Why aren’t nurses part of the conversation?

A conversation a few months ago led me to wonder (and I should have asked), why isnt a nurse part of this meeting’?



At that time, I was speaking with a physician and a project director about bedside nursing solutions using mobile to address existing workflow challenges. I realized toward the end of the conversation that the problem we, at Nightingale Apps are working to solve with Know My Patient TM, was not well understood by the meeting participants. Yet, had a nurse been part of the conversation, we would have likely had a different outcome.

Despite the ubiquitous use of smart phones on a daily consumer basis, nurses still remain dependent on scrap papers, paper towels, post it notes, their hands, tape on their pants, alcohol swabs, or even their gloves to write down vital patient information that must then be transcribed into the patient’s chart (or EHR). This is a quality of care delivery problem that impacts the entire health care team and organization at a human and a financial cost. (I can explain the costs in more detail in subsequent posts).

paper towel

Transcribing this vital information from these tools into the EHR is done when nurses have a few minutes to chart and/or when there is an available computer to do so. This might be minutes or up to hours after gathering the information. As a result of the delay and the available tool, there are times when a nurse may have lost the glove, alcohol swab, or piece of paper that had the patient’s ‘numbers’ on it. I know this because I remember it myself as a nurse. I also hear this from every nurse I speak with about Nightingale Apps and Know My PatientTM. I’m also starting to hear this from friends and family who are seeing this occur as patients in the health care facility.

So, why are nurses relying on these tools? The first answer is because it is the way nurses have been trained on the job to collect information about their patients during shift report. The second reason is because these scrap paper tools were the best solution that was available to us as nurses on a daily basis. When I started my career as a nurse in 2000, the smart phone as we know it today did not exist. As a nation, we were barely using computers for charting purposes at that time (even though the first EHR was developed in the 1960’s!).  However, we are now in a different time where we have a tool at our disposal for nearly anything… a smart phone… that fits in our pockets and can tell us where the closest Pokemon is, but it can’t tell us what we (nurses) need to know about our individual patients, while walking down the hallway.

Week after week, I have conversations with professionals in the health care technology space about this problem. Many times, I am told that it isn’t a problem because the EHR (electronic health record) should already be addressing it, or nurses have WOW’s (workstations on wheels) at their disposal so isn’t that enough? (This is another topic I would like to explore in a subsequent post). Most, if not all of these conversations, are void of the key participant, the nurse at the bedside.

Thus, there appears to be a major disconnect between what is happening at the bedside (that is challenging nurses to have to decide upon spending time nursing the patient or nursing the computer), and what is perceived to be happening at the bedside with existing technology solutions.

So, how do we begin to get at the reality of what is happening at the bedside today that ultimately impacts quality of care?

Let me offer 5 possible interventions:

First, we need to include nurses in these conversations.  A nurse’s primary focus is on caring for the patient. Yet, with advanced technologies and EHRs, nurses are also being asked to care for the computer. The use of modern technologies could be a seamless process woven into nursing workflow. The smart phone could be today (and will be in the future) an extension of the nurse in the same way that the stethoscope is today.  Yet, to do so requires understanding the current workflow and knowing the pain points first. This can only be done by watching, listening, speaking to nurses in their natural environment: while they are providing patient care.

Second, include bedside nurses in strategic conversations about what challenges are being faced day-to-day and brain storm on possible solutions. Empower these nurses who see the problem and also want to make it better with some additional responsibility. This will show that his/her expertise is valued. We don’t want to perpetuate the feelings that some have today of becoming ‘glorified data entry specialists’ with nowhere to go (trust me this is a real thing today – I’ve heard it several times myself).

Third, encourage nurses to understand the capabilities and limitations of existing technologies so that they can help design future technologies. One thing that is certain is that change is constant. The EHR training class is not enough to get the level of understanding to be able to offer recommendations for enhancements and modifications to the EHR system.

Next, be an early adopter. Partner with those individuals and companies who want to deliver value to your user groups and organization. As an early adopter, there may be a little more risk to start but the long term benefits can far outweigh the risk. (You’ll have influence on the final product more in the beginning uses of the product than at later stages).

Lastly, think outside the box. In the past, I’ve taught graduate students, who came to my classes with very little to no informatics background, to brainstorm innovative ideas to existing problems by removing any perceived barriers. Of course this has been a classroom based exercise but their ideas over the years have revealed feasible solutions.

Nurses inherently know how to solve problems because they are faced with new ones every day. However, we as an industry and a profession need to support nurses with solutions to the problems that are outside of their individual control. Doing so will be so beneficial to the nurses, patients, families, other health care professionals and the health care organization.