The job of a nurse has changed dramatically over the last couple of decades. I’ve witnessed these changes at close quarters and heard feedback from nurses in several different hospitals. The biggest change undoubtedly is the interaction with information technology and the move away from paper charting.
The theory behind this push, which is part of the federal government’s meaningful use policy, is that information technology is the way of the future and that widespread adoption of it has huge health care quality and patient safety benefits. While this may be true, the goal remains to be completely realized. I remember when the IT systems were first rolled out, seeing seasoned nurses reduced to tears by what was happening and how their job duties were changing so rapidly. Change is painful, yes. But change should also be meaningful and make life better (No pun intended with “meaningful” use.)
Earlier this year I wrote an article about how nurses spend too much time with computers and not enough time with patients. The premise of that article was that the Florence Nightingales of the future shouldn’t be robots. Glance down any modern day hospital floor and you will see nurses, who are the very heart of direct patient care, glued to their computer carts — staring at their screens and typing away.
I’ve lost count of the number of patients who have complained to me about this very issue and how nurses no longer spend enough time with them. I also hear regular complaints from nurses, who also realize that they are spending way too much time with their screens and not enough with patients. The problem is not the fact that we use information technology. Far from it. Information technology is here to stay and is very much the way of the future.
No, the main problem is that just like the IT solutions for doctors, what we have right now is slow, inefficient and cumbersome. Before the “dream” systems of the future are released that actually make life more efficient for nurses and improve patient care, here are three ways that nurses can cope with what we currently have:
1. Required documentation only. The documentation requirements for nurses seem overwhelming to a lot of frontline nurses. Is there a way for nurses to do just that — i.e., the fundamentals of what’s required? If you go over the top, for example with elaborate descriptive paragraphs instead of short, succinct notes and documentation, everything will take so much longer and seem that much more tedious when you are typing away on a computer.
Also, is there a way to cohort your non-emergent work better into dedicated “computer time” slots? A similar example in the IT world is with email, when checking it at certain defined time points is much more efficient and time-saving than checking it every few minutes. Every minute less with the computer can be an extra minute with the patient at the bedside.
2. Give feedback to your local IT department. If you see faults in your current hospital computer systems, be sure to give feedback to the IT department. Often small tweaks can be made to certain aspects such as the user interface and screen options. Even just a click less every time you do something can save a lot of time over the course of the day. Remember that the IT folk don’t work at the frontlines of medicine and don’t know about the issues until we tell them. From my own perspective as a physician, I’ve often been pleasantly surprised with how receptive hospital IT departments can be to the needs of physicians and improving our workflow. Warning: If you go this route, prepare to be persistent. But don’t give up.
3. Make it a national issue. There seems to be enough strong feeling out there to make the improvement of health care IT for nurses a national issue. The job of nursing has actually been affected more than physicians by the move away from paper. A strong united voice is needed to work towards making things better and holding true to the values of nursing. It shouldn’t just be an accepted change if the patient experience is not the better for it.
Being a nurse remains one of the most noble and vital vocations. Public opinion polls consistently rank nurses as the most respected profession (frequently higher than doctors). The practice of nursing cannot be reduced to screen staring, typing, and clicking. Anything that can be done to make information technology more efficient and enable nurses to spend more direct time with their patients needs to be done. Because when nursing loses its humanity, health care is doomed. We can’t let that happen.
Suneel Dhand is an internal medicine physician and author of Thomas Jefferson: Lessons from a Secret Buddha and High Percentage Wellness Steps: Natural, Proven, Everyday Steps to Improve Your Health & Well-being. He blogs at his self-titled site, Suneel Dhand.
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