By Debra Wood, RN, contributor
Although slow to implement clinical information technology, United States hospitals are catching up, investing in computerized record keeping as part of a push to improve safety and efficiency, but some nurses fear online charting and other electronic changes to practice.
“For a nurse to embrace new computer technologies can often be difficult and time consuming,” said Michele Kunz, MSN, RN-BC, ANP, director of nursing education/nursing informatics at Long Island College Hospital in Brooklyn, New York.
Some nurses have grown up around computers, the informatics natives, and others are new to the process, the informatics immigrants. Most new nurses possess the needed skills, but many experienced nurses have a harder time, said Elizabeth Rhodes, MS, RN, BC, department head for nursing informatics at Washington Hospital Center in Washington, D.C.
At least in part, that’s because undergraduate nursing courses are providing informatics classes, said Patricia A. Abbott, Ph.D., RN, co-director of the World Health Organization Collaborating Center for Nursing Knowledge, Information Management and Sharing and an assistant professor at the Johns Hopkins University School of Nursing in Baltimore.
Abbott believes all nurses should be able to demonstrate competency in basic informatics. Washington Hospital plans to add computer literacy to required nursing competencies. New hires already must take a hospital course or challenge it.
Trinity Health in Novi, Michigan, has noticed some reverse mentoring taking place.
“Younger nurses help older nurses with the computer and older nurses share their knowledge, wisdom and efficiencies about practice,” said Joy Gorzeman, RN, MSN, MBA, senior vice president of patient care services and chief nursing officer for Trinity.
Hospitals take different approaches to ensure existing and new nurses understand information technology systems.
“You can make errors in the computer system that could harm a patient, if you don’t know how to use the computer,” Abbott said. “You can wreak havoc, if you don’t know what you are doing. Safety nets can be circumvented.”
Rhodes encourages nurses to speak up about their computer fears and concerns, so hospital educators and information technology experts can provide additional support.
“What a lot of nurses have to do is for a period of time to push employers to help bridge the gap and be ready for the next step,” said Rhodes, adding that hospitals must help their nurses gain the basic computer skills needed to do their jobs.
As Trinity Health began implementing an electronic medical record and computer physician order entry, it provided educational opportunities for nurses and has improved its processes for each additional facility it brought online. Gorzeman said it takes nurses about three months to get used to the system and use its features, such as reviewing embedded evidence to support the actions outlined on care plans.
“We found once six months have passed, nurses are getting more face time with patients and we are documenting better,” Gorzeman said.
The first nine Trinity facilities experienced a drop in nurse and patient satisfaction immediately after implementing the system, which rebounded within a few months. At the most recent facility to switch to electronic documentation, no decrease in satisfaction occurred, something Gorzeman attributed to staff familiarity with computers, work redesign having been completed prior to bringing the health record online, and improvements to the software system.
Since implementing the electronic documentation, Gorzeman said the health system has found nurses do not spend as much time “hunting and gathering.” Orders are sent directly to the lab and radiology, and reports are posted automatically. The chart is always available.
Nurses also can take the initiative to learn the basics on a home computer or by visiting a local library. Kunz suggests searching on the word “mousersize” to find practice sites.
“We have found that Web-based training as well as having a facilitator is most helpful for new learners,” Kunz said. “Also a facilitator or nursing buddy can show you little tricks or documentation shortcuts that reduce time spent at a computer.”
Once someone understands the basics, such as pointing and clicking with a mouse or using pull-down menus, he or she can easily transfer those skills to electronic record systems.
“If you are comfortable with a computer, it doesn’t take much to use an electronic health record system,” Abbott said.
Kunz also suggests nurses serve on committees deciding about hardware and software changes. Many options exist, and some may make using the technology easier.
Nurses at Trinity participate in committees and have worked with the software vendor to streamline some features and make certain processes more intuitive.
Some nurses learn to harness the technology and make it work for them. Those interested in learning more can pursue certificate programs, such as the one offered by Stanford University in Palo Alto, California. Additionally, Informatics Consulting and Continuing Education offers a Weekend Immersion in Nursing Informatics program, and the University of Maryland School of Nursing offers a Summer Institute in Nursing Informatics.
The American Medical Informatics Association developed the 10x10 program, which prepares health professionals to deal with informatics issues in the workplace.
“It’s not going to create informatics professionals, but it will produce informatics-literate clinicians,” Abbott said. “Informatics is a necessary skill to survive in the world of health care.”
By learning more about computer systems and programs and how they operate, nurses can make the technology work for them.
“Our team says they would not go back to paper,” Gorzeman said. “In the end, it’s a whole lot more good than not.”
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