In my new capacity of Clinical Educator for a Dallas area inpatient facility, one of my many duties in the near future will be to instruct new employees at various levels how to use the hospital electronic medical record systems. I did say systemS. There are 3 systems that I'm currently learning to use and none of these systems interface with each other. It's no wonder everyone at every level within the hospital complains about how one surgical patient's medical record is completed.
As I interact with my fellow employees within the various sub-departments of the department as a whole, I am surprised by the lack of confidence so many of the employees have regarding their IT skills. I have been shock to discover that this facility has been electronically documenting for many years, but the employees are extremely vocal about any change. They know exactly how to do what they've always done and God-forbid you ask them to even consider looking at any changes even if it makes them more efficient. I've been silent about possible changes at this point but at a recent department head meeting it was announced that system wide, there would only be only EMR within the next year.
My interactions have revealed without asking that the vast majority of department employee "working" computer skills are very basic. They use wordprocessing programs like typewriters and can do some very basic "surfing" on the Internet. That's it. This is a problem that I've seen for many, many years. My skills are only intermediate at best, but I was giving and have continued to be given the opportunities since the beginning of computers as office equipment to learn and to continue learning IT skills. I do consider this one of my many blessings. Those of you who know me, know that one of my biggest fears is that the nursing profession is holding itself back from accomplishing so much more because we fail to include in our education programs real computer literacy.
The following is an excerpt from a paper I wrote about on the topic of virtual reality:
There is an interesting information technology problem within nursing. It has nothing to do with currently available software. The problems have been determined to be the users; the vast majority of educators, students, and public assuming that because they know how to “access” or create entries on BlackBoard©, internet sites such as MySpace©, YouTube©, blogs, or use instant messaging, they are “computer literate.”
Using computers for word processing, spreadsheets, databases, presentations, and downloading files for entering data or manipulation of data is considered by those in the information technology industries as “working” utilizing a computer. The other is “just playing.” Current and future students do not possess the proper computer skills to “work” when utilizing current and potential computer programs. Nursing programs should provide students with the skills to utilize all software capabilities available through computers to be a vital member of current and future professional interdisciplinary teams.
“those of us in education do our students an injustice when we assume that our familiarity with traditional library research methods translates to their experience using a mouse and looking at a computer monitor”
(Jenson, 2004).
“Until high schools have a defined set of computer skills that students must have for graduation, incoming students will have varied skill level. Today's nursing students are a diverse group. The group varied in age from 19 to 50 years but age did not correlate to computer competence” (Tarnow & Mayo-Rejai, 2005).
“. . .undergraduate deans and directors of 266 programs in the U.S., it was reported that computer and information literacy skills were expected of graduates at 80% of the schools surveyed. The integration of basic computer skills rather than more advanced informatics content and the absence of formal evaluation of student competencies were found. Faculty members were rated at the “novice” or “advanced beginner” level in teaching informatics content” (Fetter, 2008).
The sequential dates of these studies show the continuing delays of integrating information technology and nursing. As these problems continue, technology rages ahead. Rapid changes and capabilities in information technology is evident in our daily lives.
Fetter, M. (2008). Enhancing baccalaureate nursing information technology outcomes: faculty perspectives. International Journal of Nursing Education Scholarship, 5(1), 1-15.
Jenson, J. (2004). It's the information age, so where's the information? College Teaching, 52(3), 107-112.
Tarnow, K. & Mayo-Rejai, R. (2005) Quick assessment of computer skills: Setting the bar. Nurse Educator, 30(2), 50–51.
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6 comments:
Katherine,
Your post talks volume of what is going on across the board in many institutions of learning. Many people (nurses) approach change with a lot of skepticism. They find it as an extra burden to them on top of patient care. But in real sense technology comes with its own great advantage. Last year in our hospital, they wanted us to adopt a new way of doing our computer charting. Staff members are scattered along the age group mentioned. Others with minimal know how of computer basics to those with a better understanding of computer use. But neither of the group was excited about the change. Coming to learn how user friendly and easy it was to navigate through and find information for patients you care for with the new format, the staff now appreciated this. It will reach a point where nursing informatics should be included in the curricula to help nurses now and in the future. I did my clinicals for my high acuity class and I worked with a group of nurses and other medical team professional through e-ICU. We did our patients rounds through the internet, spoke with patients and their families. We also followed up on all exams or procedures done and collaborated with floor nurses and doctors in the plan of care. We reported any new findings to the floor nurses that were critical to patient care and may be they had not looked at. Doctors and nurses worked in liaison with the e-ICU team and results have showed improved care. These are some of the things we consider for the role of technology in improving patient care outcome. Won’t it be exciting to have a fellow nurse teaching IT skills than a person with no nursing background and not sensitive to patient information. I agree that nursing needs to move in the direction of technology change or we will be left behind alone.
Nelly
Katherine,
I enjoyed reading your blog. At my facility there has been much staff resistance to the use of the EMR. I think in part because of fear of users ability to adapt and change, but I think mostly because staff nurses are sooo busy. The acuity level of the in-patient is very high, nurses are expected to provide care and in addition have many documentation requirements in order to be JCAHO ready at all times (since JCAHO now audits with only a weeks notice). At the same time health care dollars are stretched and staffing ratios have not changed even though documentation and care requirements have increased. What if the staff felt like they had some control/input/support (like extra staffing) regarding proposed changes, would their resistance to change decrease?
Katherine,
I agree with you about the comment of nursing's computer literacy. I took an Informatics course during my graduate training. I felt that the course should be a part of the undergraduate training!! I admit, it was an easy "A" for me because I was so familiar with the technology, but for others it wasn't. For nurses who went to nursing school prior to the computer age, it can be intimidating. But I think computer literacy should be a part of undergraduate programs. It's the only way to move forward
Sharon
I would like to answer Deb's question and Nelly comment. Regarding staff involvement in nursing informatics. At my new hospital, I have to admit that during my EMR orientation, it reminded me of both of these points that I faced as a trainer for healthcare software vendors. I do think that when I did presentations as many staff members as possible, the "buy in" for the product was much better. I think that when only managers are involved in product selection and training, staff members feels snubbed. Introduction and conversion take much longer than they should.
I do think that when a nurse is responsbile for teaching other nurses an EMR system, teaching goes much smoother and is accepted by the nurses who are learning much better. The trainer has the understanding about time constraints, caring for patients, regulatory demands, etc.
Nelly, I'm looking for a nursing school that is open to the idea of teaching undergrads really IT skills. I will be knocking at their doors for a job! I would love to teach nursing informatics.
Incredible isn't it....
I try to keep an open mind, but I cannot help but be sad for our profession when it comes to technology usage. We wish to call ourselves professionals, but to a large extent we seem to bound ourselves in the concrete and the local. Reading Katherine's description of nurses' computer usage reminded me of buying automotive parts. The folks at the parts counter seem ruled by, rather than integrated with, the technology that is required in their jobs. It's a slow and painful process, especially when as a customer you can immediately intuit which buttons need to be pressed to find the correct alternator for your car.
Are nurses much different in this regard? We know what we need to do with our patients, just as the autozone sales associates can probably eyeball my alternator from 10 meters, but we often fail to become intuitive with regard to using the technology that we are required to use. Do we have a fundamental understanding of the technology that any 21st century professional needs to embrace, or are we just being trained to use a specific tool?
What is the appropriate approach to making a change in the way that nurses use and perceive technology as part of their practice?
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