Scripting Provides Firm Bedrock for New Nurses

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It was not an auspicious arrival in San Diego for the annual conference of the National Nursing Staff Development Organization. I arrived last Wednesday (July 7) just in time for a 5.4 earthquake.

I must confess that I didn't feel the earth undulating beneath me, which disappointed me greatly when I later watched the news reports and saw items falling off shelves and swimming pools sloshing.

But the earthquake proved to be an interesting metaphor for the graduate experience, which was greatly on the minds of the nursing professional development specialists attending the conference.

We discussed the difficulties new nurses face in their first job as they deal with the transition from nursing school to practice. Considering all the competing demands on their time and the pressure they experience, they can feel like the ground is moving under them as they struggle to keep their footing.

With that in mind, our conversation turned to scripting.

Some nurses and administrators recoil at the term "scripting," envisioning robotic intonations of "Have a nice day!" and fearing the loss of personalized interactions.

Those who have already tried it, however, know that scripting enhances—rather than stifles—communication, ensures consistency in practice, and arms nurses with tools to handle difficult conversations with patients, peers, and physicians.

Scripting is best known in customer service iterations. If you don't like the idea of scripting, one of the staff development professionals in San Diego noted, eavesdrop on some of the things nurses say to patients. Staff have their own scripts and they say the same thing day in and day out, much of which is not the message you want delivered to patients.

Some people instinctively know how to greet people, identify themselves, and provide clear and concise explanations that build relationships with patients. Many do not. And new grads are often so focused on trying to remember the technical steps of patient care that the last thing on their mind is explaining what's going on for the patient.

A script with language cues helps standardize the experience and ensures patients are comfortable. A common example lays out the steps nurses should take when entering a room, including:

  • Acknowledging the patient
  • Introducing themselves
  • Stating why they are there
  • Explaining the process
  • Thanking the patient

Scripts for such interactions can be developed through conversations with nurses. Role play and get everyone involved so they work for the unit's patient care environment. Encourage nurses to practice so they remember the steps and so they can customize parts to their natural style.

Scripts have far wider use than just improving customer service-type interactions. One of the events that strikes fear into a new grad's heart is calling the physician in the middle of the night. These conversations often go something like this:

Nurse: Sorry to wake you Dr. Smith. It's Nurse Jones over at St. Somewhere Hospital and I'm calling about Mr. Williams. He's complaining of pain and we haven't been able to relieve it with the medication you ordered.
Physician: What are his vital signs?
Nurse: Hmmm, they are right here. No, actually, they haven't finished taking them yet.
Physician: When did he last have pain medication?
Nurse: Let's see. It was right before I arrived for my shift, so it's been about two hours.

A crude example, but you get my point. New grads can benefit from practicing these calls so they know what information to convey, and the best way to convey them to ensure the conversation proceeds well:

Nurse: Dr. Smith, it's Nurse Jones over at St. Somewhere Hospital and I'm calling about Mr. Williams. He's complaining of pain and we haven't been able to relieve it with the medication he has ordered. His order is ____. His vital signs are ____. The pertinent information you need to know is _____. I'd like you to _____.

With preparation and a script to follow, the conversation goes smoothly and all sides are happy.

Develop scripts for difficult conversations with patients, for confronting hostile peers, or for improving the way information is shared at report. Scripting arms nurses with tools so they know how to act and how to respond in difficult situations. Including scripts in graduate orientation ensures new nurses have a stable footing.

Written by Rebecca Hendren