NR 527 Week 3 Difficult Conversation Script Example

Difficult Conversation Script: Asking the Emergency Department's Charge Nurse for a Written Return Summary, Written So It Keeps Working After She Says No

Student Name

College of Nursing, Chamberlain University

NR 527: Communication and Collaboration for Advanced Nursing Practice

Instructor Name

Month Day, Year

Difficult Conversation Script: Asking the Emergency Department's Charge Nurse for a Written Return Summary, Written So It Keeps Working After She Says No

Context and Aim

This script prepares a conversation between me, the nurse practitioner at a skilled nursing facility, and the evening charge nurse of the emergency department that receives most of our residents. The trigger was Mrs. B.'s return at 0145 carrying a single sentence of paperwork and an unannounced new antibiotic. My aim is modest and specific: that residents returning to the facility at night carry a short written return summary covering diagnosis, new medications with next dose times, pending results and what to watch. The charge nurse does not report to me and has no obligation to agree. The script is written in turns, with notes on why each turn is phrased as it is, and it continues past the point where she declines.

The Script

Turn 1, me: "Thanks for taking a few minutes. I'm the nurse practitioner at the nursing facility on Route 9. I want to talk about how our residents come back to us at night, and I want to start with one case, because I think we both want the same thing for her."

Note: names the relationship, the subject and a shared goal before any request.

Turn 2, me: "Three weeks ago, Mrs. B. came to you after a fall. Your team did a CT, closed her cut and started an antibiotic for a urinary infection. She came back at 1:45 with a note that said 'CT negative, see ED record.' Our night nurse can't see your record, so she didn't know about the antibiotic, and Mrs. B. missed her evening dose."

Note: one specific event, stated as facts, with the harm named plainly and without blame.

Turn 3, charge nurse: "Everything is in the portal. Your nurses should be checking it. We can't call every nursing home at two in the morning."

Turn 4, me: "You're right that you can't call everyone, and I'm not asking for calls. Our night nurses don't have portal access; only I do, and I'm not there at two. What would it take to send back one printed page with four things on it?"

Note: agrees with the part that is true, corrects a mistaken assumption and makes the request smaller and concrete.

Turn 5, charge nurse: "We print discharge instructions already. They go with everyone."

Turn 6, me: "That's helpful. Can I show you what came back with Mrs. B.? It was the patient-facing sheet, which says to drink fluids and follow up with her doctor. It didn't list the new antibiotic or when the next dose was due. Those are the two things our nurse needed at 2 a.m."

Note: brings evidence to the table instead of arguing; the gap is between the document produced and the document needed.

Turn 7, charge nurse: "Look, this isn't my decision. The physicians decide what goes in the paperwork. You'd have to talk to the medical director."

Turn 8, me: "I will. I'd rather go to him with you than around you, though. If you're willing, could we try something small for a month? For residents going back to us at night, your nurse fills in a four-line return sheet we'd supply, and we track whether it helps. I'll bring the results to the medical director either way."

Note: accepts the limit of her authority, declines to bypass her and proposes a trial small enough to agree to.

Turn 9, charge nurse: "A month, for your facility only? Fine, but if my nurses say it's too much, we stop."

Turn 10, me: "That's fair. I'll drop off the sheets tomorrow, and I'll call you in two weeks to hear what your nurses think."

If She Had Said No Again

The script has a second branch for Turn 9. If she had said no, my Turn 10 would be: "I understand. I'm going to write to the medical director and our director of nursing about this, and I'll copy you so you know exactly what I've said." That keeps the conversation honest: she knows the issue will go further, and she knows what will be said about her department. It also leaves a record, which the escalation memo later in this course would use.

Why the Script Is Built This Way

The conversation deliberately starts with one resident rather than with statistics. Numbers matter, and I carried them: in one study of 457 nursing home transfers, important information gaps occurred in 85.5% (Cwinn et al., 2009). But a charge nurse hears a general complaint about nursing homes as criticism of her department; she hears Mrs. B.'s missed dose as a problem she could help solve. Focus groups have found that emergency staff and nursing home staff both describe communication as the main barrier in these transfers (Terrell & Miller, 2006), which means she is likely to share the concern if it is framed as shared.

The request is also shaped by the national interprofessional competencies, which include communicating in a way that supports a team approach and respecting the roles and constraints of other professions (Interprofessional Education Collaborative, 2023). A request that ignored her staffing, or went around her to the director, would have violated both.

What I Will Practice Beforehand

Two turns are hardest for me. Turn 4 requires agreeing with a criticism of our facility without becoming defensive, and Turn 8 requires accepting her refusal of authority without sounding as if I am threatening her. I will rehearse both aloud with our director of nursing, who will play the charge nurse and push back harder than I expect.

I will also choose the setting carefully. A phone call during her shift would compete with her patients, so I will ask to meet her in person at the start of an evening shift, bring a printed copy of Mrs. B.'s one-line note and the draft four-line sheet, and keep the conversation to ten minutes. Having the documents in hand lets her see the problem rather than take my word for it, and bringing the solution already drafted shows respect for her time. If the meeting runs over, I will stop and ask when would suit her better, rather than press on while her department fills.

References

Cwinn, M. A., Forster, A. J., Cwinn, A. A., Hebert, G., Calder, L., & Stiell, I. G. (2009). Prevalence of information gaps for seniors transferred from nursing homes to the emergency department. CJEM, 11(5), 462-472. https://doi.org/10.1017/S1481803500011660

Interprofessional Education Collaborative. (2023). IPEC core competencies for interprofessional collaborative practice: Version 3. https://www.ipecollaborative.org/ipec-core-competencies

Terrell, K. M., & Miller, D. K. (2006). Challenges in transitional care between nursing homes and emergency departments. Journal of the American Medical Directors Association, 7(8), 499-505. https://doi.org/10.1016/j.jamda.2006.03.004