Flip the Script

Premier Nursing News

By Michele Wilson

One thing we hear when we ask for feedback about Hourly Rounding®, Employee Rounding or Nurse Leader Rounding is that professional caregivers don’t want to “sound like robots” or follow a script. Some individuals went so far as to say, “You expect us to sound like waiters at Applebee’s.” That statement made me curious, as the goal of these initiatives is not to diminish the role of the professional nurse or other care providers. The statement did make me wonder if using key words, which some call scripts, is unprofessional or robotic.

The patient experience site managers and I participated in validations of hourly rounding on several units at Miami Valley Hospital. We validated several staff (nurses and PCTs) on every shift, including weekends. Nearly all of the staff we observed said things like, “Are you comfortable? Do you need anything? How’s your pain? Do you need to go to the bathroom?” Before they left the room, every staff member said, “You have your call light so call me if you need anything.” In addition, they all stated, “I’ll be back in a little bit to check on you.” Despite the fact that so many of us claim that we hate “using scripts,” they were all using a script. The words were consistently used with each and every patient upon entering and exiting the room.

I would suggest that these are ineffective scripts as evidenced by our survey results.

We can provide better safety, quality outcomes, and service to our patients if we FLIP THE SCRIPT! More accurately, we will keep our patients safe and get better quality outcomes if we commit to using evidence-based key words at key times. It is difficult to change habits and what we say as we enter a patient room, “just checking on you to see how you’re feeling” or leaving the room, “I’ll be back in a little bit to check on you – call me if you need anything” are habits that some of us have created over the years.

Our patient communication will be more effective when we FLIP THE SCRIPT.

Instead of Saying: When you are: Flip the Script
“Just checking on you to see how you’re feeling” Entering the room “It’s been about an hour since I’ve been here and I want to do hourly rounding with you.”
“How’s your pain?” Doing the 8 key behaviors “It’s important that we manage your pain and keep track of your pain goal. I gave you [medicine] about an hour ago. What have you noticed about how it’s working? Can you tell me what side effects I discussed when I gave it you?”
“Are you comfortable?” Doing the 8 key behaviors “It’s important that we keep your skin safe while you’re here. One way to do that is to frequently move your position to keep you from getting bed sores or rashes. Let’s do that now to protect your skin and keep you comfortable.”
“Do you need to use the bathroom?” Doing the 8 key behaviors

“You’re getting Lasix and remember, one of the effects of that medication is frequently using the bathroom so that your swelling and edema is under control. Let’s go to the bathroom while I am here.”
“It’s important that we keep you safe from falling while you’re here. I know falling is a risk for you so I want to be sure to help you when you get out of bed. I’d like to help you to the bathroom now to be sure you get there safely.”

“Do you need anything?” End the round “What else do you need right now? I want to be sure you have what you need for the next hour until I come back.”
“Here’s your call light. Call me if you need anything” Leave the room “Here’s your call light. It’s for your safety which is very important to me. If you feel unsafe or have an emergency, call immediately. Otherwise, I will be back in about an hour for any other needs you have.”

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