As nursing leaders, we understand the importance of building relationships. Positive patient outcomes depend on us working closely with our fellow nurses, physicians, support staff, therapists, and others throughout the healthcare organization. Due to healthcare reform, strong relationships are more important than ever, as noted in the Institute of Medicine's (IOM) 2010 Future of Nursing report. The IOM recommends that nurses be “full partners” with physicians and other healthcare professionals to lead improvement and redesign healthcare in the United States.1
After observing numerous healthcare organizations throughout the country, I've recognized that the importance of this full partnership also extends to our colleagues in the information technology (IT) department. With technology and innovation playing a vital role in patient care, nursing and IT leaders must collaborate on decisions that impact clinical workflow, timeliness of care, and patient experience.
Ask yourself: How's the technology that nurses use on every shift impacting care delivery? If technology is helping nurses connect with the electronic medical record (EMR), communicate with team members efficiently, streamline patient throughput, and respond quickly to patient needs, then you must be working closely with your IT department. If technology is hindering efficiency, then you probably need to take a more active role in identifying, selecting, and evaluating the technology on which your nurses depend.
Let's examine four technology initiatives underway in many of today's hospitals that benefit from a strong partnership between nursing and IT leaders.
Over the past 15 years, healthcare organizations have adopted EMRs to comply with a key provision of the American Recovery and Reinvestment Act. EMR vendors offer the technology platform to switch from paper to electronic records, which has enabled a completely different workflow for the healthcare environment. At the same time, hospital IT departments, chief medical information officers, chief nursing information officers, nursing leaders, and nurse informaticists have been working to build an architecture that supports clinical excellence. Working on EMR platform selection, technology adoption, and workflow must be a shared responsibility.
Unfortunately, in many healthcare organizations, the new EMR works in a vacuum rather than integrating with the way clinicians work. I was speaking to a neurologist recently and he shared that there are five different places in the EMR where he can document the same patient information. Although he had clearly articulated in the notes that a patient could be started on a certain medication, the next day he received a call from the nurse asking whether the patient should receive the medication. She hadn't seen the note simply because she hadn't looked at that particular field or location in the EMR.
It's important that when new EMR technology is implemented, we take an integral role in how that technology will be used. Consider how your EMR can enable efficiency and empower caregivers to provide the best possible care. Be sure your frontline nurses, staff, and providers have a voice in suggesting modifications that may improve the way the technology is used.
As I visit hospitals around the country, I hear nurses, pharmacists, and respiratory therapists saying, “If only we could do this or that differently.” Nursing leaders need to value this input from people working on the front line to get the full benefits of the technology. Consider the workflow of the staff with the EMR. In some hospitals, computers are in the patient room; for others, they're in alcoves along the hallway; and yet others are using workstations on wheels to transport the documentation center.
It's incumbent on leaders to observe and identify areas where nurses can redesign their workflow so documentation doesn't become the essence of care. When I observe workflow, I often see nurses focusing on the computer, leaving the patient in isolation of the system. One healthcare organization on the west coast implemented a process mandating that nurses take 5 minutes at the bedside without their workstation on wheels. This is an example of how staff and leaders came together to be certain that the patient experience isn't compromised by the EMR workflow.
Traveling to the Midwest, I took part in a discussion on sending EMR alerts to smartphones that was led by a group of nurse informaticists. When staff and informaticists collaborate to address the critical alerts for nurses and other disciplines, it becomes a game changer. This is when new, value-based care delivery models and enhanced workflows for the team can truly impact the patient and staff experience.
At one North Carolina healthcare facility, I was recently amazed to see walkie-talkies being used in the ED. This is 2015 and staff members are still using walkie-talkies! As healthcare organizations upgrade clinical communication from pagers and legacy phones (and walkie-talkies) to smartphones, nursing leaders must work closely with IT teams to assess current workflows, set clear and attainable metrics for success, and engage nursing staff to determine how smartphones will work best at the point of care. In doing this type of work, it's imperative to have a collaborative team in place, complete a clinical communication workflow assessment, and engage end users in a workflow simulation before smartphones are deployed on each unit.
Frisbie Memorial Hospital in New Hampshire implemented a smartphone solution to help nurses respond more quickly to patient needs. According to Frisbie Memorial's healthcare project director Sally Gallot-Reeves, MSM, RN, CCM, CPM, “The IT staff is your ally. They provide direct support and are experts in the electronic functioning of systems, hardware, software, interoperability, and integration of all that we do. They're our partners in achieving continued advancements in patient safety, quality improvements, and access to information across the continuum.”
After implementing a smartphone solution, nursing leaders should create a method of collecting staff feedback. It isn't enough to know that your staff members are using the new smartphones; you also need to know how they're using them. A high level of adoption and an enhanced clinical workflow, along with greatly improved response time for our patients, is where this intersection of care becomes the focus.
At a west coast children's hospital, a strong nursing and IT team worked together throughout the entire assessment, development, planning, implementation, and evaluation of smartphones. With the involvement of frontline staff, this hospital is leveraging smartphone technology with a secondary device notification system through integrating nurse call alerts, physiologic monitor alarms, bed alarms, EMR alerts, and ventilator alarms with an actionable alarm and alert plan. This is yet another way to streamline care and provide excellence in patient care, quality, and safety.
Biomedical engineering and physiologic monitoring
With so many medical devices generating alarms and alerts, it's more important than ever to improve the technology behind them. Nursing leaders should take a lead role in helping their healthcare organizations meet The Joint Commission's National Patient Safety Goal for alarm management to alleviate alarm fatigue among nurses. Start by collaborating with your biomedical engineering staff to gather and analyze data from physiologic monitors and other high-risk medical devices. This information will point to what's driving the alarms and what you can do from a clinical practice perspective to begin reducing nuisance alarms.
“To understand if certain nursing quality initiatives are resulting in positive change, it's essential to have a strong relationship with our IT team,” says Debbie Harman, BA, RNC, CBC, clinical manager of neonatal services at Sarasota Memorial Health Care System in Florida. “IT is key to analyzing data, which can result in best practices and patient outcomes.”
Consider whether the critical handoff in care and bedside report can be improved with a clinical review of all alarms and alerts for that given shift. When conducting a workflow assessment and watching a bedside handoff report in action, I observed the leaving nurse reviewing all alarms and alerts on her smartphone with the oncoming nurse. This isn't only powerful but also empowering because the nurse can use communication technology to assist in handoff without having to remember every alarm and alert received throughout the shift.
Nurse call systems
I recently visited a hospital in the Midwest where the IT department was in the process of upgrading the nurse call system. Unfortunately, the nurses hadn't been involved in the project; they hadn't even seen the new system or learned how it was going to work. During an alarm and alert committee meeting, the nursing team questioned the biomedical engineering staff about the new system and what it meant from a change management perspective. It was clear from their questioning that the nurses had numerous concerns that hadn't been taken into account when choosing a new system.
With nurse call systems being so crucial to responsive patient care, it's vital that nursing leaders engage with their IT colleagues to set up nurses for success, optimizing and adopting these technologies to their fullest. When standardizing smart beds, creating replacement strategies, or structuring a bed rental agreement, it's necessary to involve a multidisciplinary team of IT staff, clinical procurement, facilities leaders, and others. This synergy must come together to ensure clinical adoption and, ultimately, patient safety.
After implementing any new system, take time to host interprofessional focus groups so that you and your IT partners can understand what is and isn't working. Cultivating ideas from multiple units and disciplines will enhance teamwork, drive innovation, and improve performance with technology.
Typically, technology acquisition is included in the IT, not clinical, budget, but these expenses ultimately benefit clinicians at the point of care and so must be considered by nursing leaders. You must be heard to ensure that your healthcare organization is leveraging technology to its fullest capabilities. Decisions are made at different levels of the organization, but nursing leaders and frontline staff must be engaged. Don't wait for someone else to do it, and don't do it on your own.
“Producing change is approximately 80% leadership—establishing direction, aligning, motivating, and inspiring people—and about 20% management—planning, budgeting, organizing, and problem solving.”2 As a visionary change agent, you can lead initiatives by gathering an interdisciplinary team that includes physicians, biomedical staff, and clinicians to prevent technology decisions from being made in a silo.
Although healthcare technology is continually evolving, it's important to understand and build a vision for 3, 5, and 10 years in the future. By knowing your mission, setting goals, and understanding how technology will empower nursing staff to work differently, nursing leaders can bridge the gap to ensure that technology improves the patient experience and overall quality and safety.