As an educator and consultant, I travel constantly. This allows me the opportunity to observe patterns of behavior across the United States and Canada. Based on my observations at a number of hospitals, I am concerned that the distractions of personal smartphone use have become a critical threat to patient safety.
It is 6:45 in the morning, and as I pass a patient in the ED, I see a nursing assistant watching a movie on her phone. She is supposed to be monitoring the 1:1 suicide risk, yet she appears so intrigued with the movie that I wonder if the patient is safe—or perhaps wants to talk.
Earlier that same day, a nurse tells me a story of calling the rapid response team because her spinal cord patient was in respiratory distress. The two nurses at the desk told her to “hold on a minute” when she called out for help because they were engaged in social media on their smartphones. I didn't believe this story, but the manager verified the event.
Two patients in another hospital have suffered critical injuries from recent falls, and the chief nurse tells me she thinks she should start a falls initiative. I ask permission to roam the hospital floors, and after two hours I can see for myself that when nurses have a free moment they are checking their personal messages instead of their vulnerable patients. Unfortunately, these nurses, like others, are totally unaware of their situational blindness—a perceptual state in which a person engaged in an activity is “blind” to aspects of their environment.
Research in other areas confirms that these are not isolated incidents. A survey by Smith and colleagues (Perfusion, 2011) found that 49% of perfusionists admitted texting during a cardiopulmonary bypass. And in a study by Katz-Sidlow and colleagues (Journal of Hospital Medicine, 2012), 19% of residents and 12% of attending physicians reported having missed important information on rounds because of distraction from smartphones. Is there any ethical professional who would argue that this is acceptable?
Every single hospital I visit has a social media/cell phone policy in place, yet that policy is universally ignored. This is unsurprising—in a study in Korea by Cho and Lee (Nurse Education Today, 2016), only 15% of nursing students “agreed or strongly agreed” with a policy for restricting cell phone use in hospitals.
To investigate further, I led focus groups on a large hospital unit to identify behaviors that compromised patient safety and quality care. “Cell phone use” was listed as a “frequently seen behavior,” but then never selected by the group as a factor detrimental to care. When I asked nurses why they responded as they did, they admitted simply, “We want our phones.”
It's no secret that many people are now so emotionally attached to their smartphones they feel anxious without them. Yet common sense and a growing body of research suggest they distract us from both cognitive and physical tasks. Even if nurses are unaware of the research, choosing to use a personal cell phone at work constitutes a rejection of the vigilance that is the most essential function of nursing.
Nurses are minimizing the impact of personal cell phone use on the unit and rejecting human factors research in order to alleviate their subconscious anxiety over being disconnected from family and friends. This is classic cognitive dissonance.
I am not denying the many advantages of smartphones. The problem is the insidious way personal smartphones divert and fracture our attention. If you don't take work home with you, why is it okay to bring home to work?
Our patients deserve our full attention. This is impossible when our family and friends have perpetual access to us. As a single mother of five, giving out the unit phone number as my primary contact for emergencies worked for decades and still does.
Our primary ethical responsibility is to “first, do no harm.” Professional nurses keep personal cell phones in their lockers, accessible only during breaks. And effective nurse leaders ensure that policies match reality.