Issue link: https://nnumagazine.uberflip.com/i/117874
RoseAnn DeMoro Executive Director, National Nurses United This Is a Hospital, Not Disneyland How nursing scripts and patient satisfaction surveys project a fantasy of care, not real care ��� H ello, Mr. Smith. My name is Joanne. I am your nurse. Are you experiencing any pain today? No? That���s good. Do you need help getting to the bathroom?��� (check script) ���Can I fluff your pillow, bring you a magazine, turn on your TV, move your water bottle closer?��� (check script) ���I am so happy to be of service, this is all part of the excellent care we provide here at Happy Homes Medical Center and Resort.��� ���We know you have choices when you go to the hospital, thank you for choosing Happy Homes.��� (check script) ���You will be receiving a survey��from us after you leave Happy Homes, and I hope you will remember this excellent service when filling it out. Have a nice day, Mr. Smith.��� If this scenario seems far fetched, you���re probably not a nurse who has worked in a hospital recently. Strict adherence to scripts derived from exorbitantly paid consultants like the Studer Group and Press Ganey for every interaction between the RN and her patient is increasingly a job expectation. Can���t recall it all? Not to worry, the hospital will provide acronyms and ���important key words,��� also known as the ���Five Fundamentals of Service,��� to help RNs remember their script, helpfully reinforced by their managers, as we noted in a 2010 NNU CE home study course and feature story (National Nurse, October, November 2010). Scripting is one element, another is ���rounding,��� guaranteeing that every nurse document a visit to every patient at least once every hour, even if the nurse checks on the patient more frequently, as is typically the case, or misses the hour by a few minutes because another patient happens to be coding. And, what happens if you fail to meet the scripting and rounding requirements? For MARCH 2012 the nurse, especially in a non-NNU hospital, constantly smiling? Check. Are there plants in the hospital lobby? Check. Attractive artwork it can lead to docked pay or other discipline. on the walls? Check. Soothing music in the For the hospital, it can lead to reduced elevators? Check. An espresso machine in the Medicare reimbursement, for which it will cafeteria? Double check. Free certainly exact punishment wi-fi in hospital rooms and on the nurses. If this sounds lounges? Triple check. And Welcome to the not-solike something are the nurses scrupulously Brave New World of faux out of Disneyfollowing those scripting and patient satisfaction. world or the rounding demands? CheckAbout 15 years ago, hotel and mate. during an earlier wave of hospitality If this sounds like somehospital restructuring, we industry, that���s thing out of Disneyworld or told the story about a hospinot a coincital where nurses being dence. Hospitals the hotel and hospitality industry, that���s not a coincirequired to put lip gloss on a now use the dence. Hospitals now use the patient to improve their color same consultsame consultants and the before a family visit so that ants and the same formulas. Call it Goofy family members would think same formulas. on steroids. their loved one was receiving Call it Goofy on Consultant-driven reengiappropriate care. Even as the steroids. Conneering blueprints are hospital was replacing RNs sultant-driven destructive enough in the with unlicensed personnel, reengineering service and entertainment all that mattered was the blueprints are industry. In healthcare they perception of care. destructive can be deadly. As the years have enough in the Witness a study, ���The Cost evolved, so have the reengiservice and of Satisfaction,��� just published neering methods. And the entertainment in February in the Archives of hospitals have an added industry. In Internal Medicine. Correlatincentive to substitute servhealthcare they ing patient satisfaction ice and the appearance of can be deadly. surveys with outcomes, the care for the actual delivery study said the risk of death for of quality care. the most highly satisfied ���healthy��� patients It pays. A lot. The Centers for Medicare and Medicaid Services announced last Octo- was 44 percent higher than their less ���satisfied��� counterparts. The article sparked a bevy ber that patient satisfaction survey results of medical blogs and news accounts with will be one significant factor in determining titles like, ���Do you like your doctor? It could Medicare reimbursements, and for those be the death of you,��� and a furious rebuttal executives lucky enough to meet the from Press Ganey statisticians arguing the contrived guidelines, bonuses. surveys are ���here to stay.��� To make matters worse, patient satisfacJust making the patient happy, with tion surveys are fully integrated into the inappropriate care for example, has no bear2010 Affordable Care Act, through healthing on quality of care, wrote columnist care quality initiative measures. Are the nurses, doctors, and other staff (Continued on page 10) W W W. N A T I O N A L N U R S E S U N I T E D . O R G N AT I O N A L N U R S E 9