Nursing is in the midst of a major transformation. Nursing students, faculty and practitioners are under pressure to master evidence-based practice, clinical decision support tools and the continually evolving electronic health record (EHR).
Having largely left behind manual documentation, nurses now confront a daily patient-related data deluge thanks to the proliferation of mobile devices and clinical decision support tools.
Among nurses' most pressing questions are:
- What does the tidal wave of data mean and how will it influence patient care quality, safety and efficiency?
- Will nurses be able to manage technology or will technology manage nurses?
- Could technology change faster than nurses' ability to adapt to it?
- How can nurses overcome their discomfort to better adapt to changes in clinical practice and fully integrate new technologies into clinical workflow?
The answer: New, emerging and veteran nurses alike all need the knowledge, skill and perspective to make sound decisions through multiple clinical and business technologies, including the EHR.
That, in turn, requires disciplined, ongoing support from nursing education and healthcare organizations.
Every nurse -- student, faculty member, researcher or practitioner - must help create education and work environments that support the adoption and use of the latest technologies.
They must adapt technologies to address nurses' core needs and priorities, including integration of evidence-based practice for standardized care, clinical decision support at the point of care, and use of meaningful data to measure nursing-sensitive outcomes.
Whether nurses are in the classroom or in the workplace, they want education, training and support on how to better integrate technologies such as EHRs into the workflow at the point of care.
They seek guidance on how to mobilize technology to make sound, evidence-based decisions, communicate with patients and care team members, and measure nurse-sensitive patient outcomes, which primarily focus on the prevention of complications.
The answer rests in persuading colleges, universities, career schools and healthcare organizations to support the evolving concept of the nurse as knowledge worker. Among the recommended actions:
- Build self-awareness, critical thinking and self-assessment skills among nursing students and practitioners. Teach them to question whether they're doing everything possible to engage in technology-enabled, evidence-based practice.
- Focus on organizational transformation. Empower nurses to create educational settings and workplaces that ensure the highest standards of patient care and create the best possible environments for care delivery.
Education & Attitudes
Nursing faces two underlying issues:
1. How well does ongoing nurse education support the integration of technology into nursing practice?
2. How do nurses' attitudes, beliefs and values influence - both positively and negatively - technology-enabled, evidence-based decision-making?
Resolving these issues depends on ongoing, evidence-based nursing education anchored in a series of reflective questions that are applicable to nursing students, faculty and practitioners:
- Ask: What is the best type of evidence or cluster of evidence to support this clinical decision?
- Access: Where is the place best to find this evidence? How can it be retrieved quickly and efficiently?
- Appraise: How well does this evidence meet the criteria of peer-review, timeliness, accuracy and completeness?
- Apply: Is this evidence timely, accurate, complete and content-rich enough to make sound clinical decisions? Will it be possible to use this evidence to justify and account for an evidence-based decision?
- Assess: How has the evidence-based decision influenced patient care quality, safety, efficiency and outcomes? If the impact is negligible, how did the decision-making change? Or should other evidence be reviewed?
To address these challenges, education and healthcare organizations must initiate change on multiple levels, including culture, policy and practice, mobilization of tools and resources, and promotion of vanguard nursing education initiatives. Among the recommendations:
- Build a technology-friendly culture: No matter where nurses are positioned along the career continuum, they need a culture and environment where evidence is valued over opinion, evidence-based action trumps action for action's sake, and evidence-based discussion and debate are encouraged. Several forward-looking organizations have involved nurses in software planning, selection, implementation and management, echoing results from an October 2011 survey that correlates EHR satisfaction with involvement in EHR selection.
- Match policy and practice: Educational institutions and healthcare providers must work together to build education policy and practice around best practice results, track program outcomes, implement objective metrics, and engage in ongoing evaluation. Faculty, managers and executives should model information search and retrieval so nurses can master how to search and access medical databases, pursue ongoing technology education and conduct evidence-based practice research.
- Hire the right people. Equally important to success is hiring managers and executives with nursing informatics credentials, including the chief nursing informatics officer (CNIO), who has emerged as "the leader for nursing in the design and execution of technology-enabled process changes that maximize patient safety, quality of care and operational efficiency," according to Linda Hodges, senior vice president, IT Practice, Witt/Kieffer.
- Choose the best tools. Multiple tools are available to nursing students, faculty and managers-from smartphones, MP3 players and blogs, to wikis, computer-aided assessments and micro and macro simulations. Students can master the EHR via virtual clinical case studies, evidence-based simulations and simulated electronic documentation systems.
Teaming on Technology
Getting value from new and emerging technologies, including EHRs, requires cooperation and collaboration between nursing education professionals, associations and administrations.
Educational institutions can support the practitioner community with facilities and guidance on standards for lifelong technology learning and mastery.
Hospitals and health systems can build workplaces that foster technology education, nurse involvement in technology decision making and technology-enabled innovation.
Working together, nurse clinicians, association professionals, faculty and executives can help transform the healthcare system through effective use of technology.
Ainslie Nibert is vice president, Review and Testing, Nursing and Health Professsions, producing the HESI computerized testing program of Elsevier.