For a time, I wondered why my parents rebelled against computers. My dad never learned how to use them and my mother retired from the Department of Agriculture to avoid learning computers at work. They drew the line at using a cell phone as a phone only.
Then I recall all the changes they had adopted in their lives. My father, born in 1921, grew up in a home lit by candles and kerosine lanterns. There were no radios. News came days later through a newspaper. Virtually everything they needed, they grew or made themselves.
And yet they adapted and changed. As a boy, my dad helped put in and maintain an electric generator to light their home. He and his neighbors strung wires from tree-to-tree to give the community a phone system. His home was the "switchboard" between the north-south line and the east-west line. In World War II, he gathered weather data in central Africa. While I was growing up he managed a power company supplying power to rural areas. After he retired, he and my mother traveled all over the world on vacation. Compare the last to my mother's parents, who rarely traveled more that thirty miles from their farm.
The changes they went through in the lifetimeâ€”and acceptedâ€”were far greater than anyone living today will have to cope with. Changing from a feature phone to a smartphone and a smartphone to a newer model is nothing in comparison to adapting to electric lighting, air travel, radio and television. That's why it's wrong to claim there's something wrong with the when, faced in their seventies with computers and the Internet, they threw up their hands and say "no more."
And keep in mind that they knew far more about the changes they went through that those going up today. My dad knew how to create a phone system and fix a Model T. Do today's adults, with their cell phones and complex cars, understand how they work or how to fix them? Almost certainly not.
You're a generation removed from my parents who, were they still alive, would be in their nineties. But like them, you've probably seen more changes in nursing than those younger will ever see and adapted to them well. You've also kept your attention directed to where it matters, on your patients.
Recently, I underwent my first hospitalization ever, three nights for prostate woes. The nurses who care for me were great, but I could also see with them, and with my family physician, that computers and other gadgets are intruding in the physician-nurse with patient relationship. A machine took my blood pressure, which they then need to enter into a computer. Half their time in my room centered on fiddling with it. My family physician spends about half his time with me staring at a computer screen because he now has to enter so much data it can't wait until later. And the hall at my urologist is filled with screen after screen, one for each exam room.
All that draws attention away from the one-on-one interactions that are so important at giving good care. I suspect soon hospital floors will look like our streets. Rather than looking up and out at patients and other staff, each nurse will be staring down at a screen, confusing it with the more important things in front of their eyes. It'll be like one of the scenes in a Pink Panther movie, where Inspector Cleauseau hassles a man about whether he has a license for his monkey while the bank behind him is robbed.
Years ago, when I worked on a Hem-Onc unit caring for kids from birth to nine with cancers, particularly leukemia, I rebelled against some of the expectations the hospital had for me. I was expected to collect numbers, record them (then on paper), and report when any got out of line. I did that, but I also watched my young patients like a hawk, looking for the subtle changes in behavior that can come before the numbers go bad. On two occasions, I was able to get intervention in play before those numbers turned sour. Both needed to be rushed to the ICU. I speeded that up.
One reason I was able to do that was because I had no screens to draw off my attention. Our paper notes were expected to be terse. We weren't expected to be data collection engines for who knows what purpose. That was good. What's going on today, nurses becoming little more that data scribes, may turn out to have serious downsides.
There's even a chilling parallel coming out of research with college students. They've compared students who take notes the traditional way with those who enter them on laptops. The result was clear. Those taking paper notes learned more and did better on tests.
The researchers surmise that, because handwriting is slower, those students had to understand what the professor was saying and process it enough to summarize the content. On the other hand, students using computers could type fast. They took more extensive notes, but what they were noting was almost verbatim what the professor was saying. They weren't listening. They weren't processing. They weren't learning. They were simply stenographers.
My fear is that nursing as data collection with have similar results. The focus will be on getting numbers from one source and transcribing them into another with little thought as to their meaning. That could be bad.
Aviation has an example. I believe it was in the 1990s that a Florida-bound plane leaving a DC airport failed to achieve enough speed to get airborne and crashed into the icy Potomac River. Their were a number of causes, but one of the critical ones came when the pilot and co-pilot were going through their pre-flight checklist. One said "Anti-icing?" The other said, "Off." Keep in mind the context. Everything outside the plane was iced over and covered with snow. Why did neither see that they're not done a vital step to configure their plane and its engines to take off in below freezing conditions?
They were too caught up in a process to think clearly, and that because our machines blind us to physical realities. We get focused on abstractions on screens and forget the patients lying in front of us.
If you have the time, you might watch this documentary about could have been the worst single-plane aviation disaster in history and one that would have taken place on the most sophisticated and computerized airline in existence, the giant Airbus 380. The pilots brought it in safely because they learned to see beyond the distracting data their computers were spitting out and simply fly the plane themselves, using their own judgment about what to do. They used "old school" flying.
Machines only see what we program them to see. One of the wonders of the human mind is that we can see beyond mere data and draw on our intuition for answers that defy explanation. Anything that distracts us from that will have bad consequences.
Things may be changing now, but if you wait, I suspect hospital nursing will again recognize the value of your hands-on, patient-centric "old nurse" skills. If we don't learn to master our machines, they will master us.
To paraphrase J. R. R. Tolkien. "All that glitters is not gold. All that's new is not better."