Nurses in clinical practice need to work with their counterparts in the IT industry to ensure technology meets their requirements at work and is fit for purpose
Information technology plays an increasingly important role in healthcare, with nurses split over whether this is to the benefit or detriment of nursing care. This article discusses how NHS nurses can work with those developing the technology. This approach will ensure that what is developed will be relevant to nursing care and that both nurses and patients gain the maximum benefit from advances in health technology.
Citation: Hamer S (2013) Working with industry to improve IT. Nursing Times; 109: 11, 12-14.
Author: Susan Hamer is chair of National Nurses Informatics Strategic Taskforce, University of Leeds
- This article has been double-blind peer reviewed
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There can be no doubt about the scale and pace of change in information technology (IT). We see it in all areas of our personal lives, how we shop, what we do for recreation and how we communicate with friends and family. In many respects, we can choose how we respond to it.
I have never been an individual who needs the next best thing, and I live in a “technology light” home - so does that make me a slow adopter? It depends on your perspective. To my teenage children, yes, I am deeply uncool, but to my husband it is not a new behaviour.
Knowing when to get something new is not just about things being available; it is far more complicated. Often a decision is arrived at after much consultation. You may have looked at someone else’s new product, you may need to have saved up, you may be concerned about buying something with lots of features you may not need and you may wonder if you have the time to learn how to do a previous task differently. You may ask yourself if it will generate more work initially, not less, and how you will make sure it does not just end up in the back of a cupboard, never to be used again.
If we know this is how we evaluate change in our personal lives, why do we think we will react any differently when it comes to the introduction of new technologies into our working practice?
Technology and change
Many evaluations of technology adoptions give examples of problems experienced while they are being introduced. For example, a commonly reported frustration by patients is clinicians looking at the computer screen rather than directly at them.
As with other new pieces of equipment people have different outcomes and successes (Greenhalgh et al, 2009). Janowitz and Koniger (1995) describe the information paradox of some people complaining about too much information while others report that there is not enough. Michel- Vererke (2012), looking at a nurse information system, describes nurses not trusting the quality of information entered by other health professionals and spending their time checking it.
Working with informatics nurses
So how can we improve our approach to technology-enabled practice development? Clinical engagement is widely recognised as being critical to the success of IT projects in healthcare and there are guides available on how this might be developed (tinyurl.com/IT-guide-CFH).
Perhaps what is less well explored is the opportunity to work with the clinicians in the companies that are developing the IT. They, too, work to a principle about the effectiveness of clinical engagement but we often overlook them when we consider the change process, perhaps because we are bound by our view of where we look for help. Too often, we over rely on our own organisation and people with whom we are familiar, rather than extending our professional networks as we would with other practice issues.
When advancing clinical specialist practice, we will often seek national and international nursing groups, access new literature and attend specialist conferences. Having attended a large health informatics conference last year, I noticed an absence of nurses, which was both palpable and worrying. The challenge for us all is to think actively about the nature of partners and relationships we need to develop to assist with the implementation of new technologies. We need some new practice colleagues and they may be working in new branches of the profession (nursing informatics) in less obvious locations (Box 1).
As we consider developing our practice in response to changes in society, we know that technology will be an important tool to support us. This will mean working with nurse colleagues who have very different roles with different areas of specialised practice. There are nurses working in the private sector and clinical environments as systems analysts, requirements analysts, content developers, database administrators, implementation specialists, information system liaison and trainers - a list that is expanding rapidly. As leaders, we need to encourage nurses to take on these new roles so we have the nurses we need in positions of influence so great solutions will emerge.
Box 1. Crossing the boundaries: the role of the industry nurse expert
How many times do you hear the comment: “Healthcare information technology systems– that’s something other people do. It’s what the IT department does, not us.”
Some nurses specialise in various aspects of informatics as their day job but all nurses now need the skills to manage and use information daily.
Nurses record, manage, analyse and share information about individuals and groups of patients within and across multidisciplinary teams and organisations. Information from many sources is used to deliver evidence-based care, whether helping patients to recover after surgery, managing them through a busy emergency department, providing advice on healthy lifestyles, undertaking clinical audits or conducting research. Information is at the heart of what nurses do.
For years, we have laboriously searched through records to collate data for audits demonstrating the effectiveness of the care we deliver or for reports demonstrating to management that targets are being met and best patient outcomes achieved.
Nurse managers often complain about the increasing amounts of paperwork, which distract them from their main purpose of providing clinical leadership to their teams. Why then is there such resistance to technology that can free up time?
Nurses are the biggest staff group in the NHS, and are often perceived to be resistant to new technologies and information sources. However, there are many examples of nurses embracing new technologies to deliver safe and effective care; if they can do it, why can’t everyone?
The fear of technology and change are barriers that prevent many nurses from embracing the opportunities technology brings to improve patient care.
Nurses working in the IT industry can provide support and encouragement to facilitate this transition by working in partnership with nursing colleagues in the NHS. We are often the universal translators working between technology experts and frontline clinicians to improve mutual understanding of the needs of nurses and others in the multidisciplinary team.
As IT nurses, we understand the processes involved in the delivery of care and the IT solutions available to facilitate and improve it. Through discussion and debate, we can also help identify the information needs – who uses the information and for what purpose.
However, this requires dialogue between nurses in the IT industry and those in the NHS to ensure that IT solutions are fit for purpose and assist the nursing process – whether that is at the patient’s side, improving the monitoring of vital signs or in an office collating a report, for example.
Nurses work in varied roles within healthcare IT organisations, as clinical specialists in product design, training and deployment or in leadership roles. They come from a variety of backgrounds in both primary and secondary care and have sound clinical knowledge. Many have undertaken training in the IT industry to gain a full understanding of clinical safety to ensure that IT solutions do not introduce any clinical risk.
Working together, nurses in the IT industry and the NHS are best placed to identify where the greatest benefits for patients, nurses and the wider multidisciplinary team lie.
Chris Orme and Ruth Chauhan are senior nurses at CSC Healthcare
It is all too easy to over-simplify how difficult it is to make sustainable change in practice and to think that partnering with industry is a simple task. To do both, we need to take a mature approach and a commitment to ongoing dialogue based on respect, and with all parties using the resources available to them with a shared purpose.
- Engagement of clinical staff is critical to the success of IT projects
- Technology is central to adapting practice for changes in society
- The expertise of clinicians in IT firms is often overlooked by staff in clinical practice
- Joint working with clinicians in IT firms needs to be explored
- Nurses should consider working with those in new branches of the profession, including health informatics
Greenhalgh T et al (2009) Tension and paradoxes. In electronic patient record research: a systematic literature review using the meta narrative method. The Milbank Quarterly; 87: 4, 729-788.
Koniger P, Janowitz K (1995) Drowning in information but thirsty for knowledge. International Journal of Information Management; 15:1, 5-16.
Michel-Verkeke M (2012) Information quality of a nursing information system depends on nurses: a combined quantitative and qualitative evaluation. International Journal of Medical Informatics; 81: 10, 662-673.