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The Nurse Card

Going Off Script

Published July 25, 2016 10:00 AM by Diane Goodman
By virtue of a chronic illness, I have a dual perspective on healthcare. As an occasional patient, I am able to more closely understand both the provider and the utilization side of care. As a result of my experience, I have learned that bedside communication can be enlightening, perhaps representing a barometer of how a particular institution may be doing overall.

Does the staff seem stressed, stiff, or robotic? Do they ask the same questions over and over without appearing to wait for a response? Have you noticed they get to the doorway of a patient's room, ready to leave, then stiffen a bit as they ask, almost as an afterthought, if they can do anything else? I dislike this part of a hospital stay, because it tells me the staff has been trained to work from a script.

Many hospital systems, large and small, have adopted this practice.

Hospital executives and administrators initiated scripting plans a few years ago, when staffing cuts and budgetary constraints caused Press Ganey scores to dip. Nurses and support staff were given key phrases to say when entering and exiting patients' rooms, to make sure patients were given a chance to ask for bathroom breaks, pain medication, liquids, etc. The idea was to make them feel special, to make the whole "patient experience" above reproach.

Message boards were placed in patient rooms with information about their caregivers and pager numbers filled in around the clock. A few even filled in when the next medication and/or therapy session was "due" or included reminders about not getting up without asking for help.

These were excellent ideas, but what I loved most, as a patient, were the genuine moments of heartfelt sympathy and true conversation with my providers-the times when they saw me looking sad or grimacing in pain, and they took a few minutes to laugh or share a story. A few of my nurses knew I was an NP, but many didn't. Several stopped by just to chat about dogs or discuss family members who had experienced the same surgery. The glow in their eyes, the beautiful aura of human connectedness in those moments could not be faked. Their touch was magical, and I say that not just because I, too, am a nurse. It's because their true joy is in what they bring to the room, not what they say as they're leaving.

In fact, I saw a bit of the joy dissipate as they said words they were expected to say when they left. Not because they didn't want to know if I needed anything, but because they were going off their own script, and their hearts weren't in it. Some of the beautiful patina had already left.


Nursing has changed so much!! The ART of nursing is hard to practice at this time. I, for one, feel like a pill pusher. I'm constantly being asked what patients can transfer to another unit so I can get another one (I'm on a step-down unit). Most days I end up "seeing" or taking care of up to 6-7 patients between the patients I start with and then the ones I end with in a 12-hour shift. It is so very frustrating to me!! I would LOVE to spend more time practicing my art.

Lisa October 25, 2016 4:39 PM

Well said I agree nurseses don't want to be Robots either.too often we feel pressured to admit faster hurry up loosing time and money when all we are trying to do is be human and compassionate to our patients.

Jackie Goggin, Periop - Rn, Uchc October 23, 2016 11:18 AM

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About this Blog

    Diane M. Goodman, APRN, BC, CCRN, CNRN
    Occupation: Clinical Educator
    Setting: Advocate Condell Medical Center, Libertyville, Ill

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