National Nurses United

CE 2_Nov REV 12/10/10 8:16 AM Page 21 3. Position: The RN is to ask if the patient wants repositioning help. (Note: Some scripting schemes add a 4th 'P') 4. Possessions: The RN is to ask if the patient's possessions are within reach. Another common rounding scheme refers to "the Four Rs" 1. Rx: Provide any needed medication. 2. Reach: Are the patients' belongings within easy reach? 3. Respond to questions: Ask if there is anything else the patient needs. 4. Reassure: Express care and concern. Let the patient know at what time the next rounding visit will occur. Some hospitals are using acronyms to help the RNs remember their scripts. One example is A.I.D.E.T.* (*Studer Group). The tool is marketed as reinforcing "important key words" and is also known as the "Five Fundamentals of Service" to help build customer loyalty. Managers are instructed to coach their staff using A.I.D.E.T* as a "communication framework" to improve patients' perceptions of care provided by the staff. A stands for Acknowledge the patient. "Hello, Mrs. Jones." I stands for Introduce yourself. And state your certifications/experience D stands for Duration; "Your test results won't be back until tomorrow." E stands for Explanation; "This is part of the excellent care we provide here." T stands for Thank You; "Thank you for choosing our hospital, Mrs. Jones." Many RNs who have been introduced to these schemes are aghast at the patronizing assumptions behind the introduction of these schemes, i.e. that RNs do not already acknowledge and introhealthcare needs, interests, and wishes are respected and protected. duce themselves to the patient or explain procedures to the patient. Explain the potential of protocols and patient interaction scripts for On the face of it, these seem like very obvious interventions for replacing individualized human interaction in the delivery of healthcare. an RN to perform. Where the danger lies in this scheme is that the Describe how rounding, scripts, and rigid protocols can supplant RN becomes over-scripted and is pressured to adhere to a script and critical thinking and override the independent professional clinical so ceases using critical thinking skills and focusing on the individual judgment of registered nurses. needs of each patient. State why safe staffing with specific, numerical The usual initial question asked of this scheme by RN-to-patient ratios, and the requirement that hosRNs is, "Why is this necessary?" After all, RNs are pitals staff up from the minimum based on individual Submitted by the Joint educated and experienced in meeting all of their patient acuity, is an evidence-based practice that Nursing Practice patients' needs as well as providing first-class patient improves patient outcomes, results in cost-savings, Commission, DeAnn care using the nursing process. One answer to that and increases both patient and nurse satisfaction McEwen, RN, and question is a familiar one in the corporate model of that allows direct-care RNs to be in control of the Hedy Dumpel, RN, JD healthcare: money! nursing process. Provider Approved Patient satisfaction scores rather than patient by the California outcomes have become a major driver of the corpoWhat's It All About, All "P's"? Board of Registered rate healthcare agenda. The Centers for Medicare the essentials of rounding and scripting (The 3 Nursing, Provider and Medicaid Services (CMS) is now using patient P's) are as follows: #00754 for 2.0 contact hours (cehs). satisfaction scores as a measure of quality care and The RN is directed to enter each patient room Recognized by all reimbursing hospitals accordingly. Press Ganey, an once every one or two hours. states with the excepindependent for-profit company, has marketed The RN is directed and scripted to ask three question of Arkansas, itself to the hospital industry as the "go-to consulttions of the patient regarding: Delaware, Massachuant "on how hospitals can improve their patient 1. Pain: The RN is to ask about the patient's pain setts, Minnesota, Montana, North Carolina, satisfaction scores to meet the requirements of the level. and South Carolina. new CMS criteria. In its marketing messages to the 2. Potty: The RN is to ask about the patient's hospital industry, Press Ganey makes the following toileting needs. NOVEMBER 2010 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 21

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