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Embracing EMR

Nurse managers can lead nursing toward informatics competencies.

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Information technology is one of the newest innovations in the healthcare industry, but nurse managers can be slow to accept the change from the traditional paper notes to electronic medical records (EMRs).

Nurse managers have the ability to incorporate changes and influence staff, but have been reluctant to embrace the change in technology. This reluctance of nurse managers could be due to a fear of losing control, fear of the unknown or just resistance to change. Change is inevitable, and IT will only increase in the future. 

So let us, as healthcare providers, embrace the change and move forward in the future for nursing. EMRs are beneficial to nurses because they will improve safety and quality of patient care, provide quick and easy access to patient's information, decrease medical errors, and allow practitioners to make better healthcare decisions.

What is EMR?

EMRs are an electronic way of managing health information and communication in healthcare. Bembridge, Levett-Jones & Jeong (2010) explained the term information and communication technology "refers to any technology that has capacity to accumulate, retrieve, control, convey or accept information by electronic means."1

They continue to say this information and communication technology "has the capacity to enable fast and proficient transfer of information and knowledge and can facilitate communication of information across distances to support clinical and educational processes."1   

Samoutis et al. (2007) reviewed several studies that have shown EMRs are an "essential technology tool for healthcare modernizing the management of medical information and contributing to high-quality patient care and efficient patient management."2

Benefits of EMRs

EMRs have been proven to be beneficial in healthcare, namely they enable quick and easy access of a patient's information. Nurses and doctors can retrieve patient's pertinent information such as medication records, laboratory and radiology reports, and consultations quickly.

Nurses can get information on medication instantly, thereby increasing their skills in patient's education. It is convenient for nurses, as computers are mobile. The nurse can look up patient's information on medications and laboratories to make good nursing judgment and to be expert in decision-making.

According to Griffin-Sobel et al. (2010), "Health professionals must be information literate and use technology in order to function effectively within their work environments."3 With EMRs, nurses have the ability to access information quickly and efficiently and are able to use information to improve the quality of patient care.

EMRs also improve documentation and safety of patient's pertinent records.

According to Green and Thomas (2008), studies have shown "practicing medicine on paper leads to mistakes and poor care."4 Mistakes are partly due to mislaid filing, ripping of papers, spills and poor handling. These authors further state "nurses play the most critical role in documenting the totality of patients care due to nurse's ongoing presence with hospitalized patients."4

They continue to say "the future of healthcare documentation is found in information technology through use of electronic medical records" and EMRs are "expected to increase the accuracy and precision of important patient data."4

EMRs help reduce medications and transcriptions errors. Some errors are due to poor and illegible handwriting of doctors and nurses, others are due to the lack of experience of new staff, or knowledge deficit of nurses due to lack of information on new drugs. Still others are due to just carelessness and frustration.

I worked with one nurse who almost made an error when she scanned the wrong patient. The EMR indicated she was in error and she was able to correct the mistake before giving the medication.

The EMR system is also designed to alert staff of the five rights of medication administration: right patient, right medication, right route, right time and right dosage.

The saying to err is human is prevalent among professionals, but if there is a system that can help us to avoid the error, why not use it?

Federal Government Endorsed

The federal government has endorsed IT as an integral entity of the healthcare industry.

Seeley (2009) notes George W. Bush set a goal of having Americans have access to an electronic health record by 2014 and Barack Obama signed into law the Health Information Technology for Economic and Clinical Health (HITECH) Act as a component of the American Recovery and Reinvestment Act, which will provide $20 billion through 2014 to promote the use of health information technology.5 

Despite this incentive, nurse managers are still reluctant to introduce computer-based nursing to their institutions. This could be a lack of knowledge about technology. Roussel & Swanburg (2009), stated "Although technical tools, especially computers, continue to be invented and rapidly placed in industry, the ability of organization to accept, accommodate and even embrace technology is moving at varied pace."6

What is even more disturbing is "the healthcare industry has been one of the slowest businesses to embrace the computer revolution in regards to patient care, and nursing being one of the slowest to embrace technology to its fullest."6 This further attests to the fact "nurse leaders need to embrace technology, advocating and supporting its use in all nursing operations to meet the demand for high quality care."6

To meet these demands, EMRs must be incorporated in the nursing profession.

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Reluctance to Change

Why are nurses reluctant? Several factors could explain their apprehension: fear of change, fear of losing control due to unfamiliarity with technology, and the time to invest in such a tremendous task. These are all valid concerns and need to be taken into consideration.

Welford (2006) states, "Change in nursing should be implemented with the needs of patients as its focus and the provision of a high quality service as its goal."7 With the needs of patients in mind and a high quality patient care as our focus, changes will be easier to accept and will lead to a more successful outcome.

Further studies into the reluctance of nurse managers accepting this new innovation could also be attributed to their education. Seeley (2009), in his studies found, "organizations with leaders having a longer tenure and higher level of education are more likely to be innovative" and accepting to changes.5

Lin et al. (2007) stated in their studies nurse managers are regarded as the most important assets of a hospital and because of that, their managerial responsibilities have increased. But with this increased responsibility, they have not received good training in management principles and so lack the educational preparation to make good decisions. With the increased demand and   constant changes in healthcare, nurse managers are forced to evaluate and upgrade their knowledge and skills in technology (p.157).8

Nurse managers can upgrade their skills through training in computer technology, taking classes, or attend in-services. They can even form a support group among other nurse mangers to motivate and assist them in learning this new skill.

Privacy & Security

Some critical issues that could delay the implementation of EMRs in healthcare are privacy and security of patient's pertinent health information. These are valid concerns and these issues should be addressed on all levels of nursing.

Nurses should be constantly reminded to ethically handle patient's information and also of their ethical obligations to the nursing profession. Also these issues are addressed and provisions are made to protect patient's information. Other critical areas nurse managers might be concerned about are the time to invest in this innovation and the educational ability of staff.

Education & Training

To address the issue of education and training nurse managers are encouraged to utilize the many resources available to them.

Resources can be obtained from the American Nurses Association and other nurses' organizations, which have endorsed and have made provisions for nurses to be educated and trained in IT. Nursing schools are now including nursing informatics in their curriculum to prepare nurses to deliver quality care through technology.

Griffin-Sobel et al. (2010) alluded to this fact by stating "Nurses must emerge from educational programs competent in the documentation of patient care using electronic health records and knowledge about privacy and confidentiality safeguards within information systems."3 The students at Regis College, along with the faculty and their clinical agency, were expected to create a climate where they can inspire commitment to lifelong learning in response to the rapid changes in nursing and healthcare.

Another critical issue nurse managers face is the gap in technological education among nurses. Newer nurses are now graduating from nursing schools with computer knowledge while older nurses with more experiences in nursing lack this skill. To bridge this gap, nurse managers need to introduce IT in the work place enhancing the nurse's knowledge.

Nurse managers can hire nurses who are skilled in computer science and nursing informatics to train and educate these nurses. Furthermore, nurse managers can set aside time to offer in-services and training on nursing informatics. Also they can utilize these resources to assist them to improve their skills and alleviate any fears. As an incentive, nurse managers can also offer tuition reimbursement to those nurses who are interested in returning to school for higher education. 

Incorporate Technologies

Nurse managers, because of their position in nursing, should use their influence to embrace the change to EMRs, to improve patient documentation; improve patient care and safety; and to help providers have easy and quick access to patients' vital health records.

IT has the potential also to enhance nurse's education making the nurse more efficient and competent in patient care. Nurse managers should be proactive and visionary leaders, revolutionizing the nursing profession for the next generation.

Nurse managers should incorporate these technologies in the nursing profession and to equip staff with the tools necessary to do their jobs competently. After all, patient care is our business.

References

1. Bembridge, E., Levett-Jones, T. & Jeong, S. Y. (2010). Discussion paper: The preparation of technologically literate graduates for professional practice. Contemporary Nurse, 35(1), 18-25.
2. Samoutis, G., et al. (2007). Implementation of an electronic medical record system in previously computer-naive primary care centres: a pilot study from Cyprus. Informatics in Primary 2007, 15, 207-16.
3. Griffin-Sobel, J.P., et al. (2010). A transdisciplinary approach to faculty development in nursing education Technology. Nursing Education Perspectives, 31(1), 41-43.
4. Green, S.D. & Thomas, J.D. (2008). Interdisciplinary collaboration and the electronic medical record. Pediatric Nursing, 34(3), 225-227,240.
5. Seeley, B.E. (2009). Introducing a computer-based electronic record: Perceptions of clinicians. Urologic Nursing, 29(5), 329-335, 352.
6. McHaney, D.F. (2009). Information management and technology. In L. Roussel & R. Swanburg (Eds.), Management and Leadership for Nurse Administrators (pp. 428-25100). Boston: Jones and Bartlett.
7. Welford, C. (2006). Change management and quality. Nursing Management, 13(5), 23-25.
8. Lin, L., et al. (2007). Management development: A study of nurse managerial activities and skills. Journal of Healthcare Management, 52(3), 156-169.

Ruby Brooks is a student at Regis College, Weston, MA, pursuing her master's degree in leadership and business management.


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