Enabling technologies promise to revitalize the role of nursing in an era of patient safety

Abstract

The application of information technology (IT) in health care has the potential to transform the delivery of care, as well as the health care work environment, by streamlining processes, making procedures more accurate and efficient, and reducing the risk of human error. For nurses, a major aspect of this transformation is the refocusing of their work on direct patient care and away from being a conduit of information and communication among departments. Several of the technologies discussed, such as physician order entry and bar code technology, have existed for years as standalone systems. Many others are just being developed and are being integrated into complex clinical information systems (CISs) with clinical decision support at their core. While early evaluation of these systems shows positive outcome measurements, financial, technical, and organizational hurdles to widespread implementation still remain. One major issue is defining the role nurses, themselves, will play in the selection and implementation of these systems as they become more steeped in the knowledge of nursing informatics. Other challenges revolve around issues of job satisfaction and the attraction and retention of nursing staff in the midst of a serious nursing shortage. Despite these concerns, it is expected that, in the long run, the creation of an electronic work environment with systems that integrate all functions of the health care team will positively impact cost-effectiveness, productivity, and patient safety while helping to revitalize nursing practice.

Introduction

According to studies conducted in the mid-1990s by Clarian Health Systems, nurses spend the majority of their time in activities other than the one they most value, direct patient care. From 1994 to 1996, researchers at Clarian conducted 1000 h of continuous videotaping on a medical surgical unit in 12 h segments. They discovered that, on average, direct patient contact occurred between 20 and 50 min per patient over a 12 h period, with the median being 20 min. Clarian's report shows that nurses spent the remaining time on other functions, primarily managing and coordinating the communication of patient information to other departments, physicians, or members of the health care team [1].

The scenario depicted in this study should not come as a surprise. While traditional tenets call for nurses to play a pivotal role in the direct care of patients, the inefficiencies of our current health care system are such that the nursing role has become increasingly peripheral to this objective. Not only have nurses' cognitive capabilities been put in jeopardy, but other elements in the health care work environment are also contributing to nurses' growing dissatisfaction with their jobs. There is also evidence that this issue is international in scope. According to a recent study of nurse satisfaction in five countries, nurses leave the profession when they perceive that system inefficiencies compromise the quality of care they are able to give [2]. Compounding the issue is the responsibility for patient safety, which has become a renewed priority for all members of the health care team. Yet despite this seemingly bleak outlook, the signs of change are positive as all players in the health care industry respond to the growing pressure to reduce medical errors, increase the quality of patient care, and improve the working environment. A major factor in these efforts is the deployment of information technologies (IT) that promise to streamline processes, make procedures more accurate and efficient, and drastically reduce the risk of human error.