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Mobility in Nursing: An Ongoing Evolution

July 24, 2012
by Gabriel Perna
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Why providers are investing strategically in nursing-friendly mobile solutions

In any kind of provider setting, the importance of nurses cannot be overstated. For those on the front lines, nurses are usually the “glue,” a term that Shannon Hubler, R.N., director of contact center operations at the Minneapolis-based seven-hospital healthcare system, Fairview Health Services, has appreciatively bestowed on the profession.

“In my experience, nurses are the closest ones to the patients and the families,” Hubler says. “They are the link between everything, the glue that holds everything together. They are speaking with the docs. They understand the physical therapy, the occupational therapy, the speech therapy. They interface with the social workers about what patients will need when they get home. They work with the family enough to know about dynamics. We often treat things episodically, but the truth is those patients will go home and they’ll either have a support system or none at all. The nurses are an important part of understanding that.”

For that reason, Fairview is one of many providers across the country that has invested significant dollars in mobile technology to improve nursing at the point of care. Mobile computing in healthcare is not a recent phenomenon—it’s an evolving one, and this especially holds true for nurses.  From beepers to computers on wheels to PDAs, a variety of mobile systems, with a range of nursing capabilities, have come down the pipe over the past few decades.

With the rise of mobile health (mHealth) through smartphones—recent research from Rockville, Md.-based Kalorama Information indicates that the market for mobile medical apps was worth about $150 million in 2011 and will compound annually over the next five years—many industry leaders say the evolution will only continue, while becoming more integrated and more integral to nursing care. Currently, the rising tide of investments by providers across the U.S. is evidence of how much mobility has impacted nursing.

FIXING COMMUNICATION BARRIERS

Long-standing communication problems, due to an old call center system and other connectivity issues, are the main reason why Hubler’s Fairview is in the early stages of implementing an enterprise mobile solution from Eden Prairie, Minn.-based Amcom Software. At the center of this implementation is Amcom’s mobile event notification middleware, which Fairview is integrating into its Ascom (Morrisville, N.C.) and Vocera  (San Jose, Calif.) mobile devices for nurse call requests. The middleware has the ability to process alerts straight to the nurses’ devices, which are supplied by the hospital.

“If you’re on a nursing unit and you’re being assigned four to six patients on any given shift, you’re spread pretty thin. You might geographically not be next to the room. You may not hear beepers beep. There’s a lag in hitting that call light, the message goes to the front desk and then somebody is finding the nurse by pager,” Hubler says. “The ability to push those alarms or patient pushbuttons directly to the nurse who can prioritize and get to you as quickly as possible saves time, it’s more efficient, patients are more satisfied, and it’s safer.”

Hubler would like to see further additions down the line, including the ability for patients’ families to connect to a nurse’s point-of-care mobile directly. He also foresees nurses at Fairview bringing their own devices and using Amcom’s software to send encrypted messaging.

TIME AND TEXTING

Across the country, at the Rochester, N.H.-based Frisbie Memorial Hospital, an 87-bed acute care community hospital, investments have already been made in mobile-based text messaging among nurses. Much like Hubler, Sally Gallot-Reeves R.N., healthcare project director at Frisbie, understands the criticality of time. Thus, as projects director, she oversaw the implementation of iPhones and a point-of-care application from Voalté (Sarasota, Fla.), initially for the nursing and emergency staffs and then later for the rest of the ancillary providers.

Sally Gallot-Reeves R.N.,

The application combines voice, alarm, and—most importantly, Reeves says—text messaging onto a single platform. She says text messaging is a good way for nurses to quickly say something to other nurses or care providers and coordinate with them, rather than talking on the phone, which usually opens up a time-consuming discussion. Since Frisbie first rolled out the app in the fall of 2010, 80,000 texts have been sent per month across the enterprise. Texts, she says, can be sent from mobile device to mobile device or from mobile device to a web-client.

“The first week, we had many early adopters, because of course, with the younger staff that’s their life,” Gallot-Reeves says. “They use it all the time. Then we had other people, who probably don’t have a cell phone. They said, ‘This will never work, I’m never going to do it, etc.’ Then an interesting thing happened. It became apparent that if you weren’t using a [cell] phone and you weren’t responding to messages, you didn’t know what was what going on. By the second week, if you didn’t have an iPhone, you were going to senior management and asking, ‘When can I get mine?’”

At specialty hospitals, like the 93-bed Craig Hospital, a rehabilitation facility in Englewood, Colo., mobile solutions are being used to help nurses as well. At Craig, the mobile investments are for telemetry solutions and RFID barcode scanning for medication administration. Craig uses an app from Patient Safe Solutions (San Diego) for the barcode scanning on what Diane Reinhard, R.N., vice president of patient care services and chief nursing officer at Craig, calls an “iPad-like platform.” The telemetry sits on a separate Cisco phone.

These days, mobile technology is even being emphasized during a nurse’s training. It is a huge part of the curriculum for students at the Weston, Mass.-based Regis College School of Nursing, which mandates that every incoming student adopt an iPhone.  The trainees at Regis use mobile software as reference tools at the point of care and as a way to interface with EMR systems.

“We realized we had to prepare for the nurse of the future, while keeping the nurse of the present in mind as well,” says Nancy Bittner, Ph.D., R.N., associate dean of Regis. “Because we’re in the Boston area, we use all the major [medical] centers and stay on top of what they are requiring for their nurses.”

AN EVIDENCE-BASED TOOL

Industry experts say the best is yet to come. Many, like Patricia Hinton Walker, Ph.D., R.N., FAAN, PCC, vice president for nursing policy and professor of nursing at the Uniformed Services University of the Health Sciences, Bethesda, Md., who have seen the nursing and the mobile health IT evolution first-hand, consider the present time to be the perfect intersection of opportunity for nursing, mobility, and patient/consumer health.

Patricia Hinton Walker, Ph.D., R.N., FAAN, PCC

Thanks to the developments in real-time evidence-based change technology through mobile applications, nurses are in a greater position   to empower and engage patients, she says.

Walker is one of the leaders of the Technology Informatics Guiding Education Reform (TIGER) Initiative Foundation, which primarily enables nurses (and also inter-professional colleagues) to use informatics and emerging technologies. She says a collaborative of national nursing organizations is working to create a document that identifies the competencies and type of education that a nurse coach would have.

“The point I would make about the connection of mobile technology for improving patients’ and consumers’ health to this emerging role of nurses as coaches is you can’t just dub a well-meaning nurse or other provider a coach,” Walker says. “There are particular approaches, skills, and strategies, used in coaching that are different than what we’ve historically been taught and practiced as healthcare professionals. Rather than educate and advise, the coaching model has you getting the patient or consumer to be clear about why they want to make a behavioral change and how the data that are available through mobile health technologies are linked to the need for and progress of behavior change.”

Bittner similarly sees mobility being used by nurses for evidence-based practice at the bedside. Both she and Walker point to the changing healthcare environment, and the emerging requirements to maneuver through an EMR and interface with other information systems from provider to provider, as proof that this transformation is inevitable.

“They have to have this level of technology comfort, or they won’t be able to perform in this practice environment,” says Bittner, adding why nursing in particular is so critical to this progression. “[As nurses] we spend the most time at the bedside. So we need access to that information. We’re the ones who are providing that information to other providers, to other members of the team. We’re the managers of their care, and we’re inputting that data and making sense of it. That’s what nursing education is focused on, not just using technology for the sake of technology.” ◆


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