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Taking Their Own Pulses

March 28, 2007
by Brian Albright
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Informatics nurses understand they are walking a fine line.

by Brian Albright

As the nursing profession adapts to new technology, while struggling with a growing shortage of R.N.s, the role of the nurse informaticist has becoming increasingly important.

Not surprisingly, Vernon Hills, Ill.-based CDW Healthcare's 2006 Nurses Talk Tech survey found that hospitals with a nurse informatics position on staff offered more IT training to nurses than those without one. However, only around four out of 10 organizations had such a position. Now, efforts are underway to increase training and boost informatics awareness, and nurses are clamoring for a larger role in IT development and implementation.

Although they often face a steep learning curve, the CDW survey found that the majority of nursing professionals agree that IT can improve the quality of care, and more and more nurses are using technology on the job.

According to the 2004 Health Information and Management Systems Society (HIMSS) nursing informatics survey, respondents that were engaged in implementing IT systems were focused on clinical documentation, clinical information, and electronic medical record (EMR) systems.

"Staff are better informed and more computer literate than they were even a year ago," says Ruth MacCallum, senior consultant at Healthia Consulting in Minneapolis.

Top priorities moving forward include adoption of standard nursing terminology, wider adoption of bar coding technology, and implementation of automated clinical systems, with an eye on patient safety, says MacCallum.

Many nursing departments, however, are stymied by a lack of financial resources, user acceptance or administrative support. CDW found that 36 percent of respondents said that nurse managers or staff members were involved in IT selection or implementation.

"Hospitals are building and designing the technology without really connecting it back to process and workflow," says MacCallum. "You do the training and put it out there, and the bedside nurses are saying, 'Who thought this one up?'"

Henry Ford

When Henry Ford Health System's Wyandotte Hospital in Wyandotte, Mich., deployed the ED PulseCheck system from Wakefield, Mass.-based Picis to manage clinical documentation in its emergency department, the hospital had to train 200 staff members in a relatively short time. The hospital took care to integrate the technology with staff workflow, and to do follow-up training.

"We had to be really patient, and do a lot of positive reinforcement," says Lois Vandercook, R.N., who heads the emergency department at Henry Ford. "Those that weren't very computer literate have really stepped up to the plate."

Many hospitals, though, are falling behind on training. According to CDW, 30 percent of respondents had received no IT training in the past year, while 56 percent received between one and eight hours.

Working towards improvement

A number of efforts are underway to help bridge the IT gap in nursing. In February, the Technology Informatics Guiding Education Reform (TIGER) Initiative released its summary report at the HIMSS Annual Conference, listing strategies to enable nurses to "fully engage in the unfolding digital era of healthcare."

Key among the recommendations were integrating informatics competencies into the nursing curriculum, establishing a more active role for nurses in the design of informatics tools, and integrating industry standards for IT interoperability.

Now, TIGER is focusing on coordinating industry-wide technology efforts. "If we're going to be effective at making this a major issue, our challenge will be organizing those activities in a meaningful way and sharing that information across the industry," says Donna DuLong, R.N., executive program director for TIGER.

Another promising development was the recent acceptance of the Clinical Care Classification (CCC) nursing terminology as a named standard by the Healthcare Information Technology Standards Panel (HITSP). Most of the major nursing associations are also developing programs to expand the use of technology, and study its potential impact on staffing.

"If nurses are more efficient at using technology, that could help alleviate the nursing shortage," says DuLong.

Progress can't come soon enough for Vandercook, who says that system interoperability remains one the biggest challenges she and her staff face.

"To do all of the things we're supposed to be doing, it would be nice if those pathways were automated," Vandercook says. "We need to be able to pass information from one system to another so that nothing is missed, and nothing falls through the cracks."

Brian Albright is a contributing writer based in Columbus, Ohio.