SPECIAL REPOR T: Nursing, Technology, and Information Systems This special report is sponsored by Cerner Corporation and the Healthcare Information and Management Systems Society (HIMSS). All articles contained in this special report have undergone peer review according to American Nurse Today standards. s m e t Enabling the ordinary: More time to care s y S Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, and Susan Hamer, DEd, MA, BA, RGN n o i t a Versions of this article appear in Nursing is what nurses do, m American Nurse Today and what nurses do is coordi - r (United The value of o States) and Nursing Times (Unit - nate and deliver care. So al - f n ed Kingdom) to acquaint readers though the context, technology, I technology in with common goals, challenges, and health needs of our popula - d tions have changed, nurses re - n and advances in using health in - automating and a main the foremost providers and , formation technology to enable y nurses to provide safer and more coordinators of care. g improving Why state something so obvi - o efficient care. l ous? Showcasing the caring o n patient care aspects of nursing in a techno - h logically dominated world is c e — challenging. Technology enables T , round the globe, in care and enhances safety by au - g every setting, nurses seek ening issues come to the fore - tomating functions both simple n i Ato provide care to pa - front. On the other hand, in the and complex. It doesn’t replace s r tients and families to keep them United Kingdom (UK), the de - nurses. As one expert cautions, u safe, help them heal, and return bate over resources that has automation should occur in N : them to the highest possible lev - been playing out in the media nursing, not of nursing. The val - T R el of functioning. Nowhere is the has caused confusion and public ue of technology hinges on how O struggle to achieve these simple uncertainty as to whom to be - it’s used and whether it helps or P E aims more apparent than in lieve, undermining confidence in hinders care. R hospitals. The tightrope of bal - the system as a whole. The nurs - L A ancing what nurses believe to be ing profession hasn’t been I Changing nursing practice C adequate resources for high- spared this negative view and safely E P quality care and the affordabili - has needed to reassure the pub - So why do nurses have to strug - S ty of these required resources are lic of its core values and pur - gle so hard to get the technology often at odds. Disagreement pose—that caring and compas - we need to support our practice? among leaders in healthcare de - sion are part of the core business And when this technology is livery systems as to how to allo - of nursing. available, why don’t we reap the cate 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 justi - fy 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 examin - ing all aspects of care in the pur - suit of cost-reduction measures that will not reduce quality. In the United States, nurses contin - uously rank as the nation’s most trusted professionals by the Gallup Poll and have the pub - lic’s support whenever belt-tight - American Nurse Today Volume 8, Number 11 www.AmericanNurseToday.com SR2 S benefits we’ve been seeking for P E our practice? C Comparing the U.S. and UK health systems I For years, many in the health - A care community believed nurses Despite some fundamental differences, healthcare delivery systems in the United L R were too slow to embrace new States and the United Kingdom (UK) share a national commitment to quality and E the role of nurses in improving care. In both nations, nurses are expanding the use P technologies and might disrupt O or even obstruct the change of health information technology tools to improve safety and efficiency and R involve patients in their care. The chart below compares some features of the U.S. T : process. Had they ever visited a and UK health systems. N neonatal or intensive care unit? u Although their description of Feature United States United Kingdom r s nurses and nursing wasn’t accu - i n rate, it had become a mantra Payer(s) • Government • Government g , within a wide variety of organi - • Private insurance companies (National Health Service [NHS]) T zations. • Self-pay • Private insurance companies e • Private payers c What they failed to grasp, h and continue to misunderstand, n Delivery • Hospital centric (government • Strong community-based care o are the practical realities of how l system or private) with primary-care focus o professions change and how to • Increasing shift toward • Hospitals run by trusts g support innovation in practice. illness prevention and more (public-sector corporations y , For generations, nurses have ambulatory, home, and providing services for the NHS) a changed their practice success - post-acute care n d fully and have adapted to new I challenges, such as coping with Technology • Electronic health record • Paperless system by 2018 n f rising patient acuity, safely de - vision for all citizens by 2014 • Improved availability, o • Improved availability, quality, quality, and safety of r livering dangerous drugs, and m and safety of information information preventing adverse events. And a t they did this in a world where i o management theories were only n beginning to address nursing Many of these organizations S and healthcare settings. The United States and UK treated technology to help nurs - y s At times, the need for change es deliver care as a separate t share similar goals for e has been critical and the re - case, viewing it as an additional m sponse of the nursing profession technology innovation but cost to services rather than a s has been swift. Of course, we mechanism to enhance care. can all acknowledge there are differ in the economics Thus, the possibility of being un - aspects of care we should have able to sustain the technology changed but have resisted. Nurs - and delivery-system was always real. ing professionals have sought to configurations. Increasingly, health technolo - understand how to change our gy projects have been seen as practice and increase the avail - special projects that need special able evidence on which to base if the addition would increase teams set up by senior man - our care. We understand how to the workload or change work agers, some of whom are unfa - change practice safely and how practices or whether it would be miliar with the care setting. to sustain those changes. acceptable to patients. Organi - These managers seem to struggle zations supported technology with focusing on supporting Shared vision for implementation to achieve busi - frontline practitioners to deliver technology: Enhancing care ness goals, whereas nurses saw care. Managers have failed re - The United States and UK share practice development as the peatedly to enable ordinary day- similar goals for technology in - real goal. to-day care with technologies. novation but differ in the eco - The focus on the business case The need for technology to nomics and delivery-system con - addressed primarily organiza - support practice was demonstrat - figurations. (See Comparing the tional benefits, such as the de - ed by findings from the Technol - U.S. and UK health systems .) With sire for technology to replace ogy Drill Down project of the the technology explosion, many staff time and the ability to American Academy of Nursing’s healthcare organizations have market to patients the use of Workforce Commission. Frontline sought to add new systems “cutting-edge” devices and elec - nurses and other multidiscipli - rather than integrate existing tronic record systems, not pa - nary care team members stressed ones—usually without knowing tient experience and outcomes. the importance of involving di - www.AmericanNurseToday.com November 2013 American Nurse Today SR3 s rect caregivers in technology de - m sign, selection, and testing—steps e Making care safer and more efficient with technology t often overlooked in the haste of s y acquiring systems or devices. (See The American Academy of Nursing’s Workforce Commission recognized the S Making care safer and more effi - importance of effective technologies in improving the safety and efficiency of n cient with technology .) care and in helping to return time to nurses for essential care. The Commission’s o i Technologies designed for and Technology Drill Down (TD2) project, funded by the Robert Wood Johnson t Foundation, addressed another looming nursing shortage in an attempt to a used by nurses at the point of reduce demand for nursing care. Aimed at finding technological solutions to m care haven’t always been easy to r workflow inefficiencies on medical-surgical nursing units, TD2 brings together o use. A recent international sur - f multidisciplinary teams to review the current state of nursing workflow, design n vey seeking to identify priorities the desired future state, and brainstorm technology solutions to fill gaps—with I for nursing informatics research the over arching goal of providing safer, more efficient care. d on patient care acknowledges n The Commission found that in the 25 acute-care hospitals involved in the a that despite the growing evi - TD2 project, most units already had supply storage systems, electronic nurse , y dence base on the design and documentation, provider order entry, and several other automated systems in g evaluation of health informa - place, such as telecommunications equipment and drug-dispensing units.