At a meeting of emergency nursing leaders in early 1998, work groups were asked to brainstorm and come up with a no-holds-barred wish list for the future of emergency nursing. They could ask for anything they wanted to improve their practice or patient care. One request was for a “Dick Tracy watch” that could access all current evidence-based practice guidelines. The audience had a good laugh over that suggestion, and the general consensus seemed to be that none present would live to see such a magnificent invention come to pass. Fast forward about 10 years and, with the advent of smartphones, we were essentially there. If your wrist is big enough, you can strap your phone to your wrist and not only will it tell time but it will also give you access to the Internet wherein resides a variety of up-to-the-minute evidence-based guidelines and other clinical resources (not to mention letting you make calls à la Dick Tracy.) In fact, a few smart watches with a variety of functions have already been introduced (Oremus, 2013). However, with a 1.63-in. screen, the current models probably won't be adequate to download clinical references. Be that as it may, it is clear that readily available technology allows us to access current clinical resources from almost anywhere in the world. In fact, health care providers from developed countries take their devices with them on trips to undeveloped countries so that they can easily access information without carrying along several hundreds of pounds of books (see Figure 1).
Now that we have the technology, what are we doing with it? Some institutions, both clinical and academic, have embraced it wholeheartedly and even require that practitioners and students own a device and download specific books and reference material. Some issue devices to practitioners, either on a semipermanent or shift-by-shift basis. Some have departmental and institutional resources that live on individual devices and are synchronized to download updated information on a regular basis. At the opposite end of the spectrum are many facilities that prohibit the use of such devices in a clinical area, with consequences up to and including termination. In some settings, only nursing staff are prohibited and medical staff members are either explicitly or tacitly allowed to use their devices. Clearly, guidelines are needed to allow us to meet in the middle and take advantage of convenient, portable, and up-to-date information for the benefit of our patients.
Those who prohibit their use cite the many potential and actual downsides of these devices in the patient care setting. One of the biggest downside is the distraction factor. Practitioners may be distracted by playing games, responding to texts, or reading e-mail when they should be taking care of patients. Not only does that take time away from patient care but it could also lead to poor decision making by practitioners who are not focused on the issues at hand. The concern for invasion of privacy with camera, video, or audio recording is also legitimate, and the news is replete with examples of caregivers taking and sharing photos inappropriately. Next is the concern for vetted, consistent, and approved information resources. Information from one source may differ from the information in reference or from the institution's policies and procedures. Infection control is not often cited as a concern, yet it should be given that people may access these devices at the stretcher side without performing hand hygiene. Is there a manufacturer-approved disinfection protocol for a smartphone?
These concerns should cause us to collaborate and brainstorm to find solutions, not outright ban devices. We have solved bigger problems for less benefit that we stand to gain in this situation. If you have extensive, user-friendly resources readily available on computers at every stretcher side (and in the halls), you may argue that there is no need for personal devices. However, compare the applications available on smartphones and see whether truly comparable computer resources are present in your information system. In many cases, you will be disappointed with your computer resources and impressed with what a free application can do. Let's take the lead in figuring out how to safely integrate new technology at the stretcher side. Call a meeting, establish a committee, and start writing policies and guidelines. Be sure to include the younger, more tech-savvy members of your team. Share successes and stumbles so that we can all learn and progress together. Don't ignore this issue and hope it will go away. In fact, it is clear that a robust “smart watch” is the holy grail of the techie world. Expect to see new technology and applications released at a dizzying pace. Let's try to keep up.
—Jean A. Proehl, RN, MN, CEN,
Emergency Clinical Nurse Specialist
Proehl PRN, LLC
—K. Sue Hoyt, PhD, RN, FNP-BC, CEN,
FAEN, FAANP, FAAN
Emergency Nurse Practitioner
St. Mary Medical Center
Long Beach, CA