Competency-based education (CBE) is in the news and on the agendas of nurse executives and educators throughout the country. This relatively new brand of education begins with the end in mind-specifically, the outcomes of learning and the demonstration of specific competencies by learners. The competency based approach may be used in a total program of study or related to competencies in a discrete area, such as informatics.
CBC models vary. Course-based approaches to CBC feature a predetermined number of courses with competencies clearly identified. Other models allow nurses to demonstrate informatics competencies at their own pace or integrated into the learner evaluation process.
Why CBC in informatics? Many experts worry that nurses will fail to meet the requirements of a changing nursing informatics environment. Studies with more positive findings reveal that learners who meet competency requirements are more confident than their peers in delivering patient care and communicating with physicians, patients and family members.
Moving forward will require that nurse educators secure management support for CBC and clarify expectations on nursing informatics competencies, including the fact that nurses must sustain the competency over time. For example, if educators integrate competencies into more traditional nursing informatics courses, they can require leaners to master one or two competencies before moving on to the next course.
One model for measuring informatics competency is the TIGER Informatics Competency Model, which consists of three parts: computer competencies, information literacy and information management. Other competencies that influence nursing informatics include interprofessional (IPE) competencies, including values and ethics, roles and responsibilities, interprofessional communication and teams and teamwork.
How can educators measure nursing informatics competencies? The majority rely on a combination of skills, simulation and actual performance. But for these methods to succeed, educators must insist on credible evaluation. That, in turn, requires advising learners of measurement criteria, ensuring inter-rater agreement so that all students are evaluated consistently and inter-rater reliability to ensure strong correlation between evaluations done by multiple evaluators. Equally important are the issues of validity and cost. There is cost associated with finding the appropriate measurement tool - or developing a rubric if none is available, and training evaluators to use it consistently.
Regardless of how the profession of nursing and nurse educators respond to shifting trends in education, CBC has an exciting future. Shifts in student and learner demographics, rising education costs and changes in technology have forced higher educational professionals to examine alternatives to traditional credit hour models.
CBC offers the potential for learners to move forward at their own pace while ensuring that they master required nursing informatics skills and content. These programs will likely reduce time to completion and the cost of a nursing or nursing informatics degree. They will also ensure that practicing nurses master informatics competencies as quickly, efficiently and cost effectively as possible.
Going forward, nurse executives and educators must learn how to structure self-paced, learner focused, outcomes-driven learning environments where they can more easily measure learner achievement. They will also need to define and refine informatics competencies, in turn developing creative strategies for learners to demonstrate these competencies.
The evolution to CBC isn't confined to nursing and nursing informatics. The American Enterprise Institute recently released a report predicting that colleges and universities are increasingly likely to offer credit in exchange for demonstration of learning and competency.
Still, optimism about the future CBC may be premature. The report concludes that "many questions about CBE (competency-based education) remain to be answered before its wide adoption, including which students and degree programs are best suited for CBE, overall cost of CBE compared to more traditional programs, and how to lower out-of-pocket costs for students."
The best approach for nurse executives, educators and learners is to maintain an open mind toward competency-based learning. Regularly review research in nursing and higher education. Reflect on how you could integrate competency-based learning into a familiar learning environment. To help conceptualize how competency-based education might be applied in your own setting, choose one or two nursing informatics competencies, then develop learning activities that would help nurses master these competencies, and finally, identify which measurement strategies you would use to determine if the nurse was competent.
Competency-Based Education Network
Experimenting with Competency
The Landscape of Competency-Based Education
All Hands on Deck: Ten Lessons from the Early Adopters of Competency-Based Education
Competency- Based Degree Programs on the Rise
Growing numbers of nurses are coming out of retirement to re-enter the healthcare workforce. Nursing informatics officers and nurse trainers must join forces to help veteran nurses understand and use the latest health information technologies and participate in technology-enabled learning.
Nurse executives and managers may need to develop formal or informal centers for nursing informatics. These centers can help returning RNs master and integrate new and emerging technologies, while guiding nurse trainers on how to deliver health IT modules and courses, engage nurse learners and manage learning environments.
Nurse trainers and instructors, in particular, must discover how to adapt traditional learning practices to technology-centered learning environments, making the most of resources like electronic learning management systems.
At Your Service
The key to the empowerment of returning RNs is offering online and print tools so they can better understand the function, scope, benefits and risks of health IT. The best approach is to develop an online self-service library that blends internal resources with those available through organizations like the Health Information Management Systems Society (HIMSS), American Medical Informatics Society and American Nursing Informatics Association.
In developing your self-service library, be sure to include syllabi, modules, course materials and videos of presentations, workshops and seminars. Also incorporate step-by-step guides on how to use a specific technology or participate in an enterprise-wide health IT initiative. For example, you could easily augment a guide focused on "Six Ways to Enhance Care Coordination" with blog posts, answers to frequently asked questions, and video clips from nurse trainers and practicing RNs.
Nurse trainers, facilitators and mentors benefit from health IT modules and course templates that showcase effective online learning. By experimenting with varied models and templates, nurse trainers can tap into the instructional strategies and techniques of others, including features like text-to-speech. They can also adapt content to specific groups like the formerly retired and integrate late-breaking medical and nursing evidence.
While nurse trainers benefit from training in course and module design, HCOs will reap the rewards of inviting returning nurses into an enterprise-wide community of health IT practice. Essential to this community is a peer-to-peer network that identifies health IT knowledge, skill and competence and zeroes in on the quality and impact of online and offline training and learning.
Begin by inviting diverse healthcare professionals-nurses, managers and executives-to join the HCOs health IT community. Be sure to involve professionals with expertise in clinical care, health IT and instruction, and other areas including young, mid-career and veteran nurses who are retiring, retired or just returned to the workforce.
While some professionals in the community will focus on improving clinical, financial or operational performance through health IT, others may decide to concentrate on research, innovation, competency development or support and re-design of health IT learning modules and courses.
Most important is taking a positive approach to health IT instruction, learning and engagement. Returning nurses are neither technophobic, "set in their ways" nor "old school." They need no extraordinary hand holding or training.
Returning nurses may not use Instagram, but they will respond to actual, real-life examples of RNs who have experienced the benefits and results of health IT. They will also embrace health IT if they understand how it can improve quality, safety and efficiency, while saving time and transforming them into more highly competent and effective RNs.
The path to turning returning nurses into health IT advocates is simple and direct. Consider the following steps:
- Offer returning nurses solid reasons to re-examine their biases, attitudes, beliefs, values and behaviors related to technology and health IT.
- Show them how to use new and emerging health IT and learning tools.
- Give them time to experiment and practice with health IT. Offer opportunities to work with mobile, electronic health records and data analytics, for example.
- Deliver plenty of encouraging feedback, coaching and mentoring. Pair returning nurses with experienced technology users and create a network of nurse professionals with expertise in specific areas of technology.
- Reward learning and change. Nothing is more engaging than a ceremony or awards program that celebrates newly acquired health IT skills and competencies.
Don't say goodbye to nurses who claim to be retiring or who have already retired. Tell them how nurses are using health IT to make a difference in the lives of patients, families and other clinicians. Invite them to special open houses and launches or new technologies. And keep them engaged with regular communications on the power and impact of nursing informatics.
"New Program Brings Retired Nurses Back to the Bedside"
"Hospitals Set Sites on Recruiting and Retraining Retired or Retiring Nurses"
"Nurses Are Delaying Retirement, Helping to Forestall Severe Shortage"
Choosing a learning management system (LMS) to monitor, measure and evaluate RNs' health IT knowledge, skill and competence calls for an evaluation of available LMS systems and identification of selection criteria. It also requires implementation of an LMS that fits the needs of the healthcare organization (HCO), nurse learners, trainers, instructors and coaches.
Growing numbers of HCOs, including colleges, universities, hospitals, health systems and providers across the care continuum, rely on an LMS to plan, implement, facilitate, assess and monitor health IT and nurse informatics education and learning. The reasons are understandable. An LMS performs these vital functions:
- centralizes health IT and nurse informatics educational content and resources;
- tracks nurse learner activities like discussion and collaboration;
- orchestrates the delivery of health IT and nurse informatics content;
- collects, aggregates and stores data on nurse learners; and
- delivers performance feedback and scores to learners and instructors.
In short, an LMS allows nurse trainers, instructors and coaches to develop courses, deliver instruction, facilitate communication, foster collaboration and assess learners. It also supports traditional face-to-face instruction and blended and online education.
Because learners value the use of an LMS, HCOs should take time to select an LMS that aligns with educational plans and strategies and integrates the perspectives of multiple stakeholders, including:
- RN learners;
- nurse instructors, trainers and coaches;
- chief nursing officers (CNOs);
- chief nursing informatics officers (CNIOs);
- chief information officers (CIOs);
- healthcare human resources executives; and
- external experts in online education and learning systems.
Involving these parties in LMS system evaluation and selection will ensure buy-in on the LMS purchase or leasing decision and prevent or minimize resistance to LMS implementation. Just as important, many of these stakeholders will emerge as champions and advocates of the LMS and the concept of a lifelong learning HCO.
Asking the Right Questions
The process of LMS evaluation and selection is far from easy. An LMS comes with many features. The central question to ask is this: Which features are most important to the HCO and its nurse learners, instructors, trainers, coaches and other stakeholders? The answer to this question will be unique to the HCO and its learning and nurse informatics priorities. Among the questions to consider in LMS selection:
- Organizational Assessment: What's the HCO's strategic direction, including s the emerging role and function of nursing within the HCO? What are the top needs and priorities of LMS stakeholders?
- LMS Features: How does the LMS compare and compete with other available systems in terms of reliability, reputation and other factors?
- Design: How well does the LMS support nurse instructors and trainers in the transfer and adaption of educational content or the development of content from scratch?
- Tools: To what extent does the LMS facilitate instruction and learning activities, including communication and collaboration?
- Assessment: How well does the LMS support the design and management of assignments and tests? Does it assess and track nurse learner activities and performance?
- Management: Is the LMS able to address security, data management and reporting? Does it support nurse instructors and trainers in administration and management of educational content?
- Technology: How well does the LMS address software, hardware and network requirements?
- Cost: What's the likely cost to acquire or lease and maintain the LMS fora specific numbers of nurse learners for each year of a multi-year contract?
- Support: Is there constant IT support (from the LMS or the HCO). Some of the users in healthcare organizations and educational institutions use systems around the clock and may require assistance with tests or other functions at times beyond the traditional workday hours.
An LMS could possess every desired feature but still be difficult to use. That's why it's vital to test the LMS in an instructional/learning environment, making sure it meets the HCO's technical requirements and needs for functionality. Think about using new and veteran trainers, instructors and learners to test the LMS against the criteria of flexibility, efficiency and user-friendliness. Rely on nurse informatics and HIT professionals to test LMS reliability, stability, scalability and security.
If the HCO already has an LMS, check to see that the HCO can transfer educational content to the new LMS. The best approach is to make every LMS user-trainers, instructors and learners-participants in each phase of LMS evaluation, selection and implementation and promotion.
Nurse learners are eager to use an LMS. Sadly, instructors tend to use just half of LMS features, according to a survey conducted by the Educause Center for Learning and Analysis. Nurse trainers, instructors and coaches need to understand LMS features and functions and how to use them to achieve learning objectives.
HCOs can take the lead by inviting nurse instructors and trainers from other organizations to share how they maximize the potential of LMS features. At the same time, HCOs and nurse associations can offer nurse instructors and trainers guidelines on how to develop content to engage nurse learners.
Who are today's nurse learners? They look forward to a future dominated by "healthcare anywhere" facilitated by anywhere, anytime access to educational content and information. They're eager to engage instructors, trainers and peers through face-to-face interactions and e-mail. And they seek classroom, online and blended learning environments made possible through an LMS that fit meets these criteria:
The LMS will achieve its potential only if nurse instructors and learners can use the LMS to engage and communicate with nurse learners and receive the guidance and support needed to develop and deliver content. In the end, an LMS must fulfill every stakeholder's needs and complement the learning and teaching priorities of the HCO and the nurses who work within it.
"The Post- LMS LMS"
"Life as a Healthcare CIO: Learning Management Systems"
"Use of an Automated Learning Management System to Validate Nursing Competencies"
ECAR Study of Undergraduate Students and Information Technology
"Developing and Reviewing Online Courses: Items for Consideration"
Not everything on the Internet should be considered "social media." You are probably not surprised that this blog is considered a social media website. Would you be surprised to learn that the online shoe retailer Zappos' use of Twitter is considered a form of social media? Well then, you ask, are all Internet websites forms of social media? No, as the main purpose of Zappos.com is to sell shoes and other retail items, not to provide for social interactions or communications - which social media does. Zappos does have a strong social media presence on Twitter, Instagram and Facebook (social media websites) as part of its highly publicized marketing strategy. Social media's main purpose is to allow for, promote and provide a forum for social interaction and communication. Social media unlike static webpages, is characterized by an immediacy and interaction between users. It has gained popularity due to its ability to allow user-generated content. Facebook allows people to "share" posts and pictures. YouTube provides communities for vlogging, movie-making, video and music sharing. Nursing, health and medical social media sites such as Advance for Nurses, AllNurses.com, Ozmosis.org and medXcentral community all provide social media networking between like clinicians, interdisciplinary peers or those who work in a specific healthcare domain.
Wikipedia defines social media as: "the social interaction among people in which they create, share or exchange information and ideas in virtual communities and networks. Media is defined as "tools used to store and deliver information or data." Printed media (newspapers and magazines) and broadcast media (TV and radio) are all forms of "media" or communications. Traditional media - newspapers, TV, magazines and radio are all forms of one way communication. One-way, in that you cannot communicate back or interact with (in real time) or while reading a paper magazine article or watching a TV show. Additionally, not all media communications delivered via digital (digital media) or electronic (electronic media) formats allow for two-way, bidirectional communication exchanges.
Although social media can be categorized into a few types, many social media sites have functionality and features that can also be considered a category. As an example both medicalmingle and YouTube can be categorized as Media Sharing and have features that allow for users to post comments similar to social media characterized as Blogs and Forums - Examples: Tumblr, Advance for Nurses' Blogs and NurseZone.com's Forums. Additional social media categories include Social Networks (Examples: Google+, LinkedIn, Facebook and Snapchat); Social News (Examples: reddit.com for medical and Digg); Bookmarking sites (Examples: doctorbookmarks.com, StumbleUpon, Delicious), and Microblogging sites such as Twitter and Vine.
Another reason for social media's rise in popularity is it's ability to allow for real time, two-way, bidirectional communication exchange between users. Other than marketing of healthcare organizations, what are the other implications for the use of social media in patient care, clinical practice and nursing/healthcare informatics? Do you have questions or comments about this or the previous social media blog post? Or do you want to comment on the content? Please post your comments. I'd LOVE to hear input from this community on this topic! Next Blog Post: Organizations' Social Media Policy & Procedures and the rational for implementing same.
The National Council of State Boards of Nursing (NCSBN) released in August 2014 the findings of its research, "The NCSBN National Simulation Study: A Longitudinal, Randomized, Controlled Study Replacing Clinical Hours with Simulation in Pre-licensure Nursing Education."
The core finding: When nursing educators substitute high-quality simulation experiences for up to half of traditional clinical hours, nursing students achieve educational outcomes comparable to those achieved by students with educational experiences that feature a majority of traditional clinical hours.
Both simulation and traditional clinical hour methods can create nursing graduates who are prepared for clinical practice in hospitals, health systems, ambulatory clinics and other facilities along the expanding continuum of care. Educators, nursing graduates and healthcare employers stand to benefit from the blending of simulation with clinical hours:
- Nursing educators gain added flexibility and autonomy in the design, development and evaluation of learning experiences and curricula.
- Graduate nurses can integrate the immediacy and real-word quality of simulation with the discipline and rigor of traditional clinical hours. A big advantage of simulation is that students can work in high-risk situations they don't often get to participate in during traditional clinical experiences.
- Hiring organizations know for sure that nursing graduates possess the knowledge, skill and competence to perform in varied clinical settings.
The NCBSN research focuses on the role and use of simulation in the pre-licensure nursing curriculum. Large, comprehensive and national in scope, the study zeroes in on incoming nursing students from 10 pre-licensure programs across the U.S.
Researchers randomized students in one of three study groups. The control group featured a traditional clinical experience where simulation could take up to 10 percent of clinical time. A second group permitted 25 percent simulation in place of traditional clinical hours, while a third group allowed for 50 percent simulation in place of traditional clinical hours.
Launched in fall 2011 with the first clinical nursing course, the study continued through a number of core clinical courses to the time of nurses' graduation in May 2013. Researchers evaluated the 688 participating nursing students on both clinical competency and nursing knowledge while students offered feedback on how well the simulation and clinical hour experiences met their learning needs.
Researchers discovered that nursing educators could substitute simulation for 50 percent of traditional clinical experiences in core courses in the pre-licensure nursing curriculum. Equally important, researchers discovered that educators' use of up to 50 percent simulation did not affect NCLEX pass rates.
Researchers also followed the graduate nurses who participated in the study for the first six months of clinical practice. Nurse managers rated graduate nurses at six weeks, three months and six months after being hired into a clinical position. They gave both groups of graduate nurses comparable scores on the dimensions of critical thinking, clinical competency and readiness for practice.
Implications and Recommendations
The NCBSN study has multiple implications for graduate nurses, nursing educators and trainers, and nurse managers and executives. Following are just some of the lessons already learned:
- Train nurse educators. Nurse faculty and educators need ongoing training in simulation, including how to design, develop, implement, monitor and evaluate simulation experiences. Equally important is tracking the use of simulation technologies in the learning environment within and outside of healthcare.
- Prepare for regulatory change. Just as nurse educators were unsure of the role of simulation in graduate nurse education, some state regulators insisted that nursing students experience no more than 25 percent of nurse education via simulation. The NCBSN study is a game changer, offering legislators, policy makers, regulators and opinion leaders proof of the power of simulation in nurse education and training.
- Embrace the era of "just in time: simulation." While nurse educators and trainers can rely on simulations to teach burn care, they can also tap simulation to remediate actual or likely errors. Equally important, they can rely on simulation to prepare for unlikely occurrences such as natural or manmade disasters. For the first time, nurses who are terrified by the prospect of cardiac arrest can participate in simulations designed to build cognitive and "muscle memory." To that end, simulation is as valuable to hospitals, health systems, ambulatory care centers and physician practices, as it is to colleges, schools and universities.
- Vary the experience. Professionals who believe in the power of simulation will also want to invest in simulation software packages that provide varied scenarios for nurses in nurse specialties. However, keep in mind that not all nursing simulation software is created equal. Evaluate potential software subscriptions against criteria of realism, content accuracy and timeliness and choice of multiple, pre-constructed scenarios.
The NCSBN study opens doors for nurse educators and future nurses as clinical space and time becomes limited for training. Think ahead to the possibilities of simulated nursing education and how it can supplement your current curriculum.
What are the first thoughts that come to mind when you read the term: "social media"? Do you think about your tween's Myspace page or your own LinkedIn account? Maybe when you hear the term, visions of unending kitten videos posted to Facebook come to mind? Perhaps you drew a blank when you read the term because you still refuse to even own a cell phone and associate "tweeting" with something birds do. For some, the term may conjure up everything from the Internet, to Google's search engine, to recipes for zucchini bread "pinned" on Pinterest boards.
Is it possible to utilize social media as a clinical practice tool? Perhaps social media is just a fad or only something for those of Generation X, Y or Z? Is it a way to communicate, socialize or just a marketing strategy for organizations?
Regina Wysocki, BSN, RN, school nurse, wrote that social media "is a way for nurses who work in the informatics field as well as nurses who might be interested in informatics to network with one another." Svea Welch, M.A., LPC - MHSP, clinical therapist believes: "Social media is a great networking tool ... utilized by most people in and out of the [healthcare] field. It becomes dangerous when the incorrect information or too much information is shared." Is social media HIPAA compliant, a safe or appropriate venue for clinician-patient interactions?
Were you aware that blogs (like this one) are considered a form of social media? What's the connection between social media and healthcare? How are patient care, nursing informatics and social media related? Recently the American Nursing Informatics Association (ANIA) formed a work group to examine the organization's "social media presence."
Although a great deal has been written about social media outside of healthcare, in this and my next several blog posts I'd like to explore the above questions, discuss what social media is, what it isn't, what its implications are for patient care, clinical practice and nursing/healthcare informatics and, most importantly, I'd like to hear input from this community on the topic. To prime the pump here are a few more questions.
1. What are the FIRST thoughts that come to mind when you hear/read the term social media?
2. How would you define social media?
3. How have you seen social media utilized in clinical practice and or clinical informatics?
4. Does your organization have an official social media Policy & Procedure? If so why/what was the rational for implementing same?
Big data promises to have a big impact on nurse education and training, including the performance and success rates of nurse learners, whether they happen to be young Millennials or retirees who've just re-entered the workforce.
But it will take time before big data and analytics transform the experiences of learners, educators and trainers and reshape how learners develop skills, knowledge and competencies. Nursing has just started to notice how nurse learners generate digital footprints, opening the door for nursing to collect and leverage data and information about educators and learners. Once nurse educators and trainers discover how to analyze data and control the way data works to fulfill a purpose, they'll see the impact of big data on nursing practice.
Until recently, big data and data analytics would surface in functions like application processing and course management. Much of the data was "siloed" and limited to specific functions. Now, however, educators and trainers are zeroing in on individual learner data in the quest to improve learner service and support. Big data offers nurse educators and trainers the opportunity to ask more and better questions - not only about specific learners, but also about small and large groups of learners overtime and within diverse locations.
Understanding nurse learners demands that nursing identifies preferences, perceptions, attitudes, beliefs, values, strengths, weaknesses, goals and/or desires - facts that educators and trainers can integrate like never before with big data. While some nurse educators and trainers will collect data directly from nurse learners, others will observe nurse learner behavior or document and review learner choices.
No matter what strategy educators and trainers use, they'll be able to tap big data analytics to create enhanced learning experiences for individual learners. As they collect and analyze big data across cohorts and organizations, they can apply what they've learned to nurse education and training available via colleges and universities, online courses and provider organizations.
The more data educators and trainers collect about more learners, the more they can enhance the experience of nurse learners. In other words, they can offer more customized, personalized experiences and choices to help learners meet their learning, education and training goals and objectives.
The promised outcome of big data analytics thrills the nursing profession. Educators and trainers will be able to predict learner success, improve graduate and course completion rates and track learner behavior, including learners' level of engagement. They'll also receive alerts if nurse learners become bored, distracted or frustrated.
Organization and profession-level transformation will also occur. Organizations will see the results in highly personalized learning experiences, more satisfied and successful learners and less administrative work. Nurse educators and trainers will get the input they need to revamp content and measure learner performance beyond simple test scores.
Colleges, universities and provider organizations already realize that nurse learner and educator data is stored, manipulated and shared electronically. In the quest to ensure data integrity and privacy, some organizations may need to hire a professional - or even a team of professionals - to secure and protect learner and educator data.
Big data involves big change, but it also suggests big challenge. Organizations must find ways to contain personally identifiable data and forge a culture of transparency regarding data capture, storage, use and sharing. Also important is informing educators, trainers and learners about the power, function, scope and risks of big data. Among the frequently asked questions the merit answers are the following:
- Data type: What kind of learner data do you plan to collect?
- Data purpose: What do you plan to do with the learner data? Why?
- Data value: What is the value or benefit of learner data collection and analysis? How will the learner, educators, trainers, organization and nursing profession use this data?
- Data risk: What could possibly go wrong as you collect, analyze and store this data? How do you plan to handle a crisis?
Nurse educators and trainers must enlist the support of nurse managers, executives and other members of the C-Suite to support big data literacy. Nurse learners must know how to use devices -f rom laptops, tablets and Google Glass, to smartphones, smart watches and desktop units. But they also need to develop digital literacy - the ability to access, analyze and use data and information available via data analytics systems, the Web and even social media.
Only by understanding the capabilities, uses, benefits and liabilities of big data and big data analytics can nursing fully integrate it into nurse education, training and clinical practice. Nurses owe it to themselves and the profession to become part of the big data conversation.
Empowering Nurses with Data
Unlocking Big Data to Improve Care
Nursing Knowledge: Big Data Research for Transforming Healthcare
Mother Lodes and Mining Tools: Big Data for Nursing Science
Nursing Informatics: A Specialty on the Rise
Big Data and Disruptive Innovation in Wound Care
The med/surg unit is an operationally intense care environment with typically two out of three hospitalized patients residing in this area. The acuity of patients in this setting is escalating, along with rising co-morbidities and patient age. In parallel, the hospital's patient population is shifting more toward outpatient care, increasing the number of short-stay patients. Short-stay patients are those who stay in the hospital for approximately 23 hours or less and are then discharged to go home. Often, these patients are placed in med-surg units and require a heightened level of observation to assess for subtle changes in their condition. As acuity increases, so do the number of devices at the bedside, along with the requirements for entering data into a patient's record.
Despite these conditions the nurse-to-patient ratio in med-surg units has not changed. This results in more work and immeasurable stress. Add to that the regulatory, legal and hospital compliance efforts for higher degrees of documentation, as well as pressure to discharge patients as soon as possible, and you can see that there is a "perfect storm" of increased workflow requirements that could lead to errors putting patients at risk.
The environment wherein med-surg nurses work has become incredibly complex and demanding. The result is that they must provide increased effort, energy, and attention just to perform their normal, daily activities. Many are close to the breaking point; they simply cannot take on any more work or responsibility without significantly impacting patient care.
One responsibility that steals substantial time from patient care is documentation. The increasing complexity of patients seen in the med-surg unit means that nurses are constantly moving (between one and five miles during a typical 10-hour shift), making decisions on the fly, and multitasking, all of which takes a high toll on performance and work processes.1 Given all this, nurses view documentation as a lower priority item on their list, choosing to document in batch mode when they have a few minutes rather than in the real time.
In fact, studies find that it takes between two to twelve hours after collecting data from patients' monitors before nurses enter it into medical record. The manual entry of data leads to error rates as high as 17%.2 Yet documentation is taking up an increasing amount of nursing time, with studies finding that 35% of a nurse's time is spent on documentation (147 minutes in a 10-hour shift), while less than 20% is spent on patient care and education, and just 7% on assessment and surveillance.3
The focus on quality in today's healthcare environment means the EMR must be fully integrated into clinical care and decision making. Among the benefits when used properly, for instance, are better decisions and better coordinated care. With physician order entry, physicians need an ‘information rich' record with real-time data. Ancillary departments such as respiratory, physical, occupational and speech therapy also require access to an up-to-date medical record so they may immediately know a patient's state. Such information is equally important for pharmacy, infection control and discharge planning.
However, while EMRs can bring numerous benefits to the hospital environment and improve patient care, they are impractical and even dangerous if the data is not accurate, timely, and complete. So, therein lies the paradox: much of the data entered into an EMR is on the shoulders of med-surg nurses. Yet med-surg nurses are forced to place this task towards the bottom of their list because of their patient care priorities.
The current system relies on the nurse to function as a "human bridge" between medical devices and the EMR. The med-surg unit is no exception. Med-surg nurses capture patient data throughout the day from a number of devices, manually writing the data on a clipboard, sticky pads, paper towels or even alcohol wipes. At a later time during the shift, they key the data into each of their patients' electronic record. The danger of this approach is the increased likelihood of errors and potential for omissions. Moreover, valuable time slips by - time during which critical decisions are made based on data that could be hours old. Just as important, all of this activity of capturing data from various bedside devices and manually keying it into a record takes the clinicians away from direct patient care and surveillance, which can affect outcomes. Very simply, under the current system, clinicians doing both clinical documentation and patient assessment simultaneously is ... well ... incompatible, to put it lightly.
There are solutions to this "human bridge" problem that can remove the nurse as the "middleman". There is increased focus on the automation of clinical documentation, that is: the electronic transfer of data from a medical device to the EMR, and other clinical systems. The integration of data in med-surg is even more critical as the patient acuity rises along with the number of number of bedside devices to assist in monitoring. Due to the fundamental nature of vital signs, devices that take these measurements are typically among the first to be targeted for automation. Integration, however, is not limited to devices measuring vital signs. Other types of devices that can be integrated in med-surg include (but not limited to) scales, smart beds, infusion pumps, etc. By not having to record and transcribe information into the EMR, a considerable amount of time can be saved. And, automating the collection of data ensures that all desired information is accurately collected. This eliminates the possibility of accidentally omitting essential data during documentation. Recording patient data at a higher frequency allows for catching subtle changes in a patient status much sooner.
In an environment where information is recorded automatically into the patient's record, there is no need for a physician and the interdisciplinary team to wait on the med-surg nurse to complete rounds and transcribe the data.
In the end, bringing a flexible, documentation automation system into med-surg can help reinvest nursing time to direct patient-care activities, improve nursing productivity and satisfaction, enhance the completeness of the medical record, and ultimately, improve the delivery of safe, high quality care.
My question to you is, why do hospitals choose not to automate device documentation in med-surg when the evidence is clear?References
1. Potter P, Boxerman S, Wolf L, et al. Mapping the nursing process. J Nurs Adm. 2004; 34(2):101-109
2. Wager KA, et al. Comparison of the Quality and Timeliness of Vital Signs Data During a Multi-Phase EHR Implementation Computers in Nursing. CIN: Computers, Informatics, Nursing. 2010; 38(4):205-212
3. Hendrich A, Chow M, Skierczynski B, Zhenqiang L. A 36 hospital time and motion study: How do medical-surgical nurses spend their time? The Permanente Journal. 2008;12(3):25-34
Video games aren't just for kids anymore. The earliest gaming consoles kept players stationary and sedentary, and became an object of concern in a world of rising obesity rates, diabetes and other health scares. But then came games that required players to move - to participate with their physical bodies. That opened up a whole new world of gaming that is quickly morphing into something more. It's been called the "gamification" of healthcare, and it is showing up everywhere - on computers, on smartphones and in the doctor's office.
Gamification makes a lot of sense on all ends of the healthcare spectrum. Games are fun, and that means instead of being "boring," healthcare can become more engaging and enjoyable. Games are also immediate, as they can be accessed on smartphones and other mobile devices. Value-based care focuses on prevention, and prevention often happens through changing behaviors, is something that games can help players do. The Millennial generation has grown up with gaming, making it much more likely that the use of healthcare games will increase as that generation ages and needs more medical care.
As with any new venture, the market is already brimming with hopeful startups. Games, invented by health insurers and a host of technology startups, are marketed directly to consumers, who use them to track their progress and record key health metrics such as blood sugar and pounds shed. Players of these games can win rewards, perhaps even cash, if they hit their health goals. Using motivational techniques from games is a big part, as is creating engaging experiences for people. These days, anyone with a smartphone can download a variety of games designed to make them healthier, whether that means helping them stick to an exercise routine, lose weight or manage a chronic illness.
In healthcare, however, gamification presents a distinctive set of challenges. Healthcare providers that want to offer games to their customers must do so without violating federal patient privacy regulations - a requirement that can make it difficult to target games to the patients who will benefit most from them. Even companies that are not subject to those regulations are finding themselves under pressure to protect players' most personal data. Insurers, hospitals and other health providers are bound by the Health Insurance Portability and Accountability Act (HIPAA), which requires them to conceal personal health information related to all patients in their care.
Then, there is the problem of the games themselves: How can companies make them engaging enough to keep customers interested? It can sometimes be challenging to build a game that's sufficiently serious and on topic, but also fun. But it all depends on the game, and how it's put to use. As Gartner put it in a 2012 report on the phenomenon - which predicted that, by this year, as many as 80 percent of gamified apps would be doomed by poor design - "gamification is currently being driven by novelty and hype." The verdict is still out on gamification, however as our demand for more mobile and smartphone apps increase, they are likely to continue to be utilized by healthcare consumers.
The topic of meshing the art and science of nursing with healthcare technology has come to the forefront recently. A video by National Nurses United features a patient whose care becomes compromised under the watch of "algorithms" dictated by a computer. Throughout most of the encounter, the patient is not seen by a nurse, because care by computer was deemed more cost efficient by administrators and bureaucrats, who are more interested in the patient's wallet than his well-being. Only in the last-minute, perhaps even unauthorized, intervention of a nurse saves the patient from certain doom.
The strong message is that healthcare technology takes clinicians out of the picture and force-fits patients into standardized, low-cost treatment plans without considering their individual situation. The video references a study that suggests technology is harming rather than helping the patient. Overall, the series sounds an alarm that both nurses and patients are threatened by "the rise of the machines."
Such sensationalism fails to highlight either the benefits of EMRs or the role that nursing informaticians have played in the development, training and implementation of EMRs. Nursing informatics was developed to empower nurses to combine the best of technology and nursing, while safely and effectively providing patient care. Nursing informatics is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge and wisdom in nursing practice (Nursing Informatics: Scope and Standards of Practice, ANA 2008).
Properly designed and utilized healthcare technology can indeed benefit patients. A study in the Journal of General Internal Medicine and another conducted by the Robert Wood Johnson Foundation, show EHRs to be associated with improved care. A recent literature review reported in Annuals of Internal Medicine found that clinical decision support systems were associated with quality improvements in 85 studies reviewed.
Healthcare technology is here to stay, but tools are only useful in the hands of those who know how and when to apply them. Nurses are best positioned to shape, to incorporate and to utilize technology to maximize the efficiency and the outcomes of frontline, hands-on patient care. Nursing and technology must work and grow together to address the needs and to fulfill the promises of healthcare.
Wearable technology is all the rage - not only among consumers, but also among professionals in healthcare and medicine. "Wearables" demonstrated at the 2014 Consumer Electronics Show (CES) ranged from smart watches from Pebble Steel and Razor Nabu, to fitness and sports tracker watches like Sapphire Wellness Watch, Salutron LifeTrak, Hot Watch, ZTE BlueWatch and Casio STB-1000 Sports Gear. Also making a mark was eyewear like Google Glass and Oculus Rift and heart rate monitors positioned in bands, watches and earphones.
Wearable technology is an emerging market, according to ABI Research, which projects that wearable wireless medical device sales will reach more than 100 million devices annually by 2016. The market for wearable sports and fitness-related monitoring devices is also on the upswing, soaring to 80 million device sales by 2016.
Wearable tech will one day dominate nurse education and training, although educators and trainers have only begun to tap its power. Still, experts see the potential of clothing, jewelry and accessories that alert nurse students and practitioners of dangerous conditions or patient deterioration. Nurses might also come to rely on wearable cameras to capture a patient's progress, caregiver activity or conditions within a patient's home.
Wearable tech will allow nursing students and practitioners to rely on voice commands and gestures to send information, updates and alerts via text and e-mail. As a result, students and practicing nurses will find it easier and faster to communicate with each other and with faculty members and trainers.
Google Glass has already demonstrated its ability to reveal relevant information as users go about their daily routines. Nurses will one day do the same, accessing the Internet through gestures and voice commands and receiving alerts as new information develops.
In fact, some experts have outlined how Google Glass could transform education: Growing numbers of nursing students, practitioners and instructors will share videos and photos through Google+, Twitter, Facebook and Tumblr, send voice to text instant messages and receive phone calls.
As nursing students, educators and practitioners move forward with wearable tech, they will evaluate how they can use a wearable like Google Glass for education and patient care. Following are some ideas:
- Teach and share procedure-based skills, much like surgeons have used Google Glass to guide surgeries, nurse faculty and trainers will record procedures and conduct training sessions with real-time data, reference resources and input from other nurses. In 2013, a surgeon from the Ohio State University Wexner Medical Center became the first physician in the U.S. to consult with a colleague using live operating room video transmitted via Google Glass.
- Invigorate the learning environment. With Google Glass, instructors and trainers can project information without turning their backs on nurse audiences. They can also "livestream" lectures and demonstrations for remote access or augment presentations with the latest scientific evidence and developments.
- Create mini documentaries and video essays. Instructors and trainers will encourage nurses to document a disease or condition, population group, or patient care environment. Or nursing students and practitioners will record and teach tasks ranging from deep wound packing and indwelling catheter removal, to application of an ace wrap and making an occupied bed.
- Engage with patients. As more consumers acquire technologies like Google Glass, nurses will offer patients and colleagues guidance on how to use the technology to display real-time exercise statistics or present health-related food information when shopping or cooking.
MIT Media Lab is already demonstrating the potential of Google Glass by turning any surface into an interface. SixthSense, which embeds a camera, mirror and pocket projector into a pendant, projects information on any surface.
While Google Glass is already in the hands of professionals and consumers, other wearable technologies are bound to influence nursing practice. Among the most exciting: Self-adapting cameras.
- Brain sensors: A highlight of the 2014 CES, MUSE will help nurses and patients manage stress, reduce anxiety and increase concentration. Billed as "the brain-sensing headband," MUSE uses sensors to detect and measure brain activity, which it transforms into data and displays on a tablet or smartphone. As MUSE technology grows in sophistication, nurses and other healthcare professionals may one day control electronic devices with their thoughts.
- Magic gloves: Offering "freedom in the palm of your hand," Keyglove is a "wearable, wireless,open-source, glove-like input device" that nurses and patients-particularly disabled patients-could use to enter data, play interactive learning games or manipulate objects generated by 3-D printers.
- Recorder: Billed as "the world's first wearable camera," Autographer is equipped with sensors that respond to changes in temperature, color, direction, speed and movement, triggering the camera to take thousands of pictures in a day. The technology could turn nurses and their patients into publishers and producers of healthcare content.
- I, Robot: If nurses tire of cellphone charging shirts, they might experiment with robotic suits. Wearable robotics known as exoskeletons are already helping people to walk, according to the New York Times. Other robotic suits may help nurses lift and move heavy objectives or support disabled patients in their daily routine.
The future is bright. Wearable tech will provide nurses with virtual personal assistants that remind them of appointments and meetings, log professional conversations, maintain notes and serve up data and information in a matter of seconds. If nurses need to perform a procedure, wearable computers will remind them of specific steps and risks via links to videos or instant messages shared by nursing colleagues. Although wearable tech comes with limitations related to power, privacy, interface and connectivity, nurses will benefit from this game-changing innovation.
Implementing wearable technologies will require ongoing research on the impact of wearable devices on nurse education and training. Nurse education and training programs in colleges and universities and provider organizations must integrate wearable devices into existing learning initiatives as they explore how to best use wearables to improve patient care outcomes. Educators and trainers at all levels must address wearable technologies from the perspective of rationale, role, function, scope, risks, rewards, results, success factors and implementation strategies.
Especially important is the potential threat of wearable technologies to the security and privacy of patient and provider data and information. In a worst case scenario, students, healthcare professionals and patients could become the latest victims of hackers, opening the door to discrimination, identity theft and annoying ads. But organizations can't afford to back down. Instead, they must implement privacy and security policies that protect the data within wearable devices and invest in security technologies that safeguard data files.
Educators and trainers must realize that wearable technology is a journey, not a destination. New devices will continue to emerge, as evidenced in Information Week's "Wearable Tech: 5 healthcare Wins," as well as companies just accepted into the New York Digital Health Accelerator. Embrace the wearable technology revolution, making sure that new and emerging devices enhance care quality, safety, efficiency and outcomes.
Wearable Technology at CES2014
Can Wearable Technology Boost Productivity?
Wearable Technology and the Future of Healthcare
Will Wearable Technology Bring Humanity a Sixth Sense?http://www.livescience.com/42490-wearable-biosensor-technology.html
I find myself spending large amounts of time in airports, arriving early to get through strict security, or passing time in terminals due to weather or mechanical delays. During those periods, I seek refuge at a quiet boarding gate that has a high concentration of power outlets or Internet access. Finding these spots is often a challenge, as I peer under seats, circle support columns and poke around vending machines. Occasionally, if I'm lucky, I run across a re-charging station to at least take care of my power needs.
These recharging stations are becoming more and more popular as business travelers flock to them to charge a plethora of devices. There you can find the latest "must have" or "cool" device / gadget on the market. But as I glance at the array of devices, I wonder, "Is cool always smart?" As a nurse, what really matters to me is the impact a device has on workflow or how I do my job, not necessarily its "coolness."
By many estimates, the typical nurse spends approximately 2 hours a shift simply keeping numbers current in patient medical records. By the time the doctors and multidisciplinary care team actually receive the information, it's often already outdated. To me, "smart" gadgets should help me decrease the time I spend inputting data and increase the time I spend directly caring for my patients.
Mobile devices, such as tablets and smart phones, may be the latest technology, and what many hospitals are considering incorporating into every part of nursing workflow. But I'm not so sure these devices will help a nurse achieve what he/she intends. In my experience, adding to nurses' tool belts (which can include as many as 15 other devices) can sometimes weigh us down rather than increase the time directly interacting with patients. We should be "hands on" with our patients, not with another device.
As nurses, our focus should always be on delivering safe, competent, and compassionate care. We should take caution with becoming the first to use an innovative new technology. So, before moving ahead with the introduction of the latest and greatest mobile technologies, perhaps a hospital should consider the following items:
- Is it easy to use? Has it been thoroughly tested in the care environment?
- How many steps must the nurse complete in order to get data to its end location? Is it intuitive? Simple? Fast?
- Does it need to be put down for best data input? Where do we put the device if the patient needs our immediate attention? Then what about the transmission of infectious properties as we go from room to room?
As with any technology purchase, good research and asking the right questions are musts to help assure the tools acquired are more than "cool," but actually useful. When it comes to nursing and patient care, that usefulness equates to quality care, so we must be aware of the shiny new gadget and be confident that we are implementing the right technology, for the right people, at the right point in time.
"Learning cultures" within hospitals, health systems, and other healthcare organizations across the care continuum are rooted in the practices and policies of schools, colleges and universities. This blog explores how nurse educators can use supportive learning environments created within schools and colleges as a foundation for creating positive learning environments in healthcare organizations (HCOs).
Nurse educators can build a learning culture where students, faculty and administrators develop lifelong, positive learning attitudes, beliefs, values and behaviors by taking these steps:
- Sharing: Create opportunities where students, faculty and administrators can pose questions and share information and insights. Encourage everyone to capture and tell stories about how individuals and teams have transformed patient care and the profession of nursing.
- Reflection: Offer everyone-students, faculty and administrators--the chance to reflect on lessons learned, predict consequences and explore underlying assumptions, values, beliefs, attitudes and expectations. Equally important, develop programs and activities that promote the value of sustained experimentation and innovation by RNs.
- Talent: HCOs should hire, retain and promote faculty and administrators based on their ability to learn and adapt to new processes, systems and situations, and nurse educators can help identify and foster these staff members. Anchor performance reviews in positive learning behaviors and demonstrated innovations-not just technical nursing expertise.
- Feedback: Solicit student, faculty and nursing community input on learning programs, processes and outcomes. Then incorporate the feedback into plans, programs and projects.
Engineering a positive learning culture within nurse education is the first step toward building pro-learning cultures within HCOs, including hospitals, health systems, and medical groups. Nurse executives and managers can maintain learning cultures through these actions:
- Set learning goals and objectives: Encourage the C-suite to turn the concept of a pro-learning culture into an organization-wide commitment and goal. In a second step, link learning culture to the organization's clinical, financial and operational objectives.
- Promote Individual/group accountability: Invite RNs to identify personal learning needs via analyses of performance appraisals and competency based assessments. Teamwork is just as important, so encourage RNs to join teams or networks to share information and knowledge throughout the learning process. Finally, use special events and awards to celebrate the power of individuals and teams to achieve desired learning outcomes.
- Create a low-barrier learning environment: Nurse executives can support RN learning if they design and implement learner-centric environments and remove typical obstacles to learning. Such barriers often include adequate time for learning, ongoing funding, access to learning content, tools and technologies, and integration with learning programs with nursing unit and organizational goals.
- Promote the significance of learning: Nurses executives and managers must help RNs understand why they must engage in lifelong learning, including how they will likely contribute to the development of learning cultures. One strategy is to appoint learning coaches and mentors-experienced nurses who can help RNs tweak learning plans, make program choices and solicit feedback on learning program quality, accessibility and effectiveness. This model is similar to what the Nurse Faculty Leadership Academy of Sigma Theta Tau Intl. tries to do. The NFLA is supported by a grant from The Elsevier Foundation.
- Encourage experimentation and innovation: Nurse executives can support RNs in their quest to investigate fresh ideas for nursing practice and assume calculated risks. For example, nurse executives might encourage RNs to explore the healthcare and nursing implications of innovations like 3-D printing, augmented reality, wearables and mobility. Or they might challenge RNs to analyze the evolution and impact of healthcare trends like accountable care, continuum of care, population health, care collaboration and primary care shortages on professional nursing practice.
Building positive learning environments within nursing education and HCOs means offering RNs the opportunity to simultaneously function as learners, teachers and trainers. When the C-suite commits to building a training- and learning-focused culture, it can create nurse leaders and champions at all levels of the organization. It can also attract "the best and the brightest" nurses, boost RN productivity and facilitate nurse succession planning and promotions based on results.
RNs can create pro-learning environments if they secure the commitment of top management, align the pro-learning environment with business and clinical goals and personalize and individualize learning opportunities. As RNs eliminate or minimize common learning barriers, they will create environments that support rather than constrain learning, experimentation and innovation.
"The Path to Continuously Learning Healthcare"
"Becoming a Learning Organization: The Role of Health IT"
"Continuous Learning Drives Healthcare Improvement"
"How Kaiser Permanente Become a Continuous Learning Organization"
Leadership for Learning Organizations
Advanced practice nurses (APNs) are in demand. From Q1 2012 to Q1 2013, job postings for nurse practitioners (NPs) rose 15 percent, while nurse management postings increased 8 percent. Family medicine NPs topped the list for most nurse practitioner job postings in the first quarter of 2013, according to the HealtheCareers Network and the U.S. Bureau of Labor Statistics.
The increasing numbers of family practice (FP) NPs now rely on health information technology (HIT) to deliver safe, quality care. Required HIT competencies outlined by the American Association of Colleges of Nursing (AACN) call for changes in both master's level programs and learning interventions offered through hospitals, health systems and medical groups.
Chief information officers (CIOs), chief nursing officers (CNOs), chief nursing informatics officers (CNIOs) and other members of the C-suite must join forces to educate, train, coach and mentor FPNPs in how to integrate technologies to manage knowledge and improve healthcare. HCOs should measure competency by asking these questions:
- Education/coaching: Are FPNPs able to translate technical and scientific health information to meet patients' information and learning needs? Can they assess patient and caregiver educational needs? Are they able to coach patients and caregivers in positive behavioral change?
- Decision making: Can FPNPs demonstrate information literacy skills in situations that require complex decision making?
- Systems design: To what extent are FPNPs able to contribute to the design of clinical information systems?
- Evaluation: Are FPNPs able to use technology to evaluate the quality, safety and efficiency of nursing care?
By demonstrating these HIT competencies, FPNPs have already achieved impressive gains. The Office of the National Coordinator for Health Information Technology (ONC) labels NPs "crucial primary care providers on the path to meaningful use." NPs that enrolled in Regional Extension Center (REC) programs, which now work with half of the NPS and PAs in the U.S., have made even more dramatic progress. Four out of five NPs and PAs enrolled in a REC are now live with an electronic health record (EHR).
As more HCOs go paperless, FPNPs will rely even more on HIT, according to a January 2014 survey from TCS Health. Of the respondents to TCS' 2012 survey, 30 percent said their office had already moved to a paperless environment up from 17 percent in 2008 and 23 percent in 2010. That, in turn, will require intense, ongoing education and training.
Reliance on HIT is especially strong among FP physicians who outpace other office-based physicians in EHR adoption, according to a 2013 study in the Annals of Family Practice. That trend will continue as physicians adopt technologies to ease the transition to medical home, value-based accountable care and population health management.
But HIT doesn't end with EHRs. FPNPs must learn how to deliver care via technologies like iPads, mobile health apps, applications, smartphones, cloud-based computing and remote monitoring devices. Eighty percent of physicians now access online health and medical content via smartphones, according to a 2012 Physician Mobile Survey. FPNPs will do the same.
Equally important, FPNPs must master how to provide patients and families with relevant health education and information via links to specific pages within high quality Web sites or peer-reviewed patient education and discharge instructions available in print or video formats or integrated within the EHR.
FPNPs must also learn how to manage and monitor patients' use of personal health records (PHRs). Already associated with improved medication adherence, PHRs are on the upswing. More than four million people now manage their health via My Health Manager , a personal health record available through Kaiser Permanente. This trend will continue as more patients request PHR access via portals or mobile devices.
Remote patient monitoring will emerge as an essential component of FPNP education and training. Showcased at the Consumer Electronics Show in January 2014, options range from real-time devices that allow patients to receive care in any care setting to wearable devices that allow tracking of vital signs and health-promoting behaviors. Equally important in fulfilling Intel's vision to "make everything smart" is the "smart home" and other aging-in-place solutions that allow people to monitor variables that influence health.
The potential for FP NPs to transform healthcare via HIT is evident in the Health Information Management Systems Society's decision to bestow its 2013 HIMSS Davies Award for Excellence to White River Family Practice (WRFP), White River Junction, Vermont. With six family practice physicians, two NPs and a support staff of 14, WRFP relied on EHR technology to create a "collaborative environment" that improved care quality for patients with chronic conditions like asthma and diabetes while improving smoking and alcohol cessation. As a result, the National Committee for Quality Assurance (NCQA) granted WRFP certification as a Level III Patient Centered Medical Practice.
FPNPs have a bright future-especially if they continue to build on their EHR knowledge, skill and experience through planned learning interventions in areas like remote patient monitoring, mobile health and patient education and engagement. Doing so will help FPNPs prepare for new and emerging roles as educational content brokers, health information coaches and mentors, and integrators of data from wearable devices and smart phones.
Recently I observed several staff nurses using smartphones during their shift. They used them to scan medications, communicate with other staff members, receive calls from providers/ancillary departments and even look up drug-dosing information. What I witnessed is an ever-growing trend across hospitals: nurses in large numbers are adopting the use of smartphones - often their own personal devices - at the point of care. And, this happens whether their employer supports it or not.
This finding was highlighted in a white paper from the Menlo Park, Calif.-based Spyglass Consulting Group. The report is what Spyglass Managing Director Gregg Malkary called an outgrowth of a similar study performed in 2009. Malkary said the results demonstrate a definite change in attitude among nurses in the past five years. In fact, Malkary said most hospitals have rejected a BYOD approach for staff nurses out of hand; one factor, he said, is the potential for administrators and nurses' unions to get tripped up over simple affordability of smartphones. But more than half the hospitals in the report responded that they plan to either evaluate or invest in enterprise-class smartphone solutions over the next 18 months.
In the meantime, though, it appears nurses, dissatisfied with landlines and overhead paging, will increasingly use their personal devices. The study found that 67% of hospitals reported their nurses used them and 91% of hospitals said they were aware of this usage but did not have the time, tools or resources to monitor such usage.
"I suspected nurses were using their devices," Malkary said. "I just didn't realize how widespread it was. And it's not just nurses, it's doctors as well. Nobody wants to use a secure text messaging app. They don't want to have to use two apps, they want one, and the prevailing attitude is that unsecured SMS is just fine. They know it's a violation, but it's more fluid, they know everyone else's smartphone number, and they can coordinate care. They're leveraging consumer grade tools to facilitate closed loop communication, and to support multidisciplinary care. Unfortunately, it's outside the firewall."
The "look the other way" approach does not have long to live, though, according to Malkary. The HIPAA Omnibus ruling of 2013, he said, provides a strong incentive, such as million-dollar-plus fines per incident, to get mobile governance policies in order sooner rather than later. The good news, he said, is that both hardware and application vendors are stepping up to provide durable devices - he mentioned the Motorola MC40 and Spectralink Pivot as examples - and secure software from vendors such as Voalte and Extension Healthcare.
There are many challenges to nurses "bringing their own device." Often, a hospital's IT department may ban such devices outright, since it can be difficult to monitor and distinguish reasonable personal usage from HIPAA violations, network security issues, and inappropriate usage. Furthermore, most smartphones now incorporate cameras, which if misused could be another HIPAA violation.
However, in light of all the challenges and concerns, it is worth noting that most hospitals permit and support patients bringing and using personal wi-fi devices. Doctors would be outraged if they were told they couldn't employ the tools that they found most effective. Somehow, we in healthcare must devise the tools and policies that respect and support nurses while addressing the legitimate needs of security, privacy and efficiency.
More information about BYOD here: