By Debra Wood, RN, contributor
September 12, 2012 - As with many things in healthcare these days, scripting what nurses say to patients has popped up on the radar of hotly debated issues. It seems to have both pros and cons: on one side, it is seen as a way to improve safety and patient satisfaction scores, while on the other, it has brought about a rallying cry for nurses hoping to maintain their ability to sincerely connect with patients.
Jo-Ann C. Byrne, RN, BS, MHSA, finds scripting a good way to ensure everything that must be communicated is said.
“It creates a consistent message and also serves, in some instances, as a reminder to cover certain issues with patients,” said Jo-Ann C. Byrne, RN, BS, MHSA, system director, education and organizational development, at St. Vincent’s Healthcare in Jacksonville, Fla., and co-author of HCPros’s Scripting: A Guide for Nurses.
The book describes scripting as a tool to provide nurses “guidelines for handling given situations more effectively.”
Kathy Lattavo, MSN, RN, CMSRN, ACNS-BC, RN-BC finds scripting can help ensure everything that needs to be communicated is said.
Kathy Lattavo, MSN, RN, CMSRN, ACNS-BC, RN-BC, president-elect of the Academy of Medical-Surgical Nurses in Pitman, N.J., said scripting can serve as a reminder to ensure everything that needs to be communicated is said, but nurses can personalize the message.
But more recently, some health care organizations have embraced scripting as a way to improve patient satisfaction scores, planting in patients’ heads the words “excellence” or “safety” or “privacy,” by nurses taught to say those words over and over again.
Keith Carlson, RN, BSN, warned against scripting as sounding factory-like.
Keith Carlson, RN, BSN, a writer and nurse coach in New Mexico, referred to scripting as the “Disneyfication” of nursing care, after learning the theme-park giant offers customer-service consultation to health care facilities.
“On a certain level, it’s totally admissible to give nurses and providers some guidance about how to speak to patients,” Carlson said. That may include identifying oneself and his or her role and responsibilities. “But when it comes to giving nurses and providers a script in terms of exactly what they need to say to patients, it can create that ‘Stepford Nurse’ mentality.”
Carlson said such communication could become formulaic. He fears scripting will affect the “sincerity factor.”
“Patients feel they are getting factory-like care,” Carlson said. “Some semblance of spontaneity without following predetermined phrases is in everyone’s best interest.”
A focus on customer service
Consultant Michael B. Grossman, DM, MSN, RN, NEA-BC, CNML, in Philadelphia, on the other hand, said a need for scripting exists because nurses are not naturally good communicators and health care needs to become more focused on customer service. Waiters and hotel staff regularly use scripts and address customers by name.
“It’s not part of the nursing culture,” Grossman said. “We never learned the principles of customer service, because we didn’t have to.”
In the past, patients went to the hospital their physician recommended. Now they have choices.
“People want health care to be like other industries,” said Grossman, explaining they want the personalization and concern about the experience found at a fine restaurant or hotel.
“We don’t think this way as nurses,” Grossman said.
Scripting for better communication
Cole Edmonson, DNP, RN, FACHE, NEA-BC, said consistency of communication among providers can help prevent or diffuse difficult situations when patients have a sense of care, compassion, competency and courage.
All communication must be sincere, cautioned Cole Edmonson, DNP, RN, FACHE, NEA-BC, vice president of patient care services and chief nursing officer at Texas Health Presbyterian Hospital Dallas. If not, he added, it can actually diminish the caring therapeutic relationship between the nurse and the patient.
“Key words being consistently used by nurses in interactions with patients and families can help to create a sense of comfort for patients, consistency in care and communication among providers,” Edmonson said.
Monica Key, APRN, CCRN, RN, Norton Cancer Institute, and blogger for TheONC (TheONC.org), said that scripting offers many benefits to nurses. For example, “a new or shy nurse might be better equipped with this form of communication tool.” And “scripting can help with language barriers, cultural barriers as well with honest and crucial communication. If the scripting tool or model is evidence-based, this tool may also help to achieve better results for the health care team and patient.”
Key offered as an example the SBAR (Situation, Background, Assessment and Recommendation) tool for reporting situations to physicians and other providers.
Scripting for diffusing difficult situations
A script, having verbiage in mind, when dealing with a difficult family or patient can help the encounter go more smoothly.
“In situations where someone is uncomfortable or doesn’t know what to say or is trying to diffuse a situation, scripting is helpful,” Byrne said.
Monica Key, APRN, CCRN, RN, believes scripting offers many benefits for better communication.
Key agreed that scripting can help in those situations and may bring to light a sensitive topic the patient did not initially bring forward.
“Scripting can serve as a foundation for the nurse to build on as the conversation with a patient continues or grows,” Key said.
Key has provided her nursing team with role-modeling opportunities when they are uncertain about what to say next to a patient, family member or doctor.
“Many times this role-playing not only provides communication confidence and practice for the nurse, but also usually has a very positive outcome that the nurse is thrilled about,” Key said.
Can scripting backfire?
Yes, Key said she has seen scripting backfire when nurses have gone through the motions of communication but are not sincere, which the patient will pick up on. She said, “some things that give the nurse away to the patient are: no eye contact; a frustrated tone in the voice; a condescending tone; sighing frequently, also known as “huffing and puffing;” and/or body language.”
Edmonson added, “Actions and words must match. You can’t say to a patient ‘Is there anything else I can do for you? I have the time,’ while rushing out the door and expect it to be perceived as sincere and beneficial to the patient or the nurse. Expert nurses know this and do this intuitively, taking the time to create a true and honest connection with those they care for by making words and actions match.”
Patients must believe the nurse cares for them as a person, and they must connect as individuals, Lattavo said.
“Nurses should use the words that are comfortable for them,” Lattavo added. “Everyone saying the same words is not in anyone’s best interest.”
Rote verbalization of the same sentence, especially when it’s not natural, such as “to ensure you have an excellent stay,” also can be problematic. It can sound hollow.
“If everybody is taught to say the same thing and it sounds like a tape recorder, that is a danger,” Byrne said. “It gives the patient a sense that everybody is brainwashed. We say, ‘Here are the important things to discuss, but do them in a way that is comfortable for you.’”
Byrne encourages providing a script about what to cover at each patient encounter but giving nurses the option to say it in a slightly different way. It’s a way to keep patients informed.
“It isn’t something I talk about in terms of increasing patient satisfaction scores,” Byrne said. “If the patient feels attended to and all their needs are met, satisfaction will take care of itself.”
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