The healthcare industry is depending on technology to pick up the slack in the nursing shortage and improve patient outcomes too. But it’s time to stop and assess what impact healthcare tech is having on nursing, the world’s largest healthcare workforce. Is it living up to its promise or just adding to workloads?
While there are a lot of provider roles in healthcare, nurses have the highest number of workers on the rolls. Indeed, the U.S. nurse workforce is the size of an army. According to the Bureau of Labor Statistics, there were 2.95 million registered nurses in 2016. And the ranks have grown fast: There were 4.6 million active RN licenses at the end of 2017, according to the National Council of State Boards of Nursing (NCSBN). Even so, there is a nursing shortage, and it’s getting worse.
Healthcare digitalization and related tech is accelerating, in part to help with these staff shortages. Last year was a “blockbuster year for health IT,” according to the semi-annual health IT market review from Healthcare Growth Partners, as reported in Healthcare IT News. Investments in new diagnostics, healthcare IoT, and other healthcare technologies are on similar upswings.
In the middle of that are the nurses who are trying to make it all work out for the good.
A day in the life of a nurse—then and now
Sandra Bogenrief, MSN, MBA, RN, is dean of nursing at the St. Cloud, Minnesota, campus of Rasmussen College. She says much has changed over the 43 years she’s been in nursing: “I remember counting my IV drips and actually caring for an appendectomy patient for seven to 10 days and washing out abdominal binders and letting them dry in the patient’s bathroom,” she recalls.
“Many aspects of nursing have improved with the advancement of technology. There is more accuracy, better patient outcomes, less staff injures, and better dissemination of information,” Bogenrief adds.
Technologies such as IV pumps, Omnicell, electronic charting, and portable telemetry monitors have changed much in the nursing workspace. IV pumps automatically control dosages and drips. Electronic charting replaces the rushed handwritten scrawls of busy healthcare professionals. Omnicell automates business operations and patient safety measures. Portable telemetry monitors make it possible to monitor a patient’s condition even if the nurse or the patient is on the move.
“A nurse’s work today is easier, in that we enjoy the efficiency of having medical records at our finger tips, algorithms to guide our nursing critical thinking processes, and pumps that calculate and maintain accurate medication administration for us,” says Bogenrief. “Technology has brought education to the forefront for nurses, improved communication, enhanced documentation, provided evidence-based practice, and has led to many quality innovations. It has provided a safer and more effective work environment.”
While the advantages to patients are fairly obvious, the importance of a technological assist in the day-to-day work to nurses is less apparent—especially in keeping track of tasks that on the surface appear to be easy.
“As an example, it may seem that giving five patients their medication around 9 a.m. would be simple, linear, and routine, but it often doesn’t work out that way,” explains Linda Harrington, RN-BC, PhD, DNP, CNS, CPHQ, CENP, CPHIMS, an independent consultant in health informatics and digital strategy as well as a professor at Baylor College of Medicine. “One patient may be down in X-ray, one may be nauseated or vomiting, one may refuse to take the pill, one may have lab work that contraindicates taking the pill, one may have another medication that effects the one you are trying to give, the patient may have fallen, the patient may have coded, and it may be that the medication is unavailable and the nurse must chase it down. The list goes on.”
While technologies can be invaluable to nurses, some of the changes they bring are for the better, some for the worse, and some are a little of both.
“It is not unusual for a nurse to be walking down the hall to administer a medication to a patient while answering her phone and/or pager and interacting with patients, families, physicians, other clinicians or housekeepers that approach,” explains Harrington, who is also technology department editor at AACN Advanced Critical Care, a peer-reviewed nursing journal, and past chair of the AACN Certification Corp. national board of directors.
The workday gets even more harried for nurses when technology stops working. “When tech is down for whatever reason—upgrades, updates, maintenance, or a malfunction—it is a major disruption to a very busy multitasking nurse. And it demands more work when the tech comes up, such as when manual data entry is required,” says Harrington.
Nurses as hackers
But even when the tech is functioning properly, it sometimes falls short of being helpful. “What I have described is physical work, but the majority of nurses’ work is cognitive and technology doesn’t always take nurses’ cognitive workflow into consideration during design,” says Harrington.
Nurses typically don’t complain about such shortcomings. But they don’t ignore them either. A few years ago, recounts Harrington, she had a conversation with an excellent chief nursing officer (CNO) of a large medical center. “I described to her the workaround nurses were doing that bypassed the safety of a high-risk technology,” Harrington recalls. “She said it couldn’t be happening, that she had created a special committee that met twice a month with nurses from every unit in the hospital represented. The CNO reported they specifically asked at every meeting about issues with technology and that nurses rarely reported any. I told her that was because they didn’t see these workarounds as issues. They had fixed them, or so they thought.”
Harrington should know. As an informaticist, she shadows nurses to observe what they do and how they interact with technology.
Nursing on the edge
The nursing field involves both a technological aspect and the art of nursing. “The intuitive, compassionate, and caring part of nursing can easily get lost in the business of healthcare,” says Bogenrief.
The Internet of Things (IoT) for healthcare is poised to help with both the art and the technical sides of nursing. That’s because technical elements are being pushed into the background, enabling the personal interactions necessary to the art of nursing to come to the forefront again.
“There is a lot going on in tech companies and consulting firms, with researchers and innovators. Tech-savvy consumers are also bringing IoT into healthcare and nursing with their wearables, apps, and data,” says Harrington. She’s looking forward to the day when IoT’s “real-time big, deep, and dark data” shifts tech from informing and monitoring people to actually changing their behaviors.
“This is important, as many illnesses and premature deaths are caused by behaviors that can be changed, such as smoking, diet, and exercise, and we know that tech can change behavior,” says Harrington. “Tech is also helpful in early identification of health issues, allowing for early intervention and better outcomes.”
Edge computing and machine learning will need to come into play for much of healthcare IoT to have the strongest and most meaningful impacts on patient care and outcomes, and to make nurses’ work more artful and less in need of hacks. Edge computing means processing data close to its source.
Think of autonomous cars and the sensors and analytics inside it that make such a thing possible. Data is gathered, processed, and acted on—all by the systems in the car. But that data is also pushed to the cloud where other analytics can use it to improve how other cars function, be that in rerouting trips around road construction or finding a way to find equipment problems earlier. In both cases, machine learning is also key to reacting fast enough to an immediate, possible harmful situation and detecting meaningful patterns in databases too large for humans to view unaided.
Edge computing in healthcare can similarly detect and react faster to even minute changes in a patient’s condition. For example, it can be used to detect cancer in a single drop of fluid, read the body’s reaction to personalized medicine treatments, and decode a patient’s DNA and epigenetics on the scene and in minutes.
This is vital to nursing as both the nurse shortage and innovative advances grow. The gap is widening every day. “You must understand the context in which tech has been introduced to nurses to appreciate the changing workplace of nurses. Tech didn’t arrive by itself. During my 40 years of nursing, there have been thousands more medications and procedures introduced, plus many new diagnoses,” says Harrington.
“Patients have changed in that they have more co-morbidities—multiple chronic illnesses—and are taking many more medications as well as over-the-counter drugs, herbal supplements, and more. You add new and evolving technology to the scenario and you begin to get the picture of an increasingly complex work environment,” she adds.
Enabling edge computing and cloud computing not only helps master these current challenges, but it also enables future advances. For example, edge computing can help monitor and tend to patients remotely as well as use the information to help other patients. Some of those other patients may be currently suffering the same illness, and some may be years away from experiencing the first symptom. The data can be used for both detection and treatment discoveries and preventative medicine too.
“Telehealth has also brought new opportunities for nurses,” Harrington explains. “TeleICUs now monitor thousands of critically ill patients across the country, and teleICU nurses provide an extra set of eyes and additional expertise to the nurses at the bedside. Technology has created opportunities to apply the teleICU model from rural to urban areas and from land to sea.”
The future of nursing is exciting and challenging, and the workplace is likely to be as busy as ever. Technology will become increasingly important but also more ambient and transparent so that nurses can deliver the healing touch that’s so uniquely their own.
The digital tech army: Lessons for leaders
- Nurses are the first to see the impact of digital technologies on patient care.
- It’s not just about the patients directly; enabling more effective nursing practices improves patient outcomes.
- Edge technologies can have an immediate impact.
Disclaimer: This article was originally published online for Hewlett Packard Enterprise.