Scripting sounds patronizing

psu_213, BSN, RN · Jun 30, 2015

We had a doctor who was quite angry about labs not being sent in a timely manner. The nurse said (in her most sympathetic/pathetic/patronizing little voice), "Dr. Smith, I can see that your upset..." There was going to be more the nurse's message, but the doctor cut her off, "you can see I'm upset? What is that supposed to mean? Quit trying to patronize me and just go do it!" The doctor could have been more polite, but it shows you where the trite Nurses 101 communication lines can go with colleagues.

OCNRN63, RN · Jun 30, 2015

I recently went toe to toe with a new grad who had made a mistake in judgement, was passing the pt off to me in report, and I pointed out her mistake and tried to correct her. Let me preface this anecdote by saying, I'm normally very mellow with the new nurses, I definitely don't relish putting them in the hot seat.
She became very argumentative. But, what really then infuriated me was that she then pulled out some scripted, active listening lines on me. "I'm hearing what you're saying" and crap like that. Yeah, Pumpkin, I took the same classes way back when, you aren't helping your cause...
I said "So now you're patronizing me, eh?". Arrogant little brat.
Lesson for the allnurses audience? Don't pull out that scripted nonsense on your coworkers, or actually anyone with an IQ over 100 for that matter. That's my advise for the day...

Right up there with "I'm sorry if you thought I was rude..." and any other apologies that contain the "if" clause. If I was already mad to start, when someone pulls out that crap I'm likely to get madder still.

mirandaaa · Jun 30, 2015

One thing I learned is that if anyone adds "but" to something, everything they previously said is invalid.

"I'm sorry, but..."

"No offense, but..."

"I'm hearing what you're saying, but..."

"I can see you're angry, but..."

Etc.

brownbook · Jun 30, 2015

No, you don't use scripting where there is an actual, acute, "real" problem. "You didn't notify the Dr. or decrease the insulin drip" is not the time for "I'm hearing what you are saying" it is time for either "Yes because blah blah blah"....or "you're right I should have."

'I'm not getting my lab results soon enough" is not the time for "I see your upset" it is time for...."I will talk to the lab supervisor and find out why you are not getting the results."

Scripting is fine for talking things over after the fact with friends or in therapy.

pre-nurseshan · Jun 30, 2015

Yikes! The only thing is, scripting and active listening can become second nature, especially when a person is stressed. I can see how the particular script she chose was inappropriate in the context, but maybe that's just the way she talks?

GuEsT78 · Jun 30, 2015

I agreed. Scripted responses in any context can be infuriating. It's like they're not listening to us or that we are being treated like a little child.

When I call the help line for a major company or query them with an email, the response is often a canned line about my feelings. I'm left wanting to point out that I don't care about those feelings, particularly the implication that I'm an emotional mess, I just want the blasted problem fixed. But we should keep in mind that for some people these lines, canned as they seem, do work.

Years ago, when I worked at a group home, one mostly for drug addicts and alcoholics, we occasionally got calls from people with emotional issues. One was from a guy who seemed to have a personality that invited teasing. He'd take a job and get teased. Rather than take it lightly, which would end the teasing, he became upset. Matters would get worse and he'd finally be laid off. It was easier to get rid of him than all his teasers.

When I tried to point that out to him, suggesting he lighten up and laugh along with the teasing, I go nowhere. He finally calmed down when I made the rather trite statement, "You must be very upset about this." With that, his anxiety bubble deflated. His problem wasn't solved, but he did feel better.

Keep in mind that for some people, their feelings are at the center of their lives. These canned lines, irritating as they are with us, do work with them. That's why people learn these responses. It's why classes teach them. They do work in some cases.

What's smart is to be able to tell the difference between those who need their feelings soothed above all else and those who simply want a problem corrected. Don't use a technique that works with the former person with latter or vice-versa. It will backfire.

------

Ditto for another issue other posters brought up, the non-apology apology. It's one that hints that the real problem rests with the person offended rather than the offender. "I'm sorry that you became upset that I riffled through your purse, taking all your money."

-----

Alas, not all clashes stay verbal. I worked for a time as the assistant director a homeless shelter in Alaska where upset people can become dangerous in an instantâ€”think knives suddenly appearing. In general, the best rule is to stay calm yourself and be clear and directive without being bossy. Avoid arguments. Reason isn't what they are looking for. Avoid attempts to manipulate. Strange as it seems, crazy people can be very good at picking up on psychological tricks. If they're paranoid, they expect them. Also don't become macho or threatening. That can just provoke people who may already tilt toward violence. Simply stay calm and tell them over and over what they must do. "No, Mister Jones, you cannot just walk out of the hospital. You must go back to your bed."

And yes, sometimes you need the muscle of security staff. Getting it on hand quickly makes excellence sense. Usually the person who must deal with an out-of-control person has their hands full, so if you see staff in a touchy situation, call security for them. You might want to meet security at the entrance to the unit to let them know what is happening. They'll almost certainly know what to do, but take care not to escalate to force if it can be avoided. If security wants to stay out of sight until needed, you'll know where to place them. You might find a way to convey to the nurse in the confrontation that they're there.

Once, I had to force a guy to leave that Anchorage homeless shelter. I'd sensed that he had a dangerous hostility that might explode at any moment. I asked him to step outside and calmly told him that he needed to leave. I refused to argue about the why. He pulled out a razor-equipped case cutter and held it up threateningly in my face. My first thought was, "Hey, you've just proved that my judgement about you was right. You must go."

I stayed calm, in part because he was so drunk, I figured I could protect myself with my arms faster than he could slash at my face or neck. But what really helped me stay calm was that a large, husky member of our staff who, on his own initiative had followed me out and was crouching directly over the guy, his arms stretched out to grab. I knew this unstable guy would only get a short interval to act, after which he'd be flat on the ground pinned down. That helped me stay calm, focused, and insistent at telling this guy he had to go. And in that case it worked.

-----

One other suggestion. When possible, get the results you need without triggering a confrontation.

Once, at report for night shift, the evening nurse told us that she'd become convinced that the father of a child in one multi-bed room was leering at the little girls there. Rather than make that the issue, which would have become very explosive, she achieved the needed result in another way. The room was crowded with four cribs/beds, and wasn't intended for parents to stay with their kids. She created a quasi-rule and insisted that parents weren't to stay in the room more than briefly. (Fortunately, no other parents were around at the time.) That forced him to leave, which was what mattered.

She'd make a good move. Calling him a "dirty pervert" and bringing in security armed to the teeth would have created no end of trouble. Don't create unnecessary conflicts when you can get the same result more diplomatically.

--Michael W. Perry

Been there,done that, ASN, RN · Jun 30, 2015

New grad was called on the carpet. I agree being argumentative was wrong/did not help the learning experience.

She fell back on a quite new (for her) method of communication. At that point, she was conceding the "argument".

You should have been gracious and let her.

Emergent, RN · Jun 30, 2015

Oh, she never conceded anything. She was absolutely certain she'd done the correct thing. She continued to argue her point, obviously trying to pacify me with empty platitudes.

KatieMI, BSN, MSN, RN · Jun 30, 2015

We have to, for many reasons, cooperate with acute care hospital that enforces scripting to the point of no return. Patients who come from there often comment about how patronizing, unpleasant and, at the end, directly stupid it all sounds. Isn't scripting supposed to be invented precisely with the opposite goal, i.e. pleasing "customers", in mind?

My absolute favorite is "Do you want to do... for me?", meaning asking me to do something this person is actually paid for to do, like mix contrast or even move X-ray machine. Normally I will help if I can, but only when I am asked politely and using normal human language. It is kinda funny to see shock and awe caused by mine "no, huney, I do not want to do your job".

Emergent, RN · Jun 30, 2015

I hate it when people say "Do want to..." . I didn't know it was scripting, I thought it was just lacking courtesy. When people ask me, I'll say "Well, no, I don't want to, actually. I would like to win the lottery though"

psu_213, BSN, RN · Jun 30, 2015

One thing I learned is that if anyone adds "but" to something, everything they previously said is invalid.
"I'm sorry, but..."
"No offense, but..."
"I'm hearing what you're saying, but..."
"I can see you're angry, but..."
Etc.

Exactly...that person is basically "I'm not sorry" or "I mean to offend you." The one that really gets me is when people end a statement with "just saying'," as if this excuses an inflammatory or rude statement.