There's an app for that...and other controversies

Today’s nursing arena has been blessed with amazing technology – and the BFF of any nurse can be a smartphone. Examining both sides of the argument for the use of cellphones in the workplace is essential in understanding the pros and cons of technology. Here is a simple explanation to both sides of the conflict. Nurses Announcements Archive Article

There's an app for that...and other controversies

The Cons

Starting with the "cons". Naysayers to the use of smartphones in the workplace have very few arguments on which to base their beliefs. That said, the arguments they raise are huge. Let's look at three key issues in the fight against leaving the dark ages: violation of HIPAA, security risks, and infection control.

Violation of HIPAA

American Nurse Today (2014) expresses concerns over nurses violating federal laws and the ANA Code of Ethics by using cellphones. Patient information must be protected and sending health information over the phone can put that information at risk. Posting photos of your patient or tweeting about your patient may seem like a "no-brainer" to most, but apparently, that is just not the case for ALL. Doing so could cost a nurse not only their job, but their license and possible fines and jail time. Even something as innocent as posting on your patient's hospital based support page to show support for them could be a violation - as most of these sites will list the name of the poster that can be seen by others! This is an example of inadvertent release of confidential information through social media.

Security

Hackers. They get into everything - including cell phones. More and more people are using some type of security password on their phones, but a recent survey found that two of five people do not use basic security precautions. Of the 1,000 American workers surveyed, 88.6% state they use their phone for work, but 39% do not have it secured with a password, and 52% use an unsecured Wi-Fi network (a security vulnerability at high risk for data theft), according to American Nurse Today (2014). This is another risk for a HIPAA violation. Sending a text to a physician with patient information could not only be hacked, but accidentally sent to the wrong person.

Infection control issues

According to Occupational Health and Safety (2012) the health risks involved in using mobile devices in the workplace are obvious, considering the factors that contribute to harboring bacteria on cellphones. In order to determine how MUCH bacteria grew on our cellphones, a study was conducted using swabs on healthcare workers phones. Of the 51 phones that were swabbed, only 5 phones showed no growth, and the rest were action packed with everything from Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. To name a few.

This is a concern, of course, because of the increased risk it places on our patients to obtain a hospital acquired infection.

Now for the not so big issue, but an argument against cellphone use, nonetheless. Using a cellphone in front of your patient is not professional. In my opinion, I think it has to do with the context in which your phone is used. For example, explaining to your patient why you are using it (i.e., look up drug information, diagnosis education, etc.) before you begin to use it would be polite, just so they do not think you are checking on how many likes you got on your last post. Additionally, the age of your patient as well as their culture should be considered. Many of the baby boomers might find it offensive if their nurse takes out their phone and begins to use it, as may some ethnicities who may find it disrespectful as well as unprofessional, if they do not understand what you are using your phone for.

The Pros

Enough of the cons, let's move on to the pros!

Statistics

According to Health News (2015), a recent survey by Spyglass Consulting Group found that at least 70% of hospital nurses use their cellphones for work related communications. Another survey by InCrowd found that 95% of 241 nurses owns a smartphone and 88% of them use it at work. Additionally, 52% use an app to find information related to treatment instead of asking a colleague, and 32% use it instead of asking a physician. What type of information? 73% look up drug info while at the bedside, and 72% look up diseases or disorders.

Support

The Institute of Medicine (2006) endorses the use of technology by healthcare providers to reduce the risk and the prevention of medication errors - and drug references are among the most used type of mobile apps. The Emergency Nurses Association (2013) stated in their position that nurses' access of mobile technology can provide information essential to their practice and has the potential to increase patient safety as well as emergency practice efficiency.

Interestingly, we can bring the Joint Commission into this! TJC reports that a failure to communicate properly is related to more than 60% of reported sentinel events. Nurses were reported to waste over 1 hour each shift tracking down providers regarding their patients, and texting provides a very efficient, fast, and quiet method to reach them (Journal of Nursing Education and Practice, 2014).

Apps

MedScape discusses a study published in the Journal for Nurse Practitioners (2014) concluded that apps enable clinicians to use evidence based guidelines for the treatment in care for their patients, as well as provide a greater chance in the identification of serious health issues during routine exams. According to Nurses who use apps as support tools are four to 44 times more successful in helping providers to diagnose chronic health issues.

There are hundreds of amazing nursing apps out there, but here is a 2014 list (taken verbatim) of the top 10 apps for nurses and nursing students, according to Capella University (and just look at who made number 10!!):

NCSBN Flashcard App - Medication Flashcards

This simple app downloads a medication library to your phone. Great for students preparing for exams or nurses who need a quick reference point.

AVAILABILITY: iOS and Android; Free

Nursing Essentials - Nursing Reference Guide

This app turns the RN Pocket Guide by Informed Publishing into a digital information resource. Includes sections on CPR, Assessing, Cardiac, Respiratory, Neurological, Pediatrics, and more. A helpful resource for students studying for general or specialty coursework.

AVAILABILITY: iPhone, iPad, Android, Nook; price varies by $5-$10 depending upon device

PEPID - Drug and Clinical Resource

With different versions for different professions, including nurses, EMTs, physicians, students and more, this app provides detailed information for all elements of patient care. Students gain a credible and complete resource guide for coursework, lab exercises, and clinical practice.

AVAILABILITY: iOS, Android, Blackberry, and mobile browser compatible; student subscription starts at $195 for 1 year

Epocrates - Clinical Care Assistant

This app streamlines searches for information on prescription drugs, drug interactions, and a directory of providers. Nursing students can prevent mistakes on exams, and most importantly, provide proper treatment when they begin practicing.

AVAILABILITY: iOS and Android; free, with a $160 upgrade for disease and diagnostic access, or enterprise subscription

Medscape - Informational Resource

Published by WebMD, this top free app provides access to a medical directory, continuing education, medical news, and clinical reference library. The news aspect of this app helps students stay up-to-date in the industry.

AVAILABILITY: iOS and Android; free

WebMD - Access Full WebMD Resources

App version of WebMD website. Because Web MD is created primarily for the general public, nursing students can use the available resources on the app to practice describing care to patients with non-medical terminology.

AVAILABILITY: iOS and Android; free

Code Happy - Nursing Support System

Social network for nurses and students to find support from peers. It helps users gain and share perspective on a variety of nursing topics from residency rounds to passing exams.

AVAILABILITY: iOS and Android; free

Taber's Medical Dictionary - Comprehensive Medical Dictionary

A mobile version of one of the best medical dictionaries on the market. Includes photos, videos, audio pronunciations, and functionality to save favorite entries. This dictionary has 65,000 definitions to help nursing students study for tests.

AVAILABILITY: iOS, Android, Blackberry, and mobile browser compatible; $40 for 1-year subscription

AACN Bedside - Topical Reference Guides

The American Association of Critical Care Nurses created this app to provide a mobile marketplace for its popular laminated pocket cards. Pocket card topics include lab values, medication calculations, cardiac medications, and many more. Students can use this easily digestible information while studying on the go.

AVAILABILITY: iOS and Android; free with in-app purchases

allnurses.com app- Nursing Social Network

More than 900,000 members and peer-to-peer networking for nurses and nursing students. The app allows practicing nurses and students to find professional support and the latest nursing news. Offering the same tools as the website, the app allows users to post and read message threads, read/vote on polls, and search for topics.

AVAILABILITY: iOS and Android; free

Recommendations

Using smartphones at work is a fast, easy, and timesaving way to get the information you need to better care for your patient. Nurses should follow their hospital policy for use. Use passwords to protect your cell phone. Do not send patient identifiers through your cell phone to other providers unless it is encrypted. Consider ethics when using your smartphone. Do not comment, visit, or share any patient information on any social media site. Most of all, use your head - be smart when using that smartphone!

References

American Nurse Today. (2014). Evolution or revolution? Smartphone use in nursing practice. Retrieved from: http://www.americannursetoday.com/evolution-revolution-smartphone-use-nursing-practice/

Emergency Nurses' Association. (2014). Mobile electronic device use in the emergency setting. Retrieved from: https://www.ena.org/SiteCollectionDocuments/Position%20Statements/MobileElectronicDevice.pdf

Health News. (2015). Nurses and smartphones: A vital connection. Retrieved from: http://www.mhealthnews.com/news/nurses-and-smartphones-vital-connection

Institute of Medicine. (2006). Preventing medication errors. Retrieved from http://www.iom.edu/~/media/Files/Report%20Files/2006/Preventing-MedicationErrors-Quality-Chasm-Series/medicationerrorsnew.pdf

Journal of Nursing Education and Practice. (2014). Smartphones and computer tablets: Friend or foe? Retrieved from: http://tinyurl.com/p4m6p3c

MedScape. (2014) The effect of a mobile health decision support system on diagnosis and management of obesity, tobacco use and depression in adults and children. Retrieved from: http://www.medscape.com/viewarticle/834908

Occupational Health & Safety. 2012. Mobile phones in hospital settings: A serious threat to infection control practices. Retrieved from: https://ohsonline.com/articles/2012/03/01/mobile-phones-in-hospital-settings.aspx

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Julie Reyes

About Julie Reyes, DNP, RN

Julie Reyes, DNP, RN

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What if we worked on the cons to make cell phones safer to use? For instance, health care institutions can have a meeting reminding everyone of what HIPAA entails, how it can be easily violated with the use of cell phones--basically just remind everyone to think before they do something. And reading about everything that is potentially growing on our phones--gross :yuck: Is there any antibacterial cleaner that is safe to use on phones? Regardless, there is bacteria growing on everything: wash your hands! And then go home and take a shower.

Another con I can think of is that employees will probably abuse cell phone privileges. I've worked in places that allow their employees to use cell phones, and some seem to be on it all the time.

ETA: Thanks for the links to helpful apps!

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Of all the issues, infection control is the most serious since it can mean extended hospitalization or even death. There's a 2014 WNPR article on the topic at:

Page not found | WNPR News

The issue seems at the 'more research is needed' stage, but if UV sterilization proves effective, the equipment could be used on each unit by patients, visitors, and hospital staff alike, with the last group using them multiple times each shift—a bit like hand washing. The same equipment could also be used for stethoscopes and similar equipment.

That's something nurses should think about and perhaps an issue to bring up with hospital administration. A hospital might start with the unit having the worst hospital-acquired infection rate.

The Centers for Disease Control and Prevention (CDC) estimated roughly 1.7 million hospital-associated infections, from all types of bacteria combined, cause or contribute to 99,000 deaths each year. Other estimates indicate 10%, or 2 million, patients a year become infected, with the annual cost ranging from $4.5 billion to $11 billion. In the USA, the most frequent type of infection hospitalwide is urinary tract infection (36%), followed by surgical site infection (20%), and bloodstream infection and pneumonia (both 11%).

https://en.wikipedia.org/wiki/Hospital-acquired_infection

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i enjoyed reading this article but i do have to say that many of the cons presented in the articles have more to do with bad nursing practice than it does with the technology itself.

The HIPAA violation really is a no brainer. Always reevaluate how good of an idea it is to post healthcare-related information on social media. And my rule of thumb is--if you have to think about it, its probably best not to do it. Making remarks about a day you had can blur the lines a bit, but i cant ever ever EVER see what good can come from posting a picture related to anything that happens at the workplace.

The security aspect is among my biggest pet peeve when we talk about the technological world of computers and cell phones because it is so widely misunderstood, especially (but understandably) by older generations. Much like owning a house or a car, it is your responsibility to guard the contents of your cell phone. Simply pleading ignorance to the technology is not an excuse to say that the device itself is flawed. Much like your house contains valuable information like your social security card, birth certificate etc, so does your computer and personal device. Knowing this, why would you leave it unprotected? Do you leave your car unlocked when your purse is in there? Why would you be equally as careless with your cell then? Hackers are opportunists, much like burglars. Burglars can take a quick survey of your house, and figure out 50 different ways to get in. Hackers are the same. So do yourself a favor and take advantage of applications that lockdown and secure your sensitive information, otherwise you're pretty much asking for it.

The infection aspect i probably agree with the most. Cell phones are filthy. Period. Clean it like you do your mobile workstations. Clean it or keep it away from patients you nasty.

I would love for technology to be the way of the future for medicine. There are so so many advantages, and with it's implementation, would create a surge of demand for computer information technologists, programmers, health informaticists, and countless other industries that would strive to meet the demands that we would call for. It is just so often and so easily misunderstood that we may not see the advent of that age as soon as one would hope.

great article though :)

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Another alternative is for the hospital to provide electronic tools that are more or less equivalent to those available on apps. Using links through Epic, my hospital provides the following subscriptions:

-Electronic drug reference books, including a calculator specific for peds/neonatal patients by weight

-A tool to input drugs and look for drug-drug interactions

-Hospital-approved educational materials that we can print and give to families

-A med/drip calculator

-A subscription to an electronic Lippincott nursing reference guide with pathophys, treatments, and a step-by-step guide to every procedure under the sun (specifically so that we wouldn't be caught googling the steps)

I expected to use apps in practice, but I've found that it's way easier for me to use the tools that our hospital provides. It's convenient (immediately accessible from Epic), and avoids all of the 'cons' listed above.

Whoever figures out how to effectively, safely clean an iPhone screen should win a Nobel Prize. According to Apple, using any type of disinfectant on the surface can damage the touch-sensitive screen. I've worked at a hospital that used iPhones as the means of unit communication (in spite of the fact that they were never cleaned from nurse to nurse) :barf02:

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Epic is the bes thing. Around here we use meditech, which I despise wholeheartedly. I personally would rather see mobile stations be entirely replaced by ipads or some kind of tablet. Lightweight, easy to have with you, send and receive critical values instantly, and even has memo/call/message features for you to contact other device on the same LAN. But, you know the big boys upsatiars and their "budgets" haha

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Specializes in Nephrology, Cardiology, ER, ICU.

Great article.

Our practice uses a secure app called PerfectServe - it is our paging system, our texting system and our schedule.

1. Uses secure, encrypted texting capability which allows us to send pictures as well as text to other providers. Many times this saves an office visit for our patients that are in very rural areas.

2. Our entire practice's schedule is in the app too. It is super easy to tell who is working, who is off, what hours they are on call. And we control our own schedule making coverage seamless.

3. Secure phone calls also. We dial a pts phone number from our cell phone using the app and the first thing the person sees is that the call is coming in from XYZ Medical Practice. When they pick up, they get us. This is a huge improvement over *67 as the caller ID shows the practice name, not just "blocked."

So, technology is a real boon to medical care. Telehealth is another tech advance that in my area we are seeing much more. And...many hospitals in rural areas use NightHawk or some other version of it where at night, someone in Australia or other parts of the world is electronically reading xrays, CTs, etc..

I will caution everyone though that you should use the standard set by your practice or hospital. If your hospital or practice has a set Gold standard, use that reference.

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Specializes in Pediatric Hematology/Oncology.

I always feel extra-naughty and extra-gross taking my phone out during clinical. My uniform pockets are packed to the brim with reference materials for the hospitals I'm in where we don't have access to the charts. I like using the references on the charts we do get to practice with, however, because, honestly, I will always have this nagging sense that the information my phone is giving me is not quite as accurate as it should be. I do like, however, when I come across conflicting information because that cues me to look deeper and figure out what is really going on and I learn so much from that.

I think it's fine people have their phones on them for quick reference or keeping tabs on their family (i.e. child care or their school calls or something) but if there are other things that are available those should be the go-to. The article is saying nearly 3/4s of nurses are using their phones for reference --- I believe I've only witnessed this once in two years. Everyone is using their hospital-provided addenda on the charts.

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Epic is the bes thing. Around here we use meditech, which I despise wholeheartedly. I personally would rather see mobile stations be entirely replaced by ipads or some kind of tablet. Lightweight, easy to have with you, send and receive critical values instantly, and even has memo/call/message features for you to contact other device on the same LAN. But, you know the big boys upsatiars and their "budgets" haha

Hats off to Epic, and all of the various e-resources you can access through it. I agree with you on the iPads in theory, but you still have the issue of sanitizing a touchscreen without destroying it. Maybe some kind of antimicrobial screen protector that can withstand Sani wipes?

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I use my phone all day long in my HH job and clean it with our disinfecting wipes that are provided for cleaning our other shared equipment.

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Hi Julie, great article about smartphones in the workplace. Your comments on the necessity of just-in-time information for nurses are well documented as an imperative for improving delivery of care. The Journal of Nursing management put out an article that includes a similar discussion in 2013. Hopefully as more vendors move to cloud based service offerings the quality of mobile applications for nurses will continue to increase.

Nurses can also find apps that make their live better when not in the hospital. Our company, NurseGrid, has developed a personal scheduling and communication app specifically for nurses. Its a free app (iOS available today, Android will be out at the end of this month) that makes it easy to add work schedules at multiple worksites and allows nurses to connect with their co-workers to see when they work together. Check out a recent review of NusreGrid by Nurse Eye Roll.

We've seen some other exciting apps for nurses lately that are in development and should be available soon. The years ahead look exciting for new nurse-centric technology.

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I love texting docs. Seriously. It saves me soooo much time and angst.

I just wish there was a way to do it and be compliant with federal regs and with hospital policy. Maybe hospital issued text phones? That would be awesome for the nurses, anyway, so you could get a text from the secretary about what a patient wants and not just the basic call light notification. Hmmmm..... Get rid of Vocera and those crappy Nokia type phones... Maybe replace them with the intermediate phones that aren't smartphones but still have keyboards? Text the provider, let the provider text you back... Text them with your phone number if they need to speak to you... It could work.

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