Technology... how has it changed the nursing profession?

[KelRN215, BSN, RN]

Hi all.

So I have been thinking a lot about this lately. Technology plays a huge role in medicine these days and how do you think it's changed nursing?

I feel like with this big boom of technology, things have actually changed for the worse. You spend half your day documenting and then get yelled at for not spending enough time at the bedside. At my institution, lately the focus has been on medication scanning. I am really frustrated lately because I'm DONE with this idea that whether or not I have access to a functioning computer has anything to do with what kind of nurse I am. My floor has gone so far as to say that individual nurses' scanning percentages (they keep track of your grades, just like in elementary school) are going to affect their annual raise and be placed on their performance evaluation and that they are going to start giving people "warnings" if their percentage drops below 80%.

Now, I get that there's a big push for medication scanning lately as a safety measure but I think this has gone too far. I keep remembering the one clinical instructor I had in school who always said "passing meds is just a task"... it's not what nursing is about. We are supposed to have computers with scanners in every room. If I go into a room and the scanner isn't working, I am not going hunting for another computer. THAT is a complete waste of my nursing time. It would delay me getting in to see my other patients and it delays the treatment I am in this patient's room to provide. For example, I have had it happen before that I have a patient SCREAMING in pain because he/she wasn't appopriately medicated in the PACU prior to being transferred. Would it make me a better nurse to leave this patient screaming in pain to go hunting for a computer so I can scan the morphine that I have already drawn up and am ready to give him? NO. That would make me a bad nurse. And guess which one of these situations will get me called into the office and spoken to? TPTB care more about numbers as it relates to things like medication scanning than the do about actual bedside nursing.

No matter what, we nurses can't win. If we spend time looking for a computer, we'd get yelled at for not spending enough time at the bedside and if we don't go looking for it, we get yelled at for not scanning meds.

[classicdame, MSN, EdD]

it has changed the nursing profession just as the rest of the world. More is expected since more is quickly available.

[AnonRNC]

The biggest problem I see with scanning meds has been echo'd by my co-workers: we spend so much time making the scanning system work that we neglect to check the "rights" one by one.

On the other hand, I love computer charting for VS, Pain scale and assessments (as long as the ability to free text remains).

[brandy1017, ASN, RN]

We don't have computers in every room, we have to drag them from room to room and deal with broken computers and dead batteries,etc. The computer has become big brother and yes they monitor us re late meds and scanning percentages, they do a weekly tally and if you are below 90% they will let you know to improve. It was part of are eval already.

The situation you described, I guess I would give the meds first and than get a working computer and scan them after the fact. At least they would technically be scanned and the monkey off your back! Sometimes you are forced to work around the system! If you refuse to scan the meds it will just come back to harm you and you'll end up with a write up and no raise. Is it really worth that?

Although my feeling is if they want to they find something to write you up or downgrade you on your eval to keep you from getting a raise. I don't believe in performance evals, its more favoritism and cost containment, but to the naive who believe in performance evals, it saves the company money by keeping the budget down.

[tntrn, ASN, RN]

There is less and less time for actual patient care. Instead we are being mandated to make the computer the number one priority. A former nurse manager where I work actually made "did you chart it?" as the number one item of "nursing" priorities." I will be so happy to walk away....but I fear for the future of nurses and nursing.

[TopazLover, BSN, RN]

Recently I had the misfortune to be a patient. Everything was done by computer. I felt like just another piece of trash that had to be correctly coded into the computer. The nurses were good. I am sure any of them could have handled a full blown code. What they did not do was connect with me as a human. None had any idea of my name or anything that was important to me. I was the product sent along the production line and scanned at various locations. At one point in the ER my side rail had its B/P taken q15 min.for 1 1/2 hr. until I got a hold of my cell phone and called a friend. No one could mistake this for nursing care.

Interestingly, it was the cardiologist who identified that I was in a health care field. I had told people I was retired (truth) and I worked part time as a receptionist (truth). None asked what I was retired from. It was not on the computer list and was of no interest to the nurses. Had they taken the time to find out who I was and what was important to me I would not have been such a bother to them once I had discharge orders.

In my case my symptoms were managed, I was not in receipt of any nursing care. I believe this is a direct result of technology and P-G. It also accounts for the reason we see so many more PIA patients and families. They do not see themselves as receiving care, just receiving treatment. There is a great deal of difference.

The art of nursing seems to have been pushed aside for the science of nursing.

[tntrn, ASN, RN]

aky: you said it, loud and clear. I haven't been a patient for anything but outpatient surgery lately (and I was well cared for) but I see it every day in what they want to us to do and how they want us to do it. It's sad.

[Tofayelbd]

Technology is changing our life, changing treatment systems, so some changing into nursing field also.

[RNperdiem, RN]

What I think you are describing is not necessarily technology, but the current direction of management towards standardization, control, efficiency(not for us), and calculability.

This is where you see scripting(standardization), lots of number scores like Press-Gainey(calculability), and lots of auditing of our charting to make the overseers happy(control).

This is not new in the business world, but it is now in healthcare and likely here to stay.

Welcome to the corporate world.

[HouTx, BSN, MSN, EdD]

The reason we are in this mess is because all the tech systems have been designed by non-clinicians who don't have a clue as to how care is delivered. And they probably don't care. We need more clinicians in the informatics arena -- designing systems and processes that actually work! Now that CPOM is mandated, it will be interesting to see if physicians will be as subservient to technology as we are expected to be... I think NOT.

Hey tecchies - If bedside medication verification is the 'end all and be all' for patient safety, why don't we have scanners included as equipment for each bed? The equipment is certainly cheap enough to do this. Since documentation is sooooo all fired important and taking up so much valuable clinician time, why don't we have transcription systems so nurses can simply dictate as they provide care? Maybe even video recorders at each bedside to 'document' interventions as they happen - hmmm? And when do we get the hydraulic suits (like Sigourney Weaver wore in Alien) to transport & move heavy patients??? OK - maybe that is a bit far fetched.

A final thought (tangent) - if a compliance monitoring process is intended to actually improve the process and outcome (e.g. medication safety), it should be designed to capture information about all of the process steps. When technology is broken or otherwise 'offline', it should automatically trigger an exception mode that is recorded in the monitoring system. The overall result may still be an 80% compliance rate, but it would enable an analysis of what is causing the gap & let everyone know what needs to be fixed in order to increase the compliance rate. DUH.

Are nurses the only hospital based humanoids with critical thinking ability???