Celebrating National Nurses Week: Reflections on Health Information Technology
Alicia Morton; Liz Palena Hall; Wanda Govan-Jenkins and Laverne Perlie | May 12, 2020
As we celebrate 200 years since Florence Nightingale’s birth and National Nurses Week comes to a close, the nurses at ONC would like to acknowledge the tremendous work being done on the front lines by our colleagues fighting this pandemic. We are extremely proud to be a part of such a noble profession and we humbly pay gratitude to all those tirelessly working to protect, preserve, and care for our nation’s health during this unique time in our history. Over the past couple of weeks, we reached out to a few fellow nurses practicing in direct patient care to hear directly from them how health IT has impacted their work.
Florence Nightingale – the first nurse informaticist! She championed meticulous documentation of care provided and used that data to generate information that improved care and health outcomes.
Each nurse we spoke with has been practicing since before the passage of the HITECH Act and the widespread adoption of electronic health records (EHRs). (This is also true of this blog post’s authors!) The nurses reflected on how the adoption of EHRs has led to positive changes in their clinical practice. They all noted that the ability to easily access longitudinal health information helps provide better care, and a few noted that new sources of information, such as integrating social determinants of health data will help provide services that can improve health and reduce (re)admissions.
Nursing practice is as varied as the settings in which care takes place. That is one of the many benefits of nursing and creates the beautiful tapestry of our profession. The ONC nurses appreciate this opportunity to connect with direct care nurses using health IT. National Nurses Week allows us to reflect upon the unique experiences we’ve had within ONC, implementing the nation’s vision for widespread interoperable health IT and our support of the provisions in the recently finalized ONC 21st Century Cures Act Final Rule.
Critical Care Nurse
9 years as an RN; ICU for 4 years; currently providing care to COVID-19 patients
First Experience with Health IT
In the beginning of my nursing career, we were still documenting care on paper and only had an electronic system to document medications. When we finally did get an EHR, documentation was much better overall because we could scan medications and we did not have the challenge of deciphering handwriting. The EHR really helped improve the workflow on that unit. I switched hospitals a few years later, and the new hospital was not using an EHR. It felt like going back to the stone ages. Those initial months at the new hospital were difficult until they eventually implemented their EHR system.
Health IT Making a Difference
Device integration with the EHR system has made a difference in the ICU. Often in the ICUs, you are charting frequent and critical vitals while juggling other patient care responsibilities. In the past, it was challenging to stay on top of charting and manage immediate care needs. Having the machines automatically integrate critical data directly into the EHR reduces burden on the nursing staff and provides more accurate information to the clinical team about trends so adjustments can be made earlier.
The “New Normal”
Despite all the challenges, one thing we like as part of the “new normal’ is the availability of telehealth. Our hospital provides a telehealth app for nurses and other clinical staff to connect with an on-call clinical team about any COVID-19 symptoms or other health care issues – and this has made getting care much easier and quicker.
Lead Clinical Nurse
34 years as an RN; adult medicine for 25 years, 9 years of intermediate care
Health IT Advantages
I have used three different health IT systems in the last twenty years. There are advantages to using technology. It has made care planning easier. I like that you can view notes from where the patient has been within the hospital system. Each discipline has its own unique way of documenting in the chart, yet I’m able to see the other disciplines’ notes in one place.
How We Have Adapted to COVID-19
COVID-19 has changed the way we think about providing care to patients. My hospital has decreased our staffing. The technology helps in terms of evaluating our staffing patterns, bed acuity, and the ratio of support staff to nurses. We have streamlined nurse charting because of COVID-19. Usually, a nurse spends at least 30 minutes in the room with the patient documenting. Now, whenever a patient is admitted with suspected or a confirmed COVID-19 diagnosis, we have a new process to improve safety and efficiency for care and documentation.
Making Health IT Better
What I would want to be different is that we can select and document the social determinants of health information in our nursing assessments. Many of the patients who return to the hospital with chronic conditions have so many social factors affecting their health outcomes; financial, environmental, or mental health issues can really prevent them from remaining compliant. I see this often among elderly patients with a history of diabetes, cardiac, and chronic obstructive pulmonary disease. Often, the patients who do not follow or adhere to dietary restrictions enforced in the hospital don’t have the proper diet or food intake because they do not have enough income or a location to purchase better foods nearby. Although, we do have the ability to request referrals for social workers and case managers for follow up visits.
Kori, BSN, RN
Emergency Department Nurse
14 years as an RN; 13 years in the emergency department
Clearing Up Confusion
The year I became a nurse is when the health system I worked for started transitioning to electronic charting. Prior to becoming an RN I was a secretary. I remember one of my duties was to rewrite the patients’ medication administration records (MARs), and often had extreme difficulty reading some of the staff members’ handwriting when copying these MARs. Instituting electronic MARs was much safer for patients. Similarly, entering the physicians’ hand written orders the computer system could create errors, and provider order entry is a huge safety improvement.
Embracing Technology Takes Time: Pros and Cons of Tech
Recently, due to COVID, we started using iPads for patients and doctors to virtually communicate to decrease the potential exposure. Given the circumstances, I agree with this but I feel that there still needs to be that personal contact between patients and providers. I feel it helps patients feel more at ease and build trust and confidence with their providers.
Interviews were edited for brevity and clarity.