The goal of transforming healthcare using digital technology will fail unless nurses are allowed to participate in the process of designing new IT systems, the Royal College of Nursing has warned.
The RCN surveyed nearly 900 nurses and found a “significant number” were being hindered in using digital technology by a catalogue of “depressingly mundane barriers”.
“The NHS and healthcare generally need to do much more to develop and nurture nurse leadership of the digital agenda”
These included out of date operating systems, poor Wi-Fi and a shortage of staff. Most damning of all, the survey found that managers were not giving nurses input into the design of programmes and IT systems they relied on every day to do their job.
The results of the consultation were presented at an RCN round-table event attended by digital experts from NHS Improvement, Health Education England and the Council of Deans of Health.
Earlier this month, prime minister Theresa May pledged to put the UK “at the forefront of the revolution in artificial intelligence and other technologies” for healthcare.
However, the RCN document said that such bold ambitions are a “pipe-dream” unless the NHS’s biggest staff group – nurses – were fully involved.
The RCN surveyed 896 nurses and midwives online in January and February. More than 100 others took part in five in-depth focus groups across all four countries of the UK.
“Nurses see very clearly the potential of technology to transform their and patients’ lives”
During the consultation, participants were asked to describe their vision of how new technology should help healthcare workers. They were also asked to identify the barriers preventing that from happening.
One contributor said: “As a nurse, my dream would be to go online and see any patient’s records that I needed to see. They would be together, well-curated, under that patient’s name/identifier. It would include GP, acute, community interventions and interactions and all correspondence. There would be click-through contact points for details of other staff involved. As a patient, my dream would be the same.”
But many nurses highlighted common barriers that were preventing digital technology from delivering productivity gains.
In relation to operating systems, one contributor to the consultation said: “The single most fundamental problem in our trust is the inadequacy of our IT systems.
They said: “We are currently upgrading out PCs to run Windows 7 – an [operating system] that is already nearly a decade out of date! Why? Because computers have to be procured locally rather than centrally, so the responsibility for updating hardware rests with clinical areas – and obviously, there are always other priorities.”
“The people on the frontline need technology to work as effectively as possible”
The contributor concluded: “I hate to think how much nursing time is wasted each day waiting for computers to switch on, load emails, bring up blood results – that is if you can find one that’s free.”
Another key problem highlighted was the NHS’s failure to involve nurses in relation to new technology.
“[Decision-makers] often do not know the extent of our work and have never walked in our shoes, yet they make decisions on our behalf and bring in systems for us to use,” one respondent said. “They have no idea about workflows and how information is used.”
A lack of staff was also crucial in undermining nurses’ ability to use new technology effectively. Chronic understaffing was “the biggest barrier to any system, be it electronic or paper-based”, one of those consulted said.
“If staff haven’t time to take a break, use the bathroom and are struggling to deliver patient care, they will find it difficult to engage with and learn new systems,” they said.
Another issue was the lack of training for healthcare IT in nursing degree courses. A number of contributors reported that universities were not able to access the hospital systems where students had gone on placements.
“We have nurses with backgrounds in all areas of care supporting our programmes, informing the way we do things2
The NHS has had longstanding problems with digital technology. In May last year the WannaCry cyber-attack caused widespread problems with hospitals forced to cancel treatment and some trusts temporarily unable to use computers.
In 2013 a committee of MPs concluded that the scheme to upgrade the NHS’s IT systems – cancelled after numerous problems – was one of the “worst and most expensive contracting fiascos” in public sector history.
There were some positive findings from the consultation. Mobile systems in use at some hospitals and community trusts allowed nurses and other clinicians to input patients’ vital signs and be alerted to any deterioration.
Other successes were apps that allowed patients with long-term conditions, such as diabetes to relay data to nurses and digital networks that linked up district nurses while out in the field.
Ross Scrivener, e-health lead at the RCN, said that in the lead up to the NHS’s 70th anniversary a succession of healthcare leaders had spoken in favour of digital transformation.
“But our consultation shows that that aim will remain a pipe-dream unless managers, technology providers and IT staff take more account of the views of nurses, the biggest staff group in the health service,” he said.
He said the survey highlighted “depressingly mundane” barriers that nurses encountered- “from Wi-Fi that doesn’t work to computers that take too long to log on, interference from medical equipment and outdated operating systems like Windows 7.”
“But the single most important theme to emerge from the consultation is that involving nurses in the design and implementation of programmes and systems to improve patient care is not an optional add-on,” he said.
“It is absolutely vital if those systems are going to provide the benefits they’re supposed to,” said Mr Scrivener.
He added: “The NHS and healthcare generally need to do much more to develop and nurture nurse leadership of the digital agenda.
“Nurses see very clearly the potential of technology to transform their and patients’ lives, and want to play their full part - but that won’t happen until their views are listened to,” he said.
NHS Digital, the health and social care system’s IT provider, welcomed the RCN report and its call for more nurse involvement in digital technology development.
Caron Swinscoe, NHS Digital’s senior clinical lead, who has a nursing background, said: “It is absolutely right that nurses’ views and expertise should be listened to and taken on board for all the benefits of digital technology to be realised when treating patients.
“Understanding how work is done rather than how work is imagined to be done is vital,” she said. “Every nurse had something to contribute.
“The people on the frontline need technology to work as effectively as possible whether they are in a hospital or caring for someone in their home,” said Ms Swinscoe.
She said: “The only way to ensure this happens is to involve those staff, who do the work day by day, in the design, development and implementation of digital health technology.”
Ms Swinscoe said that NHS Digital was committed to involving nurses and midwives in its work.
“We have nurses with backgrounds in all areas of care supporting our programmes, informing the way we do things and helping to build strong links with frontline staff,” she said. “It’s the only way we can ensure digital health is relevant, effective and useful in the real world.”
NHS Digital last year supported the RCN’s campaign Every nurse an e-nurse.
“Nurses will always need to give hands-on-care, and embracing new technology means they have more time to do just that,” she said.