Coping with the culture clash between nurses and IT

by John Rossheim

IT professionals are great at coming up with nifty tools for bringing clinical data to clinicians – as long as nurses are willing to memorize lots of byzantine paths to that information.

Nurses are dedicated to providing direct care for their patients and advocating for them in every way – as long as it doesn’t mean having to adapt to ever-changing computer systems.

These two stereotypes have helped perpetuate the notion that there’s a culture clash between clinicians and IT folks, a conflict that can scuttle the implementation of an electronic records system or at least reduce its effectiveness. But with careful planning and execution, this clash can be reframed to create a working coalition of healers and technologists.

The organizational challenges of a health-care IT implementation, from reengineering workflows to selling executives on the investment, are formidable. But the people challenges of HIT – especially the job of convincing clinicians that electronic records will improve patient care in the long run – can make or break the project.

Let’s start with one perceived clash that any health-care IT implementation team must address: that a new or upgraded electronic system will take direct-care time away from clinicians, at least in the early going. “Nurses have a way of viewing anything that comes between them and the patient as a threat,” says Mary Cothron, RN, a clinical trainer and implementation specialist at Informatics Corporation of America in Nashville.

Given nurses’ heavy record-keeping burden, their concern is understandable. Among the major tasks in an average shift, nurses spent 55.7 percent of their time on indirect care tasks such as documentation, versus just 32.8 percent of each shift on direct patient care, according to a 2008 study appearing in Nursing Leadership. So it’s reasonable for clinicians to push hard for an IT implementation that on balance will give them more time with patients. “When you add something to nurses’ workload, you also have to look at what you can take away,” says Harry Jacobson, M.D., CEO of Vanderbilt University Medical Center. “Nurses already have too many tasks.”

While navigating an online recordkeeping system may initially take longer than pen and paper, a digital records system has clear-cut time-saving features, and these should be highlighted. “When you bring in electronic records, you go from not being able to find the chart 20 percent of the time to always being able to find it,” says Chris Wood, M.D., medical director of information systems at Intermountain Healthcare, a nonprofit system based in Salt Lake City. “You have to remind people again and again why you’re bringing in the technology.”

To avoid, or at least mitigate, a culture clash, clinicians must play a central role in specing out and checking out any new information system. Years ago, “we tried to save money by having our IT people be super users,” says Dr. Wood. “But it works much better to have nurses and other clinicians be the super users, because they understand the workflows and the frustrations of changing them.”

Perhaps the best way to bridge the culture gap is to demonstrate to clinicians that many aspects of automation improve patient safety. Bar-coding of medications is one innovation that does just that.

Ultimately the culture clash can be tempered if technologists begin to understand the clinicians’ perspective, and if clinicians learn to appreciate how the IT implementation improves patient care, especially in the long run.

John Rossheim is a regular contributor to Curaspan Health Group’s Knowledge Exchange.

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