Secondary Logo

Journal Logo

Original Articles

Using Technology to Build Trusted Relationships Between Nurses

Samolis, Kelly BSN, RN; Pointer, Emma BSN, RN; Rolfes, Chelsea BSN, RN; Spafford, Courtney BSN, RN; Elsbernd, Ashley BSN, RN; Black, Stacie BSN, RN; Riddell, Lindsey BSN, RN; Brown, Casady BA; Lind, Anna BSN, RN

Author Information
doi: 10.1097/NAQ.0000000000000434
  • Free
  • Continuing the Conversation

Abstract

IN RECENT YEARS, travel nursing has been in high demand and temporary or supplemental nurses account for approximately 30% of the nursing workforce in the United States.1 The growth in the travel nursing industry is attributed to a combination of a nursing shortage, an increase in nurses leaving long-term roles at health systems due to burnout, and a changing workforce that is looking for more flexible work environments.2 By 2022, 1.1 million new nurses are needed to close the gap for a nursing shortage;3 yet, organizations are still using outdated recruiting, poor technology practices, and setting goals to eliminating nonpermanent labor from the balance sheet.4 There is a real need for organizations to find a different way to recruit and engage their travel nurse colleagues to deliver care efficiently and effectively. As the workforce becomes more flexible and dynamic, technology can be used to build trusting relationships, engage the flexible nursing workforce, and lead to an evolution in the professional practice of nursing while closing the shortage gap.

On average, Internet users spend 6 hours 30 minutes per day online.5 Eighty-six percent of the users in the United States are using the Internet via mobile devices.8 Patients are using secure messages to connect with their care teams, and nurses are using apps to support patient care; yet, the leadership of teams remains staunchly founded in the belief that in-person interaction is the only and best way. While in-person relationships and interactions are a core of any team over time, there is growing evidence and examples that meaningful and impactful professional relationships can be started, built, and maintained through a technology-first approach. For the travel nurse industry, technology is essential for supporting their professional practice, career growth, and moving them from location to location over time. Traditional approaches to travel nurse interactions have been through the use of people and recruiters, but there are emerging examples of how technology-forward approaches can build connections and community with travel nurses to provide them with support similar to that received in a permanent role. It is time for hospital administration and nurse leaders to join the wave of technological connection and advancement. Understanding the use and experience of the technology-enhanced travel nurses paves way for a relationship that is mutually beneficial to both the hospital and nurses along with their career goals.

TECHNOLOGY SUPPORTS PROFESSIONAL PRACTICE AND TRANSPARENCY

Travel nurses are increasingly seeking more transparency and autonomy throughout their careers. In the past, travel nurses have been beholden to opaque processes that held most information behind a single recruiting contact. This forced nurses to spend more time negotiating pay rates, digging for information about facilities, and relying on manual processes to get the travel job they desired. In worst-case scenarios, nurses were going into unfamiliar places blind and taken advantage of by recruiting companies with misaligned incentives and little to no information to share. As we enter the sociotechnical era, the modern technological world can dramatically influence a positive change in terms of relationships, culture, and professional interactions for these nurses. This technological change can occur through social media, relationship-building platforms, and other systems that allow nurses to collaborate. This collaboration, in turn, creates transparency of information and provides autonomy in their careers. Technology allows nurses to work across many different health care locations while maintaining their professional practice and connection to their peers. Nurses no longer have to work in one facility for years to feel connected to colleagues and the profession.

There is a growing assumption that technology enforces less holistic or superficial relationships between people. The principle of human touch and personal connection is a foundation within the practice of nursing that technology enhances rather than replaces. In the growing digital economy, there is also a way to build meaningful and impactful relationships between nurses using technology. Not only can technology help connect nurses professionally and emotionally but it can also be used for sharing knowledge, evidence-based practices, and experiences. For example, using Customer Relationship Management (CRM) technology, teams can create personal profiles and log personal preferences. Profiles may include the name of their spouse, their favorite place to travel, or their communication preferences. They may also include notes on the nurse's professional competencies so that the process of interaction is personal and focused. As nurses interact with the CRM platform, these profiles allow teams to quickly learn about nurses and have meaningful dialogue. Other examples of technology that provide connection asynchronously include Slack, Zoom, and Tandem, all which allow for virtual meetings, virtual break rooms, and instant communication across people, places, and time. Not only can technology help nurses connect professionally but nurses are additionally able to create communities to support them in a more personal way as well.6

Technology can also create negativity within the profession. Leaders must be aware of the influence and impact technology and social communities have on the perceptions and interactions of nurses in their organizations. Travel nurses can often feel less respect or value as supported by one study of 444 nurses who reported that it was difficult to influence change among units due to lack of receptiveness or support.7 This is especially concerning as travel nurses are often a great asset that can provide very meaningful feedback if asked. They often possess a unique point of view due to the volume of health system policies and procedures they have experienced firsthand throughout their time traveling facility to facility. That unique point of view can be tapped into to discover what did and did not work and why. While currently nurses may not express this directly in their interactions within an organization, they tend to express concerns, issues, and frustrations in their online community more openly. Nurses have created negative communities online that highlight the staffing, patient, and peer challenges that they face. With the correct facilitation, that negative feedback has the potential to turn into constructive criticism that leads to meaning within the nursing profession.

There is a growing need for leaders to understand how to build positivity and connection in the nursing workforce beyond in-person meetings, simple job boards, and online chats that dominate today's reality. By building professional relationships and practice beyond the brick and mortar health systems, we open the opportunity to create a more flexible and dynamic workforce that can shift as patient care evolves and demand for nursing services increase.

BUILDING A CULTURE OF CONNECTION

As frontline caregivers, educators, and leaders for health care, nurses should have access to information not only to do their job but also maintain their career. To build the future of nursing, enabled by technology, nurses need to build a culture of connection.

Schein8 identifies culture to be made up of 3 concepts: artifacts, values, and deep assumptions. We discuss how artifacts and value can be influenced through technology. Deep assumptions change as artifacts and values change. Artifacts and values provide a conceptual framework that allows nurses and nursing leaders to build engaging technology-driven relationships. In a physical hospital unit, artifacts can include physical layout, dress code, norms in giving the end-of-shift report, and routines in accomplishing daily work and connecting with colleagues. In a virtual unit, one that is decentralized across the country but made up of nurses connected through technology, artifacts may be shared as short videos showing interaction, emojis to express emotion, or the tone of the text and e-mail messages exchanged amongst the group. Technology can enable culture creation virtually just as in-person interactions can.

Schein's8 model further described the concept of values as the assumptions underlying the norms of a group. Values that are formative in the success of a nursing team include the individual's need for transparency, diversity, and autonomy. Surprisingly, these values can be enabled virtually as well. For example, technology enables the curation of job and facility data, pay rates, and professional competency requirements that allow nurses to find, consume, and act on data autonomously. Unlike a physical environment in one time zone, virtual nursing communities span the globe. This increases both diversity of thought and the number of connections that occur every day. Leaders can influence virtual communities through tone, posting relevant information, and asking intentional questions that begin to establish the values and guidelines the virtual community will abide by.

The goal is to create a culture with artifacts and values that accept open feedback, embrace trending communication, and present accessible information. Gauging preferences of interaction, e-mail, phone call, text, even favorite emojis or hashtags is one way the support fosters an open relationship tailored to the individual. In fact, emojis are artifacts that can shift the entire intention of electronic communication. They change a stale e-mail into an emotion-filled communication that can be interpreted much better than text alone. By being personal, adding emotion, and tying in individual preferences such as pet names or family birthdays, teams can build relationships and ultimately change a culture from transactional to transformational.

MOVING FROM TRANSACTION TO TRANSFORMATION

Virtual interactions with nurses have traditionally been very transactional. For example, nurses usually get one-way communications in an e-mail about needs for staffing, compliance requirements, or other system-focused needs. However, nurses rarely get technological interaction that is supporting their professional practice, job, or career goals. Movement from this transactional communication to one of transformation is needed and can best be done by utilizing a nurse-to-nurse relationship developed on the idea that the best person to advocate for a nurse is another nurse who best understands them and their needs.

The foundation of the nurse-to-nurse relationship is created the moment nurses begin their career. This professional connection allows for another to understand the pains, fears, highs, and lows of the other person and forms the foundation for transformational relationships. Nurses who support nurses create an instant bond through shared experiences with a once stranger. These experiences include the unexplainable mix of emotions that come with passing the NCLEX, your first code blue, watching a severely ill patient recover, and the gut-wrenching feeling of being there as a patient takes his or her final breath. By knowing that another human has felt what you have felt and seen what you have seen, the core of the nurse-to-nurse relationship, nursing camaraderie, is developed. Technology can enhance this trusted relationship by allowing nurses more modalities to express their connection and reach out to colleagues.

In addition to community and connection, formal training and experience as a nurse translate well into roles that support nurses. Nurses are experts in building trusted relationships and engaging in difficult conversations.9 The same way that a nurse can form a strong, trusting relationship with a patient in 12 hours at the hospital, nurses can build a strong relationship with other nurses through a virtual relationship via a technology platform.

Recently, the COVID-19 pandemic impacted health care systems across the globe. Many nurses on the front lines had questions about safety, pay, support, and care that were not able to be answered by individual facility leaders. Using a transformational online relationship of nurse supporting nurses, communication was able to flow easily within that relationship. Maintaining the transformational connection was crucial in the presence of a chaotic event. When issues came up with travel nurses at the forefront of this pandemic, technology allowed the nurses to bond together with like minds and navigate through problems efficiently.

TOOLS TO SUPPORT QUALITY RELATIONSHIPS

Technology can enhance relationships between nurses through the use of data aggregation platforms and CRM systems. The data that are collected can give managers visibility into where their team needs help and support. For example, one technology company has created a burnout index that takes personal preferences of nurses, uses an algorithm, and prioritizes information to nurse managers to uncover those nurses at risk for burnout.10 With nurse managers having up to 150 direct reports, technology may be the only way to effectively stay in touch and connected to their staff. Other systems such as CRM tools also enable teams and clients to engage more personally. CRM tools allow data from social media, personal preferences, and all communication channels to be aggregated and used for insights to help personalize interactions within teams. Nurses should utilize these tools to create better connections with each other.

Utilization of CRM technology is one of the strongest and the most efficient approaches in creating, developing, and maintaining strong and personalized relationships with individuals. Businesses use CRM tools to collect, report, and house their customers' important personal information. In turn, their internal staff can easily gain insight into the behavior of their customers and modify their business operations to ensure that customers are served and cared for in the best possible way. Nurse leaders can use CRM systems strategically to learn more about their nurses' or consumer needs and behaviors to develop stronger relationships.

From that strong foundation built on CRM systems, teams can deliver targeted messages to the right person at the right time and place. Having the ability to build out audiences means teams can automate their communication. Using automated communication can allow businesses to be proactive and help their customers even before the customers realize they need something. It enables teams to create a personal experience, while also being efficient. Fast-growing businesses no longer need to sacrifice experience while scaling.

Nurse leaders can use the information stored in their CRM systems to deliver the right message to the right nurse. Sending out general messages to the entire team can feel impersonal, and it shows that management is not attuned with their staff or consumer base. With anything that involves multiple types of people and work personnel, it is not realistic to intrude on the employees' workflow to hold in-person meetings for every change or announcement that needs to be made. The planning and the time that goes into those meetings are wasteful and can be replaced by other forms of communication. When nurses receive e-mail after e-mail that is unrelated to them, it becomes white noise. Having the ability to target certain audiences ensures that the communication being sent to a nurse is consistent, concise, and valuable.

Having an in-house platform to house all company processes, product updates, workflows, communication guides, and FAQs allows each team to share important information with each teammate and the organization as a whole. In today's society, the workforce is mobile and spread across different offices, cities, and time zones. Businesses need a product that gives the individual contributors the knowledge they need to do their job. It is also crucial to understand how different teams within the same organization operate to easily connect to them. This visibility allows leaders to execute effective cross-functional team projects and ensures that product development aligns within the entire organization.

Overall, technology can improve both relationships with nurses and enhance their careers. Building relationships through technology is imperative and is best done through efficient tools such as CRM systems, automated communication, and productive e-mail communication. The tools and technology being used are only as effective as the implementation of the use. Keeping the user first and personal in the process must always be at the center to induce trusting relationships through technology.

HIGH TOUCH AND HIGH TECH: NURSES CAN CHOOSE

One of the most fundamental elements needed to build a trusting relationship with nurses is transparency. Technology is crucial in that it allows facilities to maintain transparency by providing travel nurses with the information they need, especially when it comes to finding and maintaining a job. Travel nurses are typically applying to roles with minimal knowledge about important details such as specific job requirements and pay. This lack of information and transparency limits the nurse's ability to easily find appropriate roles, make informed decisions, and negatively impacts overall career satisfaction. When it comes to nursing compliance, a lack of information can greatly impact nurses' ability to fulfill requirements and fully manage their career development. To support nurse autonomy and professional advancement, technology can be leveraged to directly provide nurses with the information they seek, such as specific job details, pay packages, and how to go about maintaining licenses and certifications.

Another important factor in nursing relationships is personal interaction. While technology can provide nurses with facts and information, personalized interaction may enhance and guide nurses through tough decision-making processes, such as changing specialties or moving to a different facility. Connecting nurses with other nurses allows for the opportunity to learn from other's experiences and helps guide nurses in making decisions about their careers. Adding in human interaction and a personal touch point also promotes a sense of community, which can improve nurses' overall career satisfaction. Technology can facilitate these personal interactions by allowing nurses all over the world to connect and support each other through social media and nursing-specific Web sites. Using a blend of technology and human interaction, relationships can be enhanced during various career development stages as highlighted in the Table.

Table. - Combining Human Touch With Technology
Examples Human Touch Technology
Job search It is critical to provide firsthand experience and support throughout the job search process. Job-related search engines and CRM technology
Certification renewal and tracking It is helpful to have support and resources if needed. Healthstream, Braze, and CRM technology
Nursing community Career development is essential to assist with starting a new career. Social media; Facebook groups, Instagram influencers, blogs, and podcasts
Nurse-to-nurse support Having peer support is critical to enhancing trust and support. Shared inboxes, CRM tools
New graduate resources Nurse residency support groups enhance the support in the beginning of new graduates' nursing careers. Blogs, resources for new graduate job search, licensure information, and NCLEX review courses
Licensure process It is helpful to deliver and provide nurses with accurate and comprehensive support. Licensure guides
Abbreviation: CRM, Customer Relationship Management.

Technology can both support nurse autonomy and provide increased personal touch throughout the user experience. Nurses are trained to make informed decisions in a clinical setting and thus their career decisions are naturally inclined to be information-based as well. Having user-friendly technology and information at the nurse's fingertips leads to informed career decisions and improved experiences

CONCLUSION

Throughout the nursing profession, technology is being used to enhance and support relationships all over the world. Travel nursing has embraced the connectivity of technology as a need since a travel nurse crosses physical barriers by design. As staff nurses and nursing leaders innovate in response to the technological wave, they should look to the travel nursing industry for guidance so that all forms of staff are empowered by the transparency and autonomy technology can provide. The COVID-19 crisis is a great example of how relationships through technology are actively building knowledge, trust, support, and providing resources to our nursing profession. Technology is the foundation of the relationship between nurses in this era, which is not replacing a personal touch but, rather, further enhancing it. Using technology to support nurse-to-nurse interactions allows those interactions to drive career dialogue and fosters transparency in the flow of information. The proper implementation of technology will allow nurses to continue a culture of support in the technology age.

REFERENCES

1. Faller M, Dent B, Gogek J. A single-hospital study of travel nurses and quality: what is their impact on the patient experience? Nurse Leader. 2017;15(4):271–275.
2. Owens N. The nursing shortage: a status report. J Nurs Educ Pract. 2019;9(3). doi:10.5430/jnep.v9n3p125.
3. Baker LC, Phibbs CS, Guarino C, Supina D, Reynolds JL. Within-year variation in hospital utilization and its implications for hospital costs. J Health Econ. 2004;23(1):191–211. doi:10.1016/j.jhealeco.2003.09.005.
4. Gerber H. Is US headed for worst nursing shortage? INQUIRER.net USA. https://usa.inquirer.net/8427/us-headed-worst-nursing-shortage. Published November 29, 2017. Accessed March 23, 2020.
5. Internet Trends. Bond. https://www.bondcap.com/pdf/Internet_Trends_2019. Published June 11, 2019. Accessed March 18, 2020.
6. Walsh University Online. How nursing has changed with technology. https://online.walsh.edu/news/how-nursing-has-changed-technology. Published July 12, 2018. Accessed March 2, 2020.
7. Cooper A. Travel Nurses' Experience of Organizational Change: An Experimental Study. Tallahassee, FL: Florida State University; 2008.
8. Kukreja S. 2020. Edgar Schein'S Model Of Organizational Culture. [online] Management Study HQ. Web site. https://www.managementstudyhq.com/edgar-schein-model-theory.html. Accessed August 18, 2020.
9. Ozaras G, Abaan S. Investigation of the trust status of the nurse-patient relationship. Nurs Ethics. 2016;25(5):628–639. doi:10.1177/0969733016664971.
10. Laudio. Laudio transforms managers into exceptional leaders. Laudio Web site. https://www.laudio.com. Accessed March 23, 2020.
Keywords:

relationships; technology; travel nursing; workforce

© 2020 Wolters Kluwer Health, Inc. All rights reserved.