Ashley, a 10 veteran nurse who had recently been chosen Nurse of the Year, listened attentively at the mandatory staff meeting where her manager, Crystal, was introducing nurse scripting.
Crystal explained that when discharged patients received a patient satisfaction survey, they had the option of answering questions with “never,” “sometimes,” “usually,” or “always”.
For example, one question is “During your hospital stay, how often did nurses explain things in a way you could understand?” The only acceptable answer is “always” as the “always” answer translates to increased reimbursement.
She further said that since the hospital wants patients to choose the answer “always”, it was decided the best way to do this was through the repeated use of the word “always” by staff.
It was believed that repetition of the word “always” would make the word stick in patients’ minds. It would later then cause them to select the word “always” on a survey.
“We always want to meet your needs”
“We always want you to sleep well at night”
“We hope you will always recommend our hospital”
Ashley looked over at her friend Jason, shook her head, and mouthed “Noooooo….”
Proponents say that scripting increases consistency of the message in a workforce of size and cultural diversity.
Deena Sowa McCollum, an RN of 22 years says “Five years ago I would have told you it seemed “fake” or “rehearsed”. Today, I see the value in it. It helps new nurses and unlicensed (aides etc) who may not be confident communicators…
I think SBAR is a form of scripting we have found to be beneficial in many ways.
I have found amazing value in the use of AIDET (Studor). Patients are more informed, call bells are less, etc.”
Who can argue with Deena’s scripting suggestion at change of shift, “Mrs. Jones, we are about to start shift change and this could take 30-45 minutes. Is there anything I can get you or do for you before we start (pain med, water, bed pan, etc)” If I was Mrs. Jones, I would love it.
(Deena wrote this as a comment in Confident Nurses, a leading blog by Beth Boynton that focuses on nurse communication and current healthcare topics).
Other nurses say that rote verbalization is insincere and robotic. “I feel like a Stepford Nurse“.
Keith Carlson, RN, BSN, a writer and nurse coach in New Mexico, calls scripting the “Disneyfication of nursing” after the theme-park giant that also offers customer-service consultation to health care facilities.
A nurse who chose to remain anonymous said, “I feel like a poser, like I’m manipulating my patient when I have to say “always” or keywords I wouldn’t normally use. And it’s not about the patient, like it’s cracked up to be-it’s about reimbursement. I hate it”
But what if we gave patients exactly what they want- a human connection, and caring? Patient satisfaction scores would then take care of themselves. PACU nurses are naturally skilled at this. They prep nervous patients before surgery, put them at ease, and help them to feel safe. PACU nurses are natural, unrehearsed, and effective.
Maybe it doesn’t have to be one or the other- scripting or not scripting. A hybrid could be effective, along the lines of Deena’s change of shift scripting, combined with a sensitivity for what the patient needs, and caring. The human touch.
Yes, get certain messages across to all patients, consistently, but deliver those messages in a natural, compassionate manner.
What are your thoughts? Does scripting help your practice and patients? Or does it feel wrong to you?
Until next time friend, and in the meantime I hope you will always recommend my blog to all of your friends.
You can also come visit me at Ask Nurse Beth career column at allnurses.com for all kinds of entertaining and informative career questions and answers, and to submit your own question 🙂