Nurses demand a voice in health IT planning
Already armed with computers-on-wheels, digital charts and other high-tech medical instruments, nurses and nursing organizations say they're ready to embrace the potentially sweeping changes in high-tech health care delivery that lie ahead.
However, they say the tendency of hospital managers and government policy-makers to exclude nurses from the design and planning of health information technology means that new health care delivery systems might not be as effective as possible, especially in the critical area of bedside patient care.
"There is a lack of understanding in regard to the impact new [health IT] mandates will have on nurses and what nurses can bring to the table. Currently, we don't have a voice in Washington," said Joyce Sensmeier, vice president of informatics at the Healthcare Information and Management Systems Society (HIMSS). "Physicians give orders, but nurses are working at the grass-roots level to make it happen. It is critical that we be at the table."
In a recent poll, HIMSS' Nursing Informatics Task Force sought to determine whether nurses were apprehensive about upcoming health information technology changes, the potential of technology to depersonalize care and the degree to which nurses might rely too heavily on systems at the expense of their own clinical judgment.
The results were surprising, according to Patti Dykes, senior nurse informatician at Partners HealthCare System in Wellesley, Mass., who headed the 2005 survey. "I think in general nurses are very positive about [health IT] and are anticipating that new systems will have a positive impact on patient care," she said.
Because they are not included in decisions about buying, planning for and customizing health IT, nurses are concerned that the new electronic methods might impede workflows. "I do not like computer charting since it forces you to lie," a survey responder stated. "There are always screens that demand information that you have no way of getting."
Putting the potential for more busy-work aside, nurses show little concern that health IT systems will cloud their clinical judgment. Instead, most say they believe that technology will improve patient care, the HIMSS survey found, especially if the technology was better adapted to a bedside setting.
"Instead of having technology at a nursing station, nurses want equipment at the bedside or at least somewhere near the patient's room," said Ruth MacCallum, senior consultant at Healthia Consulting in Minneapolis.
"My wish list for nurses is that they can be standing there with a patient and have a touch screen device ? one that doesn't have too many screens but one that allows nurses not to have to run back and forth to receive information on medication or necessary documentation," said MacCallum, who helped analyze information from the survey.
Longtime nurse Anne Afshari advocates that nurses also have more access to mobile technology. "Examples include handy tracking devices. Also necessary are security devices and alert alarms for times of crisis," said Afshari, who is co-director of Exclusively RNs, a full-service call center for obstetricians and gynecologists. Biometric solutions and devices to quickly call supervisors to a patient's room are also high on nurses' list of priorities.
The nursing community is also lobbying for the continued development of programs and technologies that guide nurses toward more focused treatment and response paths.
"Specialty-specific programming is an extra that works well, as it prompts the caregiver to assess certain areas at appropriate times, given a specific set of details," said Laura Hagler, a former labor and delivery nurse who is now co-director of Exclusively RNs. "For example, the caregiver may be prompted to take a patient's temperature every two hours per the unit's protocol."
Although nurses tend to appreciate technology that assists in decision-making, the HIMSS survey found they shun solutions that require the double entry of information in paper and electronic forms. Equally unpopular are systems that require them to hunt for information in health IT systems and paper formats.
"There are silos of information in health care," Dykes said. "In some cases, certain disciplines within a facility use information systems and some do not. It leads to having to go to multiple places for information. For instance, a particular unit may have [health IT] systems in place, but physicians are still using paper charts."
Such inconsistencies easily frustrate nurses, who are already burdened with patient care paperwork and reporting requirements from oversight bodies such as the Joint Council on Accreditation of Healthcare Organizations, which evaluates about 17,000 facilities nationwide.
The survey also raised red flags about the impact of health IT on clinical decision-making. For instance, some nurses say they feel anxious when asked to use systems that do not acknowledge that critical messages sent to physicians have been received and acted upon. In such cases, nurses will naturally turn to traditional communication methods, Dykes said. "The only way I know for sure that the message has been received is by an order being written on the chart or a return phone call," one survey respondent said.
The best way to ensure that such concerns are addressed is to include nurses in health IT planning decisions, nurses said.
"It is not at all unusual for a system to be imposed on nurses," said Melissa Foster, manager of nursing informatics at Homestead Hospital in Homestead, Fla. "People assume that nurses ? especially older nurses ? don't care for computers. I don't think that is necessarily true. I think it's more that chief information officers have bought systems without consulting nurses, who are then left with a system that doesn't fit with their work processes."
McAdams is a freelance writer based in Vienna, Va.