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Enabling the ordinary: More time to care


Versions of this article appear in American Nurse Today (United States) and Nursing Times (United Kingdom) to acquaint readers with common goals, challenges, and advances in using health information technology to enable nurses to provide safer and more efficient care.

Around the globe, in every setting, nurses seek to provide care to patients and families to keep them safe, help them heal, and return them to the highest possible level of functioning. Nowhere is the struggle to achieve these simple aims more apparent than in hospitals. The tightrope of balancing what nurses believe to be adequate resources for high-quality care and the affordability of these required resources are often at odds. Disagreement among leaders in healthcare delivery systems as to how to allocate nursing resources has led to tension and discord. Despite decades of research showing that the amount of care provided by registered nurses directly affects mortality and morbidity, nurse leaders continue to have to justify requests for nursing resources.

Universally, the desire to make care more affordable has fueled efforts to make care more efficient and effective. The public recognizes this means examining all aspects of care in the pursuit of cost-reduction measures that will not reduce quality. In the United States, nurses continuously rank as the nation’s most trusted professionals by the Gallup Poll and have the public’s support whenever belt-tightening issues come to the forefront. On the other hand, in the United Kingdom (UK), the debate over resources that has been playing out in the media has caused confusion and public uncertainty as to whom to believe, undermining confidence in the system as a whole. The nursing profession hasn’t been spared this negative view and has needed to reassure the public of its core values and purpose—that caring and compassion are part of the core business of nursing.

Nursing is what nurses do, and what nurses do is coordinate and deliver care. So although the context, technology, and health needs of our populations have changed, nurses remain the foremost providers and coordinators of care.

Why state something so obvious? Showcasing the caring aspects of nursing in a technologically dominated world is challenging. Technology enables care and enhances safety by automating functions both simple and complex. It doesn’t replace nurses. As one expert cautions, automation should occur in nursing, not of nursing. The value of technology hinges on how it’s used and whether it helps or hinders care.

Changing nursing practice safely

So why do nurses have to struggle so hard to get the technology we need to support our practice? And when this technology is available, why don’t we reap the benefits we’ve been seeking for our practice?

For years, many in the healthcare community believed nurses were too slow to embrace new technologies and might disrupt or even obstruct the change process. Had they ever visited a neonatal or intensive care unit? Although their description of nurses and nursing wasn’t accurate, it had become a mantra within a wide variety of organizations.

What they failed to grasp, and continue to misunderstand, are the practical realities of how professions change and how to support innovation in practice. For generations, nurses have changed their practice successfully and have adapted to new challenges, such as coping with rising patient acuity, safely delivering dangerous drugs, and preventing adverse events. And they did this in a world where management theories were only beginning to address nursing and healthcare settings.

At times, the need for change has been critical and the response of the nursing profession has been swift. Of course, we can all acknowledge there are aspects of care we should have changed but have resisted. Nursing professionals have sought to understand how to change our practice and increase the available evidence on which to base our care. We understand how to change practice safely and how to sustain those changes.

Shared vision for technology: Enhancing care

The United States and UK share similar goals for technology innovation but differ in the economics and delivery-system configurations. (See Comparing the U.S. and UK health systems.) With the technology explosion, many healthcare organizations have sought to add new systems rather than integrate existing ones—usually without knowing if the addition would increase the workload or change work practices or whether it would be acceptable to patients. Organizations supported technology implementation to achieve business goals, whereas nurses saw practice development as the real goal.

The focus on the business case addressed primarily organizational benefits, such as the desire for technology to replace staff time and the ability to market to patients the use of “cutting-edge” devices and electronic record systems, not patient experience and outcomes. Many of these organizations treated technology to help nurses deliver care as a separate case, viewing it as an additional cost to services rather than a mechanism to enhance care. Thus, the possibility of being unable to sustain the technology was always real.

Increasingly, health technology projects have been seen as special projects that need special teams set up by senior managers, some of whom are unfamiliar with the care setting. These managers seem to struggle with focusing on supporting frontline practitioners to deliver care. Managers have failed repeatedly to enable ordinary day-to-day care with technologies.

The need for technology to support practice was demonstrated by findings from the Technology Drill Down project of the American Academy of Nursing’s Workforce Commission. Frontline nurses and other multidisciplinary care team members stressed the importance of involving direct caregivers in technology design, selection, and testing—steps often overlooked in the haste of acquiring systems or devices. (See Making care safer and more efficient with technology by clicking the PDF icon above.)

Technologies designed for and used by nurses at the point of care haven’t always been easy to use. A recent international survey seeking to identify priorities for nursing informatics research on patient care acknowledges that despite the growing evidence base on the design and evaluation of health information technology (HIT), these technologies focus mainly on medical practice. The study found that the two most highly ranked areas of importance were the development of systems to provide real-time feedback to nurses and assessment of HIT’s effects on nursing care and patient outcomes.

Agenda for leadership

We know how to support high-quality professional practice development and what conditions enable professions to change rapidly. If a profession is encouraged to annex new forms of knowledge and opportunities, it can rapidly develop appropriate practice to self-adapt. This is the route to successful, sustainable innovation. Nurses must address the leadership challenge of how to respond to and accelerate adoption of technologies to support practice. We need nurse leaders who see technologies as promising solutions, not problems, and are able to integrate technology into their vision for meeting practice needs. Nurse leaders need to model and promote examples of enabling technologies and demand systems that meet practitioners’ needs.

As technology matures, nurses and other healthcare professionals should be able to collect information only once and see it reused often. Management information should serve as a byproduct of excellent clinical practice and drive standards for high-quality data from nurses. The profession has made progress in dispelling the myth that nurses are slow technology adopters. With the help of nursing informatics experts, nursing leaders must continue to debate the issues that will help us leverage technologies to improve care and efficiency and achieve the promise that health technology can transform care.

Selected references

Aiken LH, et al. Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments. Med Care. 2011;49(12):1047-53.

Bolton LB, Gassert CA, Cipriano PF. Technology solutions can make nursing care safer and more efficient. J Healthc Inf Manag. 2008;22(4):24-30.

Cummings J, Bennett V. Compassion in practice: Nursing, midwifery and care staff:
Our vision and strategy. December 2012. Accessed September 27, 2013.

Dowding DW, Currie LM, Borycki E, et al. International priorities for research in nursing informatics for patient care. Stud Health Technol Inform. 2013;192:372-6.

Evenstad L. Cameron announces £100m nurse tech fund. E-Health Insider. October 8, 2012. Accessed September 22, 2013.

Hamer S, Collinson G. Achieving Evidence-Based Practice: A Handbook for Practitioners. 2nd ed. Baillière Tindall; 2005.

Newport F. Congress retains low honesty rating. Nurses have highest honesty rating; car salespeople, lowest. December 3, 2012. Accessed September 22, 2013.

Plochg T, Hamer S. Innovation more than an artefact? Conceptualizing the effects of drawing medicine into management. Int J Healthcare Manag. 2012;5(4):189-92.

Simpson RL. The softer side of technology: How it helps nursing care. Nurs Adm Q. 2004;28(4):302-5.

Pamela F. Cipriano is a senior director for Galloway Consulting in Marietta, Georgia, a research associate professor at the University of Virginia School of Nursing, and editor-in-chief of American Nurse Today. Susan Hamer is the organizational and workforce development director at the National Institute for Health Research Clinical Research Network at the University of Leeds, England.

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