Healthcare Training Institute - Quality Education since 1979

Section 19
Creating a "Broken Record" Script to the "Busy and Short" Reply

Table of Contents | NCCAP/NCTRC CE Booklet

In the preceding section, you wrote scripts providing the other staff member with compliance information and requesting suggestions concerning how staff might comply with Culture Change requirements, as well as indicating ways in which you have followed through with suggestions from previous meetings.  Obviously every time you observe an area of Culture Change noncompliance regarding scheduling, transporting, or activity involvement, you are not going to be scheduling lengthy meetings.  The “broken record” provides you with a one –liner that summarizes the previous groundwork you have laid with this individual.

The problem with the “busy and short” reply is that the net result is in essence the other individual is “throwing their hands in the air” and saying, “You can’t expect us to do this.  We are too busy, and we don’t have the time!”  So you need to develop a tactic to deal with this seemingly irrefutable or seemingly unquestionable reply used in many long-term care facilities.

As with the longer script in the preceding section, the best way to prepare for using the broken record is to run through some practice scripts that you write.  You will find that writing scripts that seem to fit the other individual will greatly aid your preparation and increase your sense of confidence. 

Do not worry about how you feel inside.  Your goal now is to perhaps readjust your communication pattern with this staff member.  Thus, perhaps even though you may not feel it inside, you act more self assured, professional, and open.

Practicing, rehearsing, and role-playing the scripts developed in this section and the preceding section has yet another benefit.  By exposing yourself to practice situations, you inoculate yourself against the stress that the real interaction may produce.  Or, you may not perceive this as stressful at all, depending on your history with this person and length of employment in the facility.  I have found a new employee is carving new relationships with each staff member.  Thus change is easier because there is not a long history with that employee, because you are new to the facility.  However, if you have worked in your facility for years, old patterns of accepting non-compliance regarding transporting, scheduling, and activity involvement may, or may not, be difficult to change. 

Especially if you have a long history with the DON, speech therapist, etc., eliminating stress entirely from these scripts may not be possible.  Your practice conversations will help you to cope with stress, if any is present.  In fact, psychological research shows that performance actually is increased when stress levels are contained at moderate levels, as opposed to too high or too low.  Ideally, then, practicing your script on your own or with another should help to keep you pumped up sufficiently to be energized and motivated.  At the same time, the inoculation effect should help to prevent your stress levels from skyrocketing and possibly disrupting your ability to speak or think effectively.

If you get along great with other department heads and staff who are easily complying with Culture Change, you may be asking yourself, “What’s the big deal? There is no stress for me in this area.”  If so, good for you.  However, you or your facility purchased this course for some reason.  And you have decided to read through the manual this far.  So ask yourself, why?  What is my motivation?  In what areas could my support be better?

Creating your “Broken Record” Script
So let’s say at this point you have read through the preceding sections in this Manual, and have had meetings with appropriate staff members .  However, for the fifth or the twenty-fifth time, you notice Effie is being wheeled down the hall for her shower rather than to your Crafts group.  In short, her schedule has not been altered to facilitate her attendance in Crafts.

First, you need to decide who to deliver your Broken Record script to.  The DON? The Charge Nurse?  The Inservice Director?  You have had meetings described in the previous sections in this Manual with these staff members. 

Script Part I: Briefly Describe the Area of Noncompliance
So you state to the DON or Charge Nurse, “I notice Effie’s shower schedule was not changed, and she was unable to attend Crafts.” 

Script Part II: Give the Reason
In case you are wondering, I call this script a “Broken Record” script because it is repeated over and over again as various situations arise.  In your broken record script, you explain your concern by referencing one of the following: 1. CMS Compliance, 2. your administrator’s concerns or wishes, 3. Care Plan compliance, 4. an upcoming Survey, or 5. another area that creates weight, leverage, or emphasis to your request.  In short you are not requesting Effie’s shower schedule be changed, the CMS guidelines indicate it.
        
1. CMS Guideline Compliance:  Remind the other staff member, that it is not you that is requesting Culture Change compliance, it is a federal CMS requirement.  So after you state to the DON, Charge Nurse, etc, “I notice Effie’s shower schedule was not changed, and she was unable to attend Crafts,” add one of the following, if they respond with “busy and short,” or others to be discussed in later Sections:
“I need to have a program that is in compliance.”
“The facility needs an activity program that is in compliance.”
“The facility must have an activity program that is in compliance.”
“The facility has to have an activity program that is in compliance.”

2. Administrator:  Reference a previous meeting with your administrator. 
“Mr. Jones is concerned about activity department compliance with Culture Change.”
“Mr. Jones is concerned with the facilities compliance with Culture Change.”
“Mr. Jones is concerned about the next survey.”

3. Care Plan Compliance:  Inform the other staff member of the problem this is creating, which is another way of stating number one above.  This staff member may be unaware or needs to be reminded that not only nursing has a Care Plan created for the resident which needs to be complied with.
“The problem is I am unable the check  Effie’s attendance record now.”
“The problem this creates is once again I am unable to check Effie as having attended.”

4. CMS Survey Compliance:  Reference the upcoming survey or survey follow-up.  Most facilities are gearing up for or reeling from their last survey.  So depending upon where you are in your CMS Survey cycle you might try the following.
“I know the Survey is coming up in a few months and I want to be prepared.”
“My department needs to be prepared for Survey.”
“I need to be prepared for Survey.”

As you can see all of these say the same thing with a different emphasis.  You are saying to the staff member,  “You are not doing this as a favor to me.  You are doing what is part of your job.”  However, of course no one likes to be bullied, and such a heavy handed direct statement would clearly be met with an extreme lack of cooperation and support.

So you repeat this in an unemotional, low-key, friendly, professional manner to the staff member you deem appropriate.  You repeat, for example, the following two sentences. “I notice Effie’s shower schedule was not changed, and she was unable to attend Crafts.”  If they say the schedule will be changed next week at this point you have not need to go any further.  However, if they say “busy and short,” you might reply with, “The problem is I am unable to check Effie’s attendance record.”

After writing your broken record script, rehearse and role-play it with perhaps another Activity staff member or a significant other at home.  Then use it repeatedly followed by portions of the preceding sections of this Manual.