When I began nursing school in 1978 and entered into nursing practice in 1981, things were very different. The focus was truly patient centric. For example, we were never to use gloves unless we were performing a sterile procedure as we did not want to interfere with the dignity of the patient. We took blood pressures with mercury based sphygmomanometer as instructors listened to our readings using a dual stethoscope to ensure our accuracy. Temperatures were taken with glass thermometers. We trained to use all of our senses to assess patients and their needs. And we charted manually! Detailed notes about the patients’ needs, their concerns, their past history, educational needs and family concerns were expected to be documented hourly. We received no prompts related to documentation and there were no mandated nurse to patient ratios.
While I no longer practice the art of bedside nursing, it is important to keep a pulse on the concerns of those that do as we continue to build out technology and assess its impact on care. From my research and conversations with practicing professionals, it is clear technology is a very mixed blessing. While it has increased efficiencies it has made us reliant and removed the need to “know how” without technology. It is akin to what has happened since the advent of smart phones; people rarely know phone numbers “by heart” because technology manages this for us.
Here’s what I heard from speaking with practicing nurses on the front lines about their worries, changing roles and technology:
Sioban Mooney Maslar RN, MSN Instructor at a large university and practicing bedside nurse
“What worries me the most is that students coming out of school are less inclined to use their hands and they rely more on technology in caring for patients. I think that modern day simulation labs in nursing schools help nursing students learn how to prioritize and handle situations they might not see in the hospital setting. I often use a simulation lab to bridge that gap.
I do not let my students look in the computer until they have physically assessed their patients.
When the computers crashed, I swear any nurse younger than 30 totally lost it. Younger nurses may have no idea how to care for a patient without the use of computers or how to document if they have not been trained that way. That’s why I have my sophomore students’ paper chart. I know it’s antiquated, but the computer systems give them all the “answers” and this prepares them for the unexpected.”
Donna Montemurno Ciufo RN, MSN, DNP CNO at a large trauma center (part of an IDN)
“Quality of care is number 1 for the organization. One worry I have is we have multiple computer systems that are not interfaced. We worry about omission and duplicate errors, and now we are in the process of changing to Epic’s EHR, which will put information all on one platform.
Another concern is the aging workforce. Most of our more seasoned nurses work in specialty areas with complex patients. We have expanded our float pool to cover some of those areas to get younger nurses more experience in preparation for the seasoned nurses’ retirement.”
Kristine Acampora Galizio RN, BSN in a NICU at a large IDN
“As a preceptor, I worry about the continuing decline of the orientation process for brand new nurses. Mistakes are often shoved under the rug and no one wants to realize that sometimes, people just aren’t getting it and would be better off working in another unit or career. Too often people worry more about how much money was already invested.
I worry about administration seemingly not understanding or appreciating the role of the bedside nurse in patient satisfaction, in regards to staffing ratios and pay.
I think technology is helping in terms of patient care, and I LOVE to learn, so, I definitely think it is helping. It just takes a while to get everyone up to speed with the education component with new things.”
No one wants to go back to documenting on paper or logging each data point from a medical device manually in a record. As technology advances, seasoned nurses are looking for ways to teach nursing students to embrace the efficiencies of healthcare IT without becoming too reliant on it. We don’t want it to interfere with care for the patient or critical decision making when lives are at stake, and we certainly don’t want it create a barrier between nurses and their patients.
Nurses of all ages should explore and master tools and technologies that can help give time and attention back to the patient and ease the growing documentation load. One example near and dear to my heart is using technology to mine patient charts for performance trends and data that point to gaps in quality. This can shed light on where performance improvements are needed and will have the biggest impact on patient care. That’s a win- win for everyone.
For more information on technology to focus on improving quality instead of managing date, visit: http://www.nuance.com/for-healthcare/clintegrity360/quality-management-solutions/index.htm