When the nurses at Genesis Health System in Davenport, Iowa started utilizing laptops, a small problem presented itself. They found they had to strain their eyes in order to read the information on the compact screens; some even had to get bifocals. To remedy this, the IT staff brought in bigger models that were easier to read, but — as it turns out — more difficult to maneuver. As a result, the devices sustained a great deal of damage from being picked up improperly and dropped.
As the staff at Genesis learned, the road to IT implementation can be a bumpy one, particularly for nurses who are thrust into the driver's seat and forced to find ways to navigate.
Abandoned carts and other roadblocks
The types of problems that the nurses at Genesis experienced are not at all uncommon. In fact, in many facilities, the issues extend far beyond just wireless devices into many other areas of health IT.
In December 2008, Spyglass Consulting released the findings of an end-user market study focusing on the current state of computing adoption by nurses across the United States. The results were eye-opening, to say the least. According to the report, “Healthcare Without Bounds: Point of Care Computing for Nursing,” which was written by Gregg Malkary, founder and managing director of Menlo Park, Calif.-based Spyglass Consulting Group, nurses are growing increasingly frustrated with obtrusive mobile carts, overly secure log-in systems, and unreliable infrastructures.
After speaking with 100 nurses, Malkary unearthed some startling statistics. Seventy-six percent of the nurses reported that mobile clinical carts remain abandoned in the hallway where they are being used as a fixed location terminal, and the estimated number of times nurses were forced to log in and out of systems due to stringent security policies was as high as 80 per day.
He also found that 64 percent of nurses believe that wireless infrastructures are not reliable to support point-of-care computing solutions. “The majority of the time,” says Malkary, “it's a problem of the network, not the device.”
And it's a problem that can't be overlooked by hospital administrators. “If a CIO reads that metric, he's going to say ‘that's not my hospital,’ when in fact, it probably is,” says Chris Click, vice president of marketing at InnerWireless in Richardson, Texas. “There's a lot more to this than just simply having the wireless access points in the ceiling.”
Marion Ball, Ed.D., professor at the Johns Hopkins University School of Nursing (Baltimore) and fellow at the IBM Center for Healthcare Management (Washington, D.C.), was disturbed — but not shocked — by the findings. In her research, she has found that the biggest barriers to IT adoption among nurses stem from unfamiliarity with technology and a lack of understanding as to how they can integrate solutions into their workflow.
“Their job is not to be technologists. They're there, believe it or not, to take care of the patient,” she says, adding that when nurses are averse to using equipment, extra work such as double documentation is often the result. “Nurses are running up and down the hallways to get information. You can put one of those odometers on them. They're literally doing miles and miles of walking because of poor workflow.”
Ball, like many others, has found that while nurses who are skeptical of solutions are more likely to lose faith in the system and to work around the technology, those who have been included in the implementation process are more likely to embrace it. That is precisely why a number of hospitals and health systems are making a concerted effort to include nurses when selecting, testing, and implementing IT solutions.
Making nurses part of the solution
Genesis Health System utilizes a collaborative documentation group composed of nurses when designing and building documentation systems, according to Shirley Gusta, IT manager of application services. “Their role is not just to look at the hardware. They've helped us design the actual tablets in the system to capture the electronic clinical documentation,” she says.
One of the most important benefits of using a collaborative group, according to Gusta, is that it promotes duality of ownership. “If IT just says,and ‘Here's what you're going to use,’ without getting nurses' feedback, you're going to fail right out of the shoot. We need to make sure that whatever we provide will support their workflow and allow them to do the documentation at the point of care, which is truly what we're trying to achieve, so that they don't go back to the nurse station and document.”