“That is a training issue.”

July 19, 2026

Anyone who works with technology development knows that there will be a time when someone will say, “That is a training issue”. This statement often comes after someone asks, “how will the user know how to do <insert workflow step>?”

Sometimes the technical steps are not necessarily intuitive to the user’s anticipation of what to do next. This is a mismatch in the user experience. When this occurs, the user has (at best) confusion in trying to identify the next step. The confusion can lead to extreme frustration that halts progress toward completing the next step in the process (and lost time). 

Example: Pop Up Window Advertisements

Consider when you see a pop-up window to save you 10% on your first order for any given advertisement. You may or may not be interested in the welcome discount. If not, it can be quite difficult to find the “X” on the screen to exit the offer. You look around all four corners and sometimes need to locate the very faint area where you can exit out. If not found, you could exit the screen or put in your email to just get to what you wanted to see. (Of note, this is likely by design to obtain your email address  ). 

The lack of visibility of the “X” is a user experience or more specifically, a usability design issue. Sure, one could say it is a training issue and tell each person they need to look VERY CAREFULLY each time they accidentally find themselves with a discount offer. However, this becomes the user’s issue rather than the system design issue that removes this extra step. This usability design issue turns into a training issue. The usability shifts from the responsibility of the system designers to that of the individual to “learn” how to “workaround” the intended design.

Healthcare Training Issues

Now, let us look at healthcare. Healthcare is dependent upon clinical and administrative information systems to manage the individual and population level care. However, most clinicians are not formally educated on the foundations of informatics and/or information system design. Therefore, there is an inherent concern and perhaps intimidation faced where there is concern about whether they are charting the right way. 

Some clinicians will over chart while others will struggle to know what exactly needs to be charted and may unintentionally miss something. The extremes here are a result of a culture, especially in nursing, of “if it is not documented, it is not done”. However, when it becomes hard to know where to go next or how to enter some data correctly, you see the (largely unintentional) risk of error.  Add to this baseline, a handful of “training issues” and we have just added more stress to an already  stressed and fatigued workforce. 

Of course there are some aspects that do require training. However, for a moment think about how many times you have turned to watch a video or training session to use your new smart phone. Much of what you need to be able to do with your smart phone or device can be figured out without a training session.

We should be striving for this type of user experience with healthcare technology.  The need for formal training sessions should be minimal or very brief. Instead, the design of the systems should be such that the user is able to follow what the next step is through an intuitive human computer interaction experience. 

There is an abundance of qualitative and quantitative data to show that nurses, doctors, and healthcare professionals in general are working against the clock each day. There are never enough minutes to go around for everything that needs to get done in that shift. To add more things to what is expected of them will only increase the burden felt rather than create relief.

Healthcare cannot be delivered without the use of technology. However, we must consider that we have a workforce already spread thin. Instead of putting more responsibility through “training issues”, why not create a sense of ease and/or intuitive flow for them to experience each day? 

~ Dr. Kelley

Nurses Week 2025

May 07, 2025

Today, May 6th, marks the start of Nurses Week…

I started this journey as a candy striper volunteer at Jordan Hospital on the weekends in High School to help bring patients to their cars on discharge from the hospital. I wanted teh experience before nursing school at Georgetown.

I would often get asked why I wanted to become a nurse, and not a doctor. It turns out that you can be both 😉 (after a lot of years in higher education).

I have spent much on the last 20 years asking why and pushing the boundaries of what is possible in this profession. I can tire people out with my questions and vision for what should be, and not yet is, but I keep going…

My trajectory has given me the opportunity to speak to others in a variety of ways about how to think about the profession as well as creating one’s own personal trajectory.

Today, I reflected on Nurses Week as I recorded a promotional video for an upcoming event where I will serve as the Opening Keynote Speaker.

When I do speak, I often reflect back on what it was like as that new nurse and how much effort it took to get there. You can see me here as a nursing student in clinical at Georgetown in my starchy clinical outfit!

Nurses are the largest group of healthcare professionals in the world. There are 4x as many nurses to medical doctors.

Nurses are masters at knowing how to suggest treatments to doctors without making the doctors feel like it was not their initial idea (this helps build relationships 🙂 ).

Nurses are also masters at knowing something is off or not right with you (at work of course, but also with friends, family, and even strangers outside of work), without even saying anything… They will likely start trying to help you or ask you questions to figure out how they can help.

However, taking care of ourselves, as nurses, is hard at times. We have been trained to care for others first and literally put the needs of others before our own basic needs (e.g., lunch and bathroom breaks for example).

One way you can take care of yourself is taking that step forward that you have been wanting to take but have been nervous about making the move…

Maybe it is a new job, a new role, a new degree, a new specialty, a new schedule… Maybe it is not now but in the next few years.

Whatever you choose, embrace serendipity along the way….

~ Tiffany Kelley PhD MBA RN NI-BC FNAP

Who is putting the puzzle together?

March 24, 2025    |   ,

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So many data elements distributed across so many screens….

Pre-check online forms in texts…

Paper forms on clipboards…

Online forms in the waiting room…

Screening questions during the appointment…

Many duplicative questions asked by those who do not make the decisions on what to ask..

Existing answers to many of these questions already in the EHR….

For a patient this can be quite frustrating to experience.

Why is this data collection experience broken into so many pieces?

Who is putting the puzzle together?

How is this level of data fragmentation making the patient’s experience, patient centered or dare I say, person centered?

Patient-centered care is one of the six dimensions of care quality as defined by the Institute of Medicine (IOM, now National Academy of Medicine).

That term is defined as, “Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.”

After all, isn’t the premise of healthcare to provide care to the person who is seeking it for the person’s health?

~ Tiffany

Tiffany Kelley PhD MBA RN NI-BC FNAP

Founder & CEO

Nightingale Apps

Nurses are the most trusted for the 23rd year in a row.

March 23, 2025    |   , ,

Their patients come first, often even before themselves.

On January 13th, the Gallup poll released its data for the most honest and ethical professions as ranked by the public.

“Three in four Americans consider nurses highly honest and ethical, making them the most trusted of 23 professions rated in Gallup’s annual measurement.”

As a nurse, this is of course a great honor to continue to receive this recognition from the public for over two decades straight.

Nurses operate according to the American Nurses Association (ANA) Code of Ethics. The code of ethics has 9 provisions. The first provision is:

“The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.”

A core principle of patient care delivery is providing individualized care. To deliver individualized care, nurses come to know their patients.

Individualized care differentiates the patient experience from feeling like a number or diagnosis to that of feeling like you are a person who is a patient in that moment.

We learn the role of ethics in nursing early in our undergraduate nursing educational preparation and it is continually reinforced throughout clinical rotations and in practice.

Ethics often supersede regulation requirements. What does this mean?

What may be possible to do through regulations (or the lack thereof), may not necessarily be ethical. Therefore, extra protections will often be taken on top of regulatory protections.

This will especially be of consideration for forthcoming artificial intelligence (AI) tools that aim to support consumers with answers to health related questions.

Another example may be the expectation to turn a patient every two hours. That would be the minimum. A nurse may find that another patient may need to be turned more frequently to optimally heal or relieve pain.

Nurses take great pride in providing optimal care for patients and to do so in an ethical manner. Their patients come first, often even before themselves. The public’s recognition of trust in nurses is of great value.

A link to the article from Gallup on this year’s released rankings can be found here.

~ Tiffany Kelley

PhD MBA RN NI-BC FNAP

Founder & CEO,

Nightingale Apps

Patients are People Too

January 25, 2025

Patients are people first. Patients are people who should have a voice in their care.

Patients are people. While this is inherently known amongst us all, the words do have some differences in meaning within healthcare settings.

The first pilot research study that I conducted investigated the meaning of knowing the patient. To know the patient is to know the clinical aspects of the individual as well as the personal aspects of the individual.

Of course, it is essential to understand the clinical needs of the individual patient. This includes the diagnosis, reason for visit, treatments and plan of care to name a few items.

However, as a person, the personal aspects of the the individual can be overlooked at times when a patient. This could be any type of preference. However patients tend to have categories of preferences. For example, I know that my right antecubital vein is very difficult to find in my arm whereas the one on the left tends to be easier. Knowing this as a healthcare provider can make a significant difference for the patient who sees his or herself as a person first.

Knowing this can save unnecessary sticks in the arm when knowing that the phlebotomist has a great chance of being unsuccessful the first time. Knowing this can make the person feel known as a patient. Knowing this can improve the patient experience overall.

Patient-centered care is one of the six categories of healthcare quality as defined by the Institute of Medicine (now the National Academy of Medicine).

Patient-centered care is defined as, “Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.”.

After all, patients are people too. Patients are people first. Patients are people who should have a voice in their care.

For patients, be sure to ask questions and share information that can help provide more individualized care.

For nurses, doctors and all healthcare professional roles, be sure to include patients in their care. They are the reason we are there and deserve to have a high quality experience.

Change can be good.

January 05, 2025

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We have just entered a new year, the year of 2025. My year of 2024 was quite full of events, effort, activities, and more from start to finish. So full, that I did not quite catch my breath until the last day of the year. Even on the first day of the new year, I felt the need to slow down instead of speed up. Last year, I came out of the gate ready to go. I am not reading too much into this shift at this point. However, it is an indication of change. Change can be good.

                  Change can be good. However, change is often perceived as something to approach with trepidation and/or resistance depending upon where you fall in Rogers’ Diffusion of Innovation Adopter category for the particular change (e.g., innovator, early adopter, early majority, late majority, laggard).

                  I teach this in my academic role and see it in practice every day. When introducing a new idea or product to someone, there will be a reaction. The reaction will provide insight as to where that person or group falls on the adopter curve. That insight is crucial to understand the readiness of that person or group for change.

                  I will give you an example from my own experience thus far this year. Every January, I have my eyes examined to order my annual supply of contact lenses. I have worn glasses since I was in middle school. I had trouble reading the board in the classroom. As time went on, I was able to get contact lenses in college. Since that time, I have worn them nearly every day for some years now. 🙂

                  Two years ago, I was introduced to multifocal lenses. I spend a lot of time in front of my computer but need the prescription primarily for distance vision. The optometrist thought that I would like them. She sent me home with them to try out. I did not like them.

I did not like this change. I felt as though my eyes were looking all over the place and it was hard to focus with these new lenses. I called the office and asked them to fill the prescription from the lenses I had been wearing for years.  

                  I resisted the change because I did not need it. I was ok with how it was, and they worked for me.

                  However, this year, two years later, I shared that I was finding the ability to see tiny print (think of the print on an acetaminophen bottle 🙂 ) from the contact lenses quite difficult. I would fluctuate between my contact lenses, glasses, and readers and found it quite annoying to go back and forth throughout the day. I thought perhaps my vision had dramatically changed in the last six months.

                  As it turns out, my prescription remained the same but this time, she introduced the multifocal lenses again. Immediately, I felt the difference. I lit up and she even noticed my excitement and happiness.  I could see the tiny print and the distance with these lenses without difficulty. Those readers are now collecting dust, and I am absolutely ok with that for the time being!

                  She sent me home with a few trial lenses to confirm that I like them before committing to a year supply. I have been wearing them for the last two days and excited for this change. I did not expect this positive change from that visit. Change can be good.

                  Change can be good, but we need to give it a chance. We also need to feel that need for change to increase the likelihood of adoption. If the need for change is not yet there, it may just be too early for that person or group. Give it time and try again.

                  Cheers to a new year. May you find good change in 2025.