgent, please call again right away or send your family out to the desk." I have never had a patient complain that I was rude to them, EVER. I think in great part, it is due to luck. Some patients do complain, no matter how good the staff is to them. If management knows you are a good nurse, then they should stand up for you.

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Specializes in Nephrology, Cardiology, ER, ICU.

At the hospital where I used to work, they use scripting too. The "I have the time for you" was what we were to use every single time we encountered a patient. It got to be ridiculous. We'd be doing CPR and muttering under our breath "I have the time for you." This got to be stupid and I too refused to do it.

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Specializes in Cardiac, ER.

We've tried many "scripts" were I work,.most last a few days and no one uses them for all of the reasons listed in PP,..it is especially rude in my oppinion for a pt to spend 3 days or weeks in the hospital and hear the exact same words from every nurse that walks in the room!! The words, no matter how well meant, sound reheorificed and robotic when everyone says them!

I have recently transfered to the ED and durring my "ED orientation" last week we had a meeting w/ the "pt care coordinator". It is her job to listen to all the complaints "and find a way to make these pts happy". She said that one of the biggest c/o of pts in the ED is that they leave feeling every bit as bad as they did when they came in, then a week later they get a huge bill and feel that nothing was done. The example she used,. Friday evening 35yr male to ED c/o cough, runny nose, sore throat,.was seen at our sister hospital Urgen Care on Tuesday,.has the dc papers with him,.they did a strep screen (neg) a CXR (WNL) CBC (WBC 22) and blood cultures. He was told he had an upper resp infection, given RX for antibiotics, an excuse for work until Thursday, increase fluids etc. He says he is no better,.
RN
asked if he is taking his antibiotics (I've only taken one,.couldn't afford to fill the RX until this morning"),...okay we see this guy,.he insisits that he is "worse instead of better",.they repeat everything the Urgent Care did (at twice the price) get all the same results,.tell the pt to cont his antibiotics, increase his fluid intake, rest etc,..a week later when he gets his bill (twice of what Urgent Care was) he is furious,.WE didn't do anything that hadn't already been done,.why should he have to pay for it!!!!!! The Pt Care Coordinator's answer to this was that maybe his "perception" of care would have changed if we started an IV and given him some fluids and changed his antibiotic "simple things" she says!! If the Dr seeing him doesn't want to do that,.perhaps we should talk with our charge nurse and see if another DR will see this pt and give him what he wants!!! HELLO???? What is wrong with educating this pt re: taking meds as prescribed, follow the dc instructions, we don't have a "fix all, cure all pill" that will make everyone miraculously "feel good" an hour after taking it!!!! Then the guy has the nerve to say "when I went to my Family Dr on Monday he said it was probably a virus and would go away in a few days w/out treatment, so I didn't need all that stuff anyway!" AAARRRGGGHHHHHHH!! Ok,..I'll get off my soap box,....what do you do???

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Specializes in Critical Care,Recovery, ED.

I am not totally against scripting providing you are telling the truth to the patient and that you are not building expectations in your patients that the nursing staff can not live up too. The real problem here, at least in the OP place of employment, is a 7:1 patient ratio on a telemetry and step down unit. IMO the scripting bit is some admin's try to gloss over and cover this unacceptable ratio up.

Just a question why aren't the nurses protesting the ratio as oppossed the scripting.?

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Specializes in Tele, ICU, ER.

I hate scripting as much as the next person, without a doubt. That said, though, I have to wonder sometimes. What scripting does is force basic politeness and professional speach in those that don't do it naturally.

I am a second career nurse, a non-medical secretary from my army-days at age 19 onward. It comes very naturally to me to answer a phone with "XXX Emergency Department, this is Emernurse, how can I help you?" Just spills off my tongue. Guess it's easy compared to the "Deputy Chief of Staff for Information Management, This is SGT Emernurse, how may I help you?" that I USED to have to say LOL.

So very often I hear people answer the phone "ER!", no matter how many times they've been asked not to do so.

I never ever use the ACTUAL scripted lines they hand me. I think they're silly and robotic. But I do generally express the same ideas in my own words - and they sound like I MEAN it (which I do most of the time). I've never had a problem.

Where did I learn to speak this way? Hell if I know. But I think it's a skill that's lacking and everyone can use. I just don't know that scripting is the answer to teaching it. Funny, I was required to take a communication/speech class as a rereq before nursing school and never once did the subject of professional communication come up. It was all about overcoming the fear of speaking in front of others, which I never had (being a big mouth I-talian anyway).

Just my thoughts.

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I hate scripting as much as the next person, without a doubt. That said, though, I have to wonder sometimes. What scripting does is force basic politeness and professional speach in those that don't do it naturally.

I see what you are saying, but I feel that the impolite person is isolated. The rushed person who doesn't know if there is time for them to take another breath is the problem. I really think the answer isn't to give someone a canned spiel to rattle off, but to fix the cause of the problem. Many times, the cause is not enough staff or no one to specifically answer the phones, etc. If you fix the cause, then you fix the problem. Giving a person who has 10 patients to care for a little speech to give when they run breathless down the hall to answer a phone and a scolded for not getting it on the second ring is garbage. I am not ragging on you. I think people should make every effort to be polite, I just don't think it is always the real problem. It is a lot easier for someone in PR to fix a problem by conjuring up a speech to give and think the staff is simply rude, than for someone in admin. to admit that there are not enough staff and the facility needs to pony up w/ some cash.

I refuse to lie to patients. The "I have time for you." is often simply not true. Part of it may lie in what I believe about nursing. We are here to work with patients, not to serve them like servants. That is not because we are lazy, it is because self-care is the goal of nursing to the greatest extent to which it is possible. Part of our job is to get that patient back to self sufficiency to the greatest extent possible. I have spent many hours working past my shift to chart, etc. because I have had many patients w/ many priority needs which I needed to work to meet. When at all possible, I try to spend a lot of time talking to patients, but there are those times when I am stretched so thin that I just can't spend prolonged periods providing niceties or extras to patients. I feel that over and over again, we have people in charge of facilities who have no idea or appreciation of what goes on at the bedside. They try to provide extremely simplistic solutions to very complex problems, because their level of understanding is just not there. I also get annoyed by facilities who build incessantly, pay for elaborate landscaping, advertising, Press-Gainey type surveys, and then cry the blues that they can't pay $ tohave adequate staffing. They don't know how to prioritize IMHO.

BTW emerg nurse I think most nurses do have great interpersonal skills like you do!. You are probably very nice to work with!

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Specializes in OR, transplants,GYN oncology.

unbelievable....

one of the things have always liked best about nursing was the ability to inject my own personal style into my care. not to mention that one of the things that distinguishes rns from some other caregivers is our ability to assess patients. that includes determining the appropriate style and level of communication for a specific patient.

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Specializes in L & D; Postpartum.

They're hinting strongly at it where I work. I have, for 30 years, asked as I prepared to leave a room, Is there anything else I can do for you right now?"

And I ask that question from the heart. NOW, it sounds hollow and fake.

And even if you do say all those pat little phrases, there's no guarantee that the questioned patient will remember you said it, will admit you said it, or whatever. No guarantee whatsoever. Where does the "he said, she said" principle come in.

Right now, our managers are even scripting: when a staff nurse is about ready to blow, their phrase of choice is "take a deep breath." Now when you hear that one time, it's okay, good advice. But when you hear it all the time, and everybody hears it all the time, and all the managers in the entire place are saying it to their staff members, then you start to smell a rat and you realize that instead of doing something about the problems, they are going to instruct you to take a deep breath (and then dive right back into that unsolved problem.)

I am so happy that I'll be getting out of this in a couple of years. I'm scared for the future of nursing and health care to be honest. Nurses are not being allowed to do nursing care.

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Specializes in Tele, ICU, ER.

Imenid - I'm sorry if I gave the impression that 99% of the nurses I work with are not polite. QUITE the opposite. Sad to say though, it only takes one with a bad attitude to bring the almight administration down on everyone in the form of Press Ganey, Scripting, Inservices aimed at one person but mandatory for everyone (because management would rather not confront the problem person).

My comment about not understanding how to come off professionally and polite was based on the assumption that the 1 or 2 % who DON'T sound nice, sound that way because they don't realize it, NOT because they're miserable schmucks.

Oh and hey - anyone had their managers give the "thank you John", thank you Mike", "thank you Sue", thank you Bonnie" end-of-shift management script? I HATE that one.

Hope I clarified myself - sorry if I wasn't clear - tired.

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Our pt satisfaction survey has a question regarding how satisfied the pt was with the nursing care during their stay. The pt rates from not satisfied to extremely satisfied. So we have been asked to say to each pt..."I want you to be extremely satisfied with your care."

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