Anticipate Resistance
While up-front preparation is
critical, nurse administrators still need to anticipate resistance at every
point along the way.Sometimes that resistance stems from nurses’ sense that
systems appear to be geared toward doctors’ workflows.
In order to implement it
properly is helping people understand how the system will benefit them. The
value of the change needs to be understood, and that value is different for
each person who touches the system. Sometimes, however, understandable
resistance can be addressed by a discussion of the greater good.
Gird for the Initial Weeks
In the end, no matter how well
prepared a team may be, people need to expect that the initial weeks will bring
a drop in productivity. Some researchers suggests that adding extra nursing
staff around this time could help this problem
Understand the Impact on Patient Interactions
The eye contact issue raises
another concern many nurses have expressed: what are the subtle effects on
patient interactions? Three overlapping challenges seem to be at play.
Time is one. Research has
demonstrated that nurses spend more time inputting information with EHRs, but
less time finding the information needed to make wise decisions. Usually, that
clinical information is also more complete and more accurate than it was with
paper records.
That said, for home health
nurses who must race from one setting to the next over their day, the time
issue can be particularly vexing. The inputting of information definitely puts
pressures on.
A second concern is that
computer screens could become physical barriers between nurse and patient. “I
show both nurses and doctors how to create a triangle between you, the patient
and the computer screen,” “You can then use the screen as a blackboard, a
teaching moment, a way to actively engage patients in health care.” UCSF’s James
Kahn
Third, some nurses have worried
that templates will foster a robotic effect on their clinical judgment. Marilyn Chow , (UCSF School of
Nursing ’70, ’72, ’82), vice president, National Patient Care Services at Kaiser Permanente, believes
this can be addressed through time and education – and it is similar to some
past challenges.
Strive for Interoperability
Across Sett
ings
To truly achieve the type of
change that health care reformers seek, tighter clinical integration across
practice settings is a must. Systems have to talk with each other to gather the
clinical information they need. This is the thinking behind health information
exchanges that will store and communicate patient data across multiple health
systems.
Keep an Eye on Information Overload
For all the advantages of having
more information at one’s fingertips, nurses and others have begun to voice
concerns about information overload.
“In designing these systems you
have to think about our ability to retain and incorporate information; things
can get to the point where a nurse isn’t seeing the important information
clearly,” says Chow, who believes this is an important area for research. “We
need to create [decision support] systems that have a limited number of logical
triggers and alerts that focus entirely on what the nurse is going to need to
know, so that the nurse can focus on the patient.”
Measure the Impact on Patient Care
The good news is that those who
make the commitment are finding improvements in patient care. “The
documentation has increased so much in the favor of patient care that any
learning curve is worth it,” says Kenig. “Patients are 10-fold safer.”
Looking Ahead
Perhaps what’s most exciting is
that EHRs still have an enormous amount of untapped potential. “As you get more
and more sophisticated, you can use the system so much more efficiently,” says
Lee. “Your understanding is constantly evolving.”
Yet even in these relatively
early days, with their many pitfalls, the universal sense from this group is
that EHRs have already begun to transform nursing care and the entire health
care system for the better.
(http://scienceofcaring.ucsf.edu/future-nursing/nurses-adopt-electronic-health-records)
