Day in the life-8 weeks in

[DM74LA]

Hi all,

This is a bit overdue, but here it is. I was hired Aug 5th of this year to come in on a software build that is about a year in development. We are moving from our old system to an evidence-based system with CPOE, electronic MAR, decision support. I have been a nurse for 5 years now, but I hold a bachelors in computer science, so I was a rare blend between clinical and technical. There are nine of us nurse informaticists.

I was originally hired to design and build workflows, since that area involves some programming with which I have experience. But our workflow deadline was not as pressing as other things and I was given the task of getting all our plan of care (POC) interventions configured and ready to upload to the software-I have oversimplified this because this in itself has been a challenge. Let me explain. We are driving at an interdisciplinary POC where all departments involved in patient care chart patient problems, goals, and interventions. The other departments however cannot seem to get their head wrapped around the need for a POC as they have their own treatment plans and our interventions are often too basic. So after much back and forth, we finally came up with a happy medium.

We are also having assessment data trigger problems for POC and suggest appropriate ones based on the fields that have abnormal responses. So much combing of the assessment forms ensued. Of course, every patient will get a discharge POC and many will get a couple of others.

So, having the POC stuff mainly complete, I'm starting to look at workflows again. This should be retitled rules and workflows. Rules allow the software to make decisions and send notifications, alerts, remimders, prompts and other whatnots. I had my first rules class today and there is some basic programming to evaluate data retrieved. There is a workflow called consult triggers that is rather involved. It sends consults to ancillary departments based on assessment data. So I have to meet with all departments involved to discuss what new triggers they want with the new system. The departments are also wanting more bells and whistles thrown in to make their life easier...understandable. So more negotiating with department heads.

My job after the software is running live will be to maintain what we have and to add additional functionality to the rules and workflows area. We have 3 nurses working on assessment forms. 2 nurses working on predefined order sets. 2 nurses working on offline forms, 1 nurse and the systems analyst working on uploading all the current orders for every department (a huge endeavor). We also have a project manager who has been working with the order sets and POCs.

All of us at some point, collectively or individually, interface with some of the finance people, some of the IT people, heads of departments, MDs, pharmacists, DONs, etc. We attend weekly and bi-monthly meetings. We have regular webinars, classes, conference calls, and other various meetings to attend to. I have to stay on top of email and make sure I respond in a timely manner. Although, the systems analyst and project manager probably get around 80 emails a day.

The atmosphere is very laid back. If we need to come in late or leave early it's usually not a big deal. We have laptops we can take home and work from home some if we want. One nurse works ten hour days and leaves early Friday or does not come in on Friday. We get holidays and weekends off. So it's not a bad gig.

But some days can be exasperating. I have been utterly confused to the point of mind-mush. Sometimes my mind is 4-5 steps behind a conversation and only catches up when the conversation stops or later that evening at home it'll hit me what they were talking about. I've wondered many times if I made the right decision entering this field. But today, when we started getting into programming, I knew everything was going to be OK.

So that's it, not really a day in the life in chronological order, but more of a 'what I've been up to'.