Nurses are expected to provide compassionate, high quality and safe care in an increasing technical environment. The role of the practicing nurse has evolved over the years as the rise in the use of clinical technology has become a part of nursing practice. "High touch" is now high-tech, as hospitals and health systems equip nurses with new tools and sophisticated nursing technologies intended to enhance care, improve safety while meeting health reform criteria for meaningful use.
Workforce Demographics & Technology
The average mid-aged nurse who grew up without smart phones, iPads or wireless computing may feel overwhelmed with the prevalence of technology in the nursing field. The plea, "I'm just a nurse" is a defense uncovering a nurse's anxiety when faced with the challenges and complexity of using advanced technology. A sense of loss in their autonomy and a lack of trust in the technology is often heard. Over the next few years, these "digital immigrants" will be further disadvantaged in keeping up on a rapidly technical environment; one that's driven by federal health reform, to be fully electronic.1 On the other hand, nurses with higher levels of technology competence, the self-proclaimed "gearheads", will feel empowered in this digital environment. These nurses will use technology to delegate non-value tasks to, while increasing their time in critical thinking and bedside activities, which no technology can replace.
It's inevitable that a plethora of sophisticated technologies, including advanced smart devices, real-time locations systems, robots, patient monitoring, etc., will continue to transform nursing practice. According to a recent HealthLeaders Media Intelligence Report on capital spending, respondents shared that 27 percent of their capital funds will go to nursing technology this year. Therefore, it is imperative that nurses become fluent and capable of using the technology to practice safely and effectively.
It is a nurse's professional responsibility to advance their education and be "forever students of nursing". Nurses must stretch the boundaries of their education beyond just clinical and into the domain of technologies. The Institute of Medicine (IOM) and the Robert Wood Johnson Foundation (RWJF) jointly created a roadmap to transform nursing in order to respond to the changing healthcare environment. The IOM report, "The Future of Nursing: Leading Change, Advancing Health" released on October 5, 2010, provided a bold message in regard to the nursing education and training.2 The report contains a "blueprint for action" in the form of eight recommendations with specific actions, one of which distinctly mentions, ensure that nurses engage in lifelong learning. There is no doubt that the development of competencies in nursing technology falls within this recommendation. How can nurses, of every level, become fluent in nursing technology?
· As technologies move closer to the bedside, the practicing nurse naturally becomes the largest user of technology. Therefore, it is critical that ample time and, yes, resources are allocated to the training and education of these users. This means removing the nurse from the distraction of a busy shift and allowing them to learn and practice in a safe environment, either in simulation or a demonstration lab. Multigenerational learning should also be considered when educating the nurse. In terms of technical competency, the experienced nurse may require more time and coaching compared to the new graduate nurse. Expanding the limits of education to how the technology impacts nursing practice and benefits patient care instead of how to simply use technology is a requirement.
· Charge nurses require the same technology competencies along with skills in mentoring and motivating others. They should regularly provide feedback and coaching to other practicing nurses along with nursing management.
· Nurse managers should fully understand the benefits of the technology while engaging staff to know how to use the system, not just the technology. In addition, they should regularly measure and evaluate the technology to gauge results and report outcomes.
· Nurse managers and nursing leadership should continue to monitor whether the technology meets the needs of the nurse and patient. They should analyze if the technology helps to recover nursing time, improve safety and even reduce/eliminate the potential for human error. A holistic view of credible, comparative information helps them understand the full potential of the technology on overall operations.
A Collaborative Approach
Nurses are at the center of care coordination and intimately familiar with the flow of nursing work and thought processes. Hospitals too often assume the technology decision and implementation process is the responsibility of the IT or biomed department. IT or biomed may be motivated by a different set of goals than nursing. Therefore, it's vital that the voice of the nurse be heard and included in the decisions for any technology impacting patient care. It's important to engage nurses early in the design, selection, implementation and evaluation of technology. Failing to do so introduces tremendous risk and usability issues. A multidisciplinary approach, including a variety of experienced, new graduate and specialty nurses, is key to helping the hospital gain the maximum benefit in the adoption of technology. More importantly, it allows for the vision and voice of the nurse to be heard.
Nurses should embrace the opportunity to actively participate in the selection and implementation of nursing technologies with IT and biomed. Nurses, along with their interdisciplinary colleagues of physicians, pharmacists, informaticists, and other caregiving departments can offer invaluable feedback on the way a technology interacts with the profession, and ultimately the patient. Technology should simplify a nurse's work, not add to it, and provide guidance for the safe delivery of care. The best way for nurses to get involved in technology decisions and implementations is to:
· Ask nursing management, informatics and leadership about opportunities to participate in interdisciplinary technology committees that align closely with your specialty.
· If there are no committees, question how nursing can insert themselves on future technology projects.
· Review draft materials and monitor committee activities through meeting minutes. With the coordination of the nurse manager, attend meetings in person.
· Read up on the technology and ask questions as the meeting progresses. If the technology does not meet the workflow and information flow requirements, be sure to highlight it with committee members.
· If unfamiliar with the language used in the meeting, ask for clarification and seek opportunities to learn more.
· Network with others affiliated with the technology either through conferences, webinars, blogs, Twitter, Facebook, LinkedIn, etc.
Getting nurses involved in selecting and implementing nursing technology requires investment, as much investment as the technology itself. It requires education and evaluation time, as well as nursing leadership to say it is important to have nurses involved in the entire lifespan of the project.
Guidelines for Leveraging Technology
Technology will play a leading role in the future of nursing and healthcare. Like any investment, a key set of core principles should guide nurses in the development and evaluation of any sophisticated technology. Leading edge technologies implemented in your hospital should always:
· Improve the safety and efficiency of patient care.
· Increase nursing time with the patient and family by freeing the nurse of non-value added activities.
· Bring evidence for decision making at the point of care.
· Create a better work environment for the practicing nurse.
· Enhance nursing workflow while supported by the hospital's IT infrastructure.
The changing healthcare landscape requires the nursing profession to rethink its relationship with technologies. The call is loud and clear. To thrive in the digital era, nurses must come together and engage in the rapidly advancing technology revolution.
1. The Technology Informatics Guiding Education Reform. (2009). The TIGER Initiative. Collaborating to integrate evidence and informatics in nursing practice and education: An executive summary. Retrieved March 12, 2011 from the World Wide Web: http://www.tigersummit.com/.
2. Stubenrauch, J.M. (2010). Report on the future of nursing. American Journal of Nursing, 110(12), 21-22.
Susan Niemeier is CNO and clinical product manager, Capsule, a medical device integration company based in Andover, MA. Ruth Suchomski is an application analyst at Aspirus Wausau Hospital, Wausau, WI.