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Nurse managers as knowledge workers

Conrad, Sharyn DNP, RN, FNP-BC; Sherrod, Dennis EdD, RN

doi: 10.1097/01.NUMA.0000393010.34127.44
Department: Career Scope: South Atlantic

Sharyn Conrad and Dennis Sherrod are faculty members in the Division of Nursing at Winston-Salem State University in Winston-Salem, N.C.

Healthcare reform's emphasis on improved access, increased quality, and decreased costs is focusing particular attention on the use of technology and the development of electronic systems for data collection and analysis. As increasing healthcare costs are highlighted by the media, the national strategy for decreasing these costs is almost unanimously touted as implementation of electronic health records (EHRs) and technologies that will increase healthcare efficiency and prevent service delivery fraud and redundancy.

Much of the challenge of matching technologies to specific patient-care units or service lines is guided by nurse managers and their staff. Although informatics nurses are helpful in conceptualizing and managing data entry and analysis systems, it's the nurse manager and nursing staff who determine which data can be most useful in guiding patient-care delivery and ensuring positive patient outcomes. Nursing units are collecting more and more data on a daily basis and nurse managers and their staff members need to begin now to develop knowledge worker skills to ensure accurate data collection, reliable methods of analysis, and logical findings and conclusions.

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A digital revolution

As units move away from paper documentation, the primary transformational elements for the "digital revolution" are expected to include EHRs, health information exchanges, and healthcare analysis tools.1 The first wave will be implementation of EHRs adapted to the workflow of primary care providers and healthcare delivery systems. Digital formats will be standardized so that data can be easily entered into health information exchange networks and analysis tools can be used to analyze data from large populations.1

Utilizing technology in healthcare promises to improve evidence-based decision making and should make it quicker and easier to share medical and nursing information with other healthcare providers, decreasing the cost of redundant tests and speeding diagnosis, treatment, and accuracy of healthcare decisions.1 National healthcare reform, or more specifically, the American Recovery and Reinvestment Act (ARRA), provides funding for technology systems infrastructure as the primary component of the global healthcare market's budget and is expected to grow healthcare technology expenditures from $35 billion in 2008 to $60 billion in 2013.1 If your healthcare organization hasn't already implemented EHRs, it's likely to occur in the near future—and the data and knowledge this provides will be more important than ever.

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Knowledge workers

It's vital that nurse managers develop knowledge worker skills related to data gathering, analysis, and identifying clinical trends and patterns. Hebda and Czar identify four specific knowledge worker skills utilized in patient-care delivery decision making: data gatherer, information user, knowledge user, and knowledge builder.2 For example, upon review of patient fall data (data gatherer) on your unit, you identify your fall rate is higher than expected. You interpret reports from patients, family members, and staff (information user) to gain insight into this important clinical issue. Individualized patient data are compared with evidence-based nursing knowledge (knowledge user). Clinical data on all patient falls in your hospital are then aggregated throughout your organization to create new knowledge, interpretations, and strategies to prevent future falls (knowledge builder) and improve patient safety outcomes.

As unit leaders, nurse managers need to equip themselves with skills to harness the power of electronic data systems and rapidly translate patient findings and information into knowledge that informs and produces quality patient-care outcomes. They must champion electronic technology initiatives on their units and develop approaches to instill excitement, education, and empowerment that assist unit staff to gather clinical data and identify patterns for delivering more efficient and effective patient-care services.3

This national technologic surge will surely impact nurse managers, as they're on the frontlines of patient-care delivery systems. Nurse managers have great influence on quality, efficiency, and integration of technology in this new healthcare dimension and can lead the way in the effective use of electronic technologies.

Nurse managers who develop and/or strengthen their knowledge worker skills are better equipped to be creative and visionary and are prepared to provide greater sustainability and growth for their unit and organization. These nurse managers are self-starters and have a high degree of autonomy.4 Nurse managers who develop themselves as knowledge workers and leaders are better able to understand, adapt, and drive new and evolving healthcare system technologies.

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Technology role models

For nurse managers to effectively move staff into the electronic information age of healthcare, they themselves must be competent in dealing with data information and knowledge. Nurse managers must possess and role model basic knowledge in word processing and the ability to use data spreadsheets, databases, electronic medical records, and the Internet. Other areas of skill development include data analysis and data decision making. Successful nurse managers will serve as technology role models by assisting staff to develop the ability to collect, analyze, and synthesize data that guide improvement of patient outcomes.

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Change agents for quality improvement

Nurse managers serve as change agents for quality improvements on their units and they can also serve as gatekeepers to implement or not implement new technologies. The best decision making occurs when leaders have an understanding of advantages and disadvantages of any new technology and its possible implications on patient care. Even if an organizational decision is made to go with a certain technology, individuals may be overtly or covertly supportive or not. As nurse managers develop electronic technology skills, they have a better understanding of the potential applications. Keep an open mind and look for opportunities in which technology may be helpful.

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Critical communicators

A nurse manager must possess the critical communication skills needed to keep staff members apprised of the data results, benchmarks, and outcomes of the unit—all of which improve patient-care delivery. The ability to work effectively and infuse excitement and teamwork for the changes being made requires that a nurse manager be skilled and committed to improvement in the healthcare outcomes on the unit. The importance of ensuring that electronic patient data remain private and confidential must also be communicated with staff.

Additional technologic skills useful to the nurse manager include electronic staff scheduling systems, online staff development, unit forecasting models, budget spreadsheets, research analysis, and finding needed Internet resources for the unit or patients. This isn't to say that nurse managers must be experts in one or all of these technologies, but a working knowledge is helpful.

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Be prepared for success

In summary, if your unit isn't currently utilizing an electronic patient record, you probably will be soon. Successful organizations in an era of healthcare reform must engage nurse managers who are knowledge workers, technology role models, change agents for quality improvement, and critical communicators. Nurse managers who incorporate knowledge worker skills and competencies will be better prepared to improve patient outcomes and assist their staff and unit to succeed in a complex and ever-changing healthcare environment.

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1. DePompa B. Technological advances key to healthcare transformation .
2. Hebda T, Czar P. Handbook of Informatics for Nurses and Healthcare Professionals. 4th ed. Upper Saddle River, NJ: Pearson Education, Inc; 2009.
3. Kirby KK. Are your nurse managers ready for health care reform? Nurs Econ. 2010;28(3):208–211.
4. McGonigle D, Mastrian K. Nursing Informatics and the Foundation of Knowledge. Sudbury, MA: Jones and Bartlett Learning; 2009.
© 2011 by Lippincott Williams & Wilkins, Inc.