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Transforming the nurse’s role through technology

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Claire Read reports on a roundtable event discussing the benefits of technology and how nurses can use it 

It is three and a half years since clinicians at Cambridge University Hospitals Foundation Trust stopped keeping paper notes. Nowadays, nurses don’t reach for a clipboard at the end of a bed to record and check patient information. Instead, they use an electronic patient record (EPR), accessible from any location via a digital device.

Transforming the nurse’s role through technology

Transforming the nurse’s role through technology

Helen Balsdon

According to chief nursing information officer Helen Balsdon, it is a change that has fundamentally enhanced the ability to provide excellent nursing care. That includes by removing one of nurses’ traditional bugbears: the need to decipher medical colleagues’ handwriting.

“Nurses still say one of the biggest impacts after the system went live was they could read the doctors’ writing,” she says with a knowing chuckle. “You don’t realise how much of a barrier it is, but for everybody to see the same thing, know that they can find it all there and then, it’s made looking at things much easier.

“Our rapid response, our falls coordinators, tissue viability, all of those teams that work peripatetically, are saying: ‘I can look at the record [from anywhere], I can triage where I go, I can give advice, I can prioritise where I go, when I go, and I’ve got all of that information at my fingertips to be able to keep an eye and track things’.”

Ms Balsdon was speaking at a recent Nursing Times roundtable debate. Held in association with NHS Digital, the event brought together a small panel of experts to discuss how nursing and midwifery care might be enhanced through technology. Together they considered how much progress the professions have already made in embracing technology, what benefits have been seen, and what the future might hold.

Certainly our panellists expressed absolutely no doubt that technology can support nurses to offer even better care across a variety of settings. Cath Johnson – a general practice nurse who is clinical specialist at NHS Digital – spoke of how it can help ensure that clinicians spend time with the patients who most need their support.

Cath Johnson

Transforming the nurse’s role through technology

Cath Johnson

“Some GP surgeries are using online functions such as e-reception. This enables patients to log on from their computer, tablet or smartphone and answer a series of questions. The responses then enable them to be directed to the best person or service to fulfil their needs.

“This can mean the patient doesn’t need to have an appointment with a clinician as the issue is solved through signposting to further information, or to another member of the practice team such as a physiotherapist or pharmacist.”

And Su Davis, senior clinical governance and clinical safety officer at Humber Teaching Foundation Trust, explained how technology can transform the delivery of nursing in the community. She explained that her trust – much like Cambridge – now has electronic records of patients’ information, which unite details from a variety of healthcare professionals.

“It really is information at the fingertips to be able to make safe decisions really quickly,” she reported. “Previously they would have relied on requesting records – waiting for the records to be requested, which even on an urgent request it was taking 24 hours. So often people were treating patients with the best information available at that point in time rather than the richness of information that’s available across a care economy, from multiple providers – whether that’s therapists, nurses, GPs, consultants for both community and mental health.”

Natasha Phillips, the chief nursing informatics officer at University College London Hospitals Foundation Trust, argued such setups make it easier for nurses to fulfil their role as “the glue in the system”.

Natasha Phillips

Transforming the nurse’s role through technology

Natasha Phillips

“Nurses spend a phenomenal amount of time trying to connect all these disparate bits [of information] at the bedside. When you have a much more integrated [electronic] system, you’re just making it easier for nurses to have what they need in order to do their job well.”

But, interestingly, Ms Balsdon admitted that the sudden wealth of easily accessible information technology offers could in some ways be daunting. “When you have information at your fingertips you know exactly what’s working and exactly what’s not working – all of a sudden it’s there, overnight, at the flick of a switch. That was quite scary [for us].”

It was a point echoed by Jane Benfield, chief nursing information officer at Gloucestershire Hospitals Foundation Trust. “What I’ve experienced [with greater use of technology and digital] is that a lot of things are becoming transparent. Now we can see what we’re doing less well. And I think that’s really quite frightening for people.”

While our panellists were united in the belief that technology can make a difference to nursing and midwifery, they all also agreed that its introduction can sometimes provoke worries.

“I think when you’re introducing technology, there are a lot of questions about: ‘Is this safe?’” mused Helen Blee, clinical safety officer and ICT clinical lead at Norfolk and Suffolk Foundation Trust.

Ms Phillips added: “It’s funny how we amplify our perception of risk.”

She introduced the example of the implementation of the new electronic prescribing system, which will mean all areas of the patient record are accessible to nurses including prescribing. Some worried this introduced new risks as nurses would have access to the area for documenting these orders.

But she pointed out that previously nurses had access to hard copy drug charts, and could easily have written on an order – with no clear audit trail, unlike with digital. They’re not suddenly going to act outside of their scope of practice [because it’s gone digital]. But everyone does get quite nervous once things are digital,” she said.

How can any worries nurses may have about new technology best be addressed? Many panellists argued that clinical engagement was absolutely crucial here – and, indeed, to the successful implementation of any new technological system.

Lorrayne Dunn, digital matron at Nottingham University Hospitals Trust, said the roll-out of electronic observations, handover and bed management at the trust had greatly benefited from being clinically-led. “I think we’ve been in a very fortunate position to be able to have a team of nurses and doctors that drove that, so it wasn’t seen as an IT project; it was seen as IT and nurses [working] together.”

“The biggest success we’ve had is with the electronic observations, getting them up and running”

Sam Neville

Sam Neville said it was a similar situation at her trust. “The biggest success we’ve had is with the electronic observations, getting them up and running. Staff came in and did the design phase with us and implementation. So it’s all run by nurses, as they’re the ones who tend to do the observations,” she said.

But how does one go about engaging nurses in a technology project? For Deborah Sanders, it is a case of carefully describing the expected benefits. “It’s fascinating: whenever anybody said anything to me about digitising the nursing record, they said to me what will be really good about it is you don’t have to write the patient’s name down on every bit of paper. And I thought: ‘Well that can’t be it. That doesn’t sound very good to me.’ So it kind of put me off for a bit,” she said with a laugh. 

“So I think it’s really, really important how you get those benefits across to people. And I think it is great to be able to say it will save you time, but [then] to say what we want you to do with that time is be with patients,” she added.

Katie Trott, chief nursing information officer at Royal Free London Foundation Trust, agreed. “The other day a nurse looked and me and said I spend two hours a shift looking for notes – literally. Her very first thought [was that the electronic patient record the trust is implementing] is revolutionary; it’s actually going to change the way my day is laid out, and reduce the frustrations of the day. Because happy staff, happy patients.”

Caron Swinscoe

Transforming the nurse’s role through technology

Caron Swinscoe

So how can senior nurses help more colleagues understand the power of technology? As Caron Swinscore, senior clinical lead at NHS Digital, put it: “How do we start to bring in our colleagues out there, and get them to see the possibilities?”

It was a question which made Su Davis think of the World War I poster with Lord Kitchener: ‘Your Country Needs You’. “No matter how small your part is, you have a role,” she argued. “Whether that’s just using the technology you’ve been given by your organisation to deliver good patient care, or whether that’s putting yourself forward as a leader because you really want to run with something.

“Everybody has got a role,” she concluded, “and it’s really important that they step up.”

The panel

Helen Balsdon, chief nursing information officer, Cambridge University Hospitals FT

Jane Benfield, chief nursing information officer, Gloucestershire Hospitals FT

Helen Blee, clinical safety officer and ICT clinical lead, Norfolk and Suffolk FT

Su Davis, senior clinical governance manager and clinical safety officer, Humber Teaching FT

Lorrayne Dunn, digital matron, Nottingham University Hospitals Trust

Steve Ford, acting editor, Nursing Times (roundtable chair)

Cath Johnson, clinical specialist, NHS Digital

Sam Neville, chief nursing information officer, Basildon and Thurrock University Hospitals FT

Natasha Phillips, chief nursing informatics officer, University College London Hospitals FT

Deborah Sanders, director of nursing, Royal Free London FT

Caron Swinscoe, senior clinical lead, NHS Digital

Katie Trott, chief nursing information officer, Royal Free London FT

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