Nursing faces a critical shortage of the right technology
Nurses want technology that works the way they do
Published: December 16, 2005
One of the biggest challenges I see in healthcare in the years ahead is how to deal with a critical shortage of qualified clinicians, particularly nurses. Government statistics show that one million or more new nurses will be needed by the year 2012—far more than are in the training pipeline. And those nurses already on the job, meanwhile, will face new pressures as healthcare begins to feel the full effects of aging Baby Boomers on the system.
For these reasons, helping nurses perform their jobs better and more efficiently has never been more important. I know from my own experience how vital nurses are to patient care. Good nursing improves patient outcomes, results in more satisfied patients, and helps cut medical costs. For most patients, the majority of the contact they have with staff during a hospital stay is with nurses.
Most nursing records still paper-based
But like the rest of the healthcare profession—where 83 percent of all physicians still work on paper rather than with digital records—the nursing profession remains mired in the pre-digital age. Even nurses who use the latest patient-monitoring equipment in an intensive-care unit are likely still doing much of their routine record-keeping on paper. Or, they have access to a single desktop computer located somewhere in a “nursing station” on the hospital floor, and they must walk to it each time they need to update a patient’s records, obtain medications from a centralized cart, or process a physician’s orders. That’s why, according to Dr. Brenda Zierler, associate professor of biobehavioral nursing and health systems at the University of Washington School of Nursing, nurses sometimes walk as far as 11 miles during a single shift.
Nurses also have been ignored in what has become a fairly broad push to digitize patient records. Most networked wireless devices such as Pocket PCs or Tablet PCs, used to help record patient data and link patient records between multiple care points (such as the doctor’s office, hospital, and perhaps an outpatient clinic) are sold to doctors or hospitals, with nurses included as an afterthought. It’s not that nurses aren’t an important link in a patient’s medical care—it’s just that many of these systems have a component that helps with billing, and in hospitals nurses aren’t a “billable” expense. Says Dr. Carol Bickford, a senior policy fellow with the American Nurses Association, “Nurses aren’t valued in the reimbursement structure, so we tend to be invisible.”
Clearly, the nursing profession could benefit from technology that is designed to help them perform their jobs better and more efficiently. Technology can improve job satisfaction, reduce errors, and give nurses more time for direct patient care. And at its best, technology can help nurses take information and turn it into insight—giving them greater ability to make potentially life-saving decisions at a patient’s bedside.
 | Nurses aren't valued in the reimbursement structure, so we tend to be invisible. |  | | Dr. Carol Bickford
American Nurses Association | |
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Nurses want tools that help with care
A large number of nurses with experience in many of the current technology offerings say the same thing: Give us systems that are designed to work the same way we do, not ones that make us reinvent our jobs. That isn’t stubbornness talking. Nurses want systems that help them perform what they see as their primary task—performing patient-centered care. If technology gets in the way of that or forces them to focus more on the technology than the patient, they want no part of it.
So how to design systems that offer the most benefit to nurses and their patients? Nurses uniformly agree on four key ways to achieve such an outcome, discussed below.
Talk to us
Dr. Bickford, for one, doesn’t necessarily agree that nurses haven’t had access to technology. “You name it, we have the technology,” she says. “The problem is that those technologies are inserted upon us, not developed with us.” So she pleads for technology suppliers to really engage with nurses when designing tools for the nursing profession. She cites as an example the growing number of centralized medication-dispensing stations. Nurses formerly pushed medication carts from room to room, dispensing to patients as they went. Now they must go to a central station, log in, and get the medications needed by patients. “That’s great for the pharmacy, because of better record-keeping, but it doesn’t help the nurses,” says Bickford. “Now they have to walk back to a patient’s room, maybe carrying a syringe or with drugs in their pockets, maybe with two patients getting the same medication but in different doses.” The system makes more work for nurses and actually may reduce patient safety. A better setup would put patient medications closer to their beds.
Give us integration
Nurses are also requesting better software integration. Today, nurses may have to deal with a half-dozen different applications, each with a unique log-in procedure and password. (Some nurses say they must remember as many as 50 passwords.) Each of these applications may have a unique user interface, with tools, commands, and keystrokes that are shared by the other applications. How can nurses (or doctors, for that matter) be expected to learn so many different systems? For log-in procedures, some suggest using biometrics—fingerprint or eye-scan identification, for instance—to speed up and simplify log-in while retaining excellent security. And forget log-off procedures. Nurses want to be able to finish their task at a computer or other workstation, then leave and let the system shut down automatically until the next nurse or physician logs in. Nurses also are eager to see systems that are standards-based so that equipment or software used for different purposes—such as updating charts and requesting medications—look and behave similarly.
Work the way we do
Nurses often use the word “story” when talking about patients. That makes sense, as each patient does indeed have a story. They become ill, they enter a hospital, and hopefully are they are discharged with the problem solved or well on the way to resolution. But lots of devices aimed at helping nurses record or assess a patient’s condition don’t allow that story to be told. Instead, they document a patient’s condition at a single point in time, requiring a nurse to scroll back to get the complete picture. That’s why paper-based graphs and charts remain popular—by flipping a few pages, a nurse can see in seconds how a patient’s blood pressure, temperature, urine output, and other indicators have changed over a number of days. So nurses would like technology that at least gives the option to view critical patient data graphically instead of numerically, when it’s appropriate to do so, to help them better and more quickly understand a patient’s entire “story,.”
It’s also important to keep in mind that nurses are not a single collective monolith, says Dr. Zierler. Nurses functioning in different capacities and environments have different technology needs. For example, nurses specializing in home-based healthcare need systems that enable the transmittal of data to a central database, designed to monitor chronic illness for populations of patients—including the specific patients the nurse may be caring for on any given day. Nurses in a hospital, on the other hand, need tools to help them manage patients across an array of clinical settings—from the operating room to intensive care to discharge.
Give us training
Nurses often complain that when new technology is given to them, they don’t get sufficient training on how to use it because training time takes them away from their job. But training is vital to ensuring that technology is not only used, but used effectively. And so far, a number of ways to introduce technology and the associated training have been effectively implemented. At Overlake Hospital Medical Center in Bellevue, Washington, for instance, tech-savvy nurses called “super-users” are the first to be trained in any new technology. They then evangelize the new technology to their peers, speeding acceptance and giving nurses hands-on experience with the new equipment. And many hospitals are now taking advantage of Web-based training programs that can be made available “on-demand” from an organization’s intranet or Web portal. This allows much more flexibility around when and where training can be facilitated.
Nurses need the best of IT
Technology can help compensate for the chronic shortage of nurses while improving care and better serving patients. But to reach that goal, nurses need technology that serves as an effective assistant, advisor, and record-keeper. These tools require the best of what software and hardware companies have to offer—intuitive interfaces, wireless connectivity, applications that integrate seamlessly with nurses’ work priorities, the ability to access data when and where it is needed, and affordability so our cash-strapped healthcare system can put its resources into patient care, not infrastructure. Microsoft is working diligently with technology partners to help give nurses what they need to go beyond even their current all-important role.
Microsoft solutions for healthcare and life sciences
Dr. Bill Crounse, M.D., is the worldwide health director for the Microsoft Corporation. Dr. Crounse is responsible for working with industry partners and healthcare organizations to help them benefit from using Microsoft technologies and solutions. Prior to joining Microsoft, Dr. Crounse was vice president and chief medical information officer for Overlake Hospital Medical Center and the Overlake Venture Center in Bellevue, Wash. |
