Using Scripting to Alter the Impact on Clinic Staff of Aggressive Patient Behavior Over the Phone

Purpose: To measure the impact on clinical staff experience and handling of uncivil or verbally aggressive behavior by patients or caregivers over the phone when using scripted phrases to deescalate the call.
Description: The ambulatory care nursing practice council at an academic medical center identified cyber incivility and verbal violence over the telephone as issues negatively impacting clinical staff. A survey of nurses, medical assistants, and non-clinical staff who interact with patients or caregivers by phone demonstrated that experience with uncivil or aggressive behavior is widespread and affects workplace well-being, attitudes toward work, sick leave usage, and willingness to stay in the job. The organization has previously provided resources and training focused on workplace violence when the patient is physically present in the setting, but there is a gap in resources for ambulatory care staff who provide significant amounts of patient care over the phone. Responding to aggressive behavior in the moment can be anxiety provoking and can rapidly escalate, especially when staff have varying degrees of experience or comfort in dealing with it. Staff are already trained to use scripting embedded within the electronic health record, commonly used to provide prompts to ensure complete documentation. The practice council developed a tool using scripted phrases to support staff in de-escalation of telephone verbal aggression and disengaging the caller when appropriate. Training in the use of de-escalation scripting has been provided to staff in primary care and specialty clinics. We are re-surveying staff to measure whether the availability and use of the scripting has an impact on the type of interventions used in responding to telephone verbal aggression or incivility and the emotional impact on staff who receive such phone calls.
Our work was inspired by the sharing of work done in this area by nurse researchers at UC Health, as presented at the 2023 AAACN Annual Conference. In developing our tool, we have worked with our patient advisory council, risk management partners, and experts in behavioral health.
Evaluation/outcome(in progress): Evaluation areas include comparison of interventions used by staff during uncivil or verbally aggressive phone calls before and after training on use of de-escalation scripting and whether availability of the scripting has an impact on staff well-being, including attitudes toward work, sick leave usage, and willingness to stay in the job.