When the computers crash, all that's left are the patients

Ruby Vee, BSN · Sep 14, 2004

Interesting article!

As nursing has become increasingly computerized, I've noticed an increasing tendency on the part of the nursing staff to hang out at the nursing station (with it's bank of computers) rather than near the patients. Years ago, hourly "sheet checks" were an absolute -- these days I work with folks whose butts I am sure have not lost contact with the chair at the station for hours on end. (And I work in ICU!) When we charted on paper, we actually had to walk over and LOOK at the monitors to see the rhythm, the blood pressure, etc. (And being that close, we'd look at our patient, too!) Now we can be two buildings over in another ICU chatting with a friend and call up our patient on THEIR monitor!

Don't get me wrong -- I'm not advocating an end to computerized charting. When I started in ICU, we shot 3 cardiac outputs and averaged them by long division. (Calculators were far too expensive for the average person to own one, and the hospital provided one for the pharmacists only.) We calculated all of our drips with a pencil and paper (and depending on your math skills, an eraser). We all knew the formulas by heart: SVR, PVR, MAP. The BSA nomogram was plastered to every chart. If my patient weighs 188 pounds, and I have 400 mg. of Dopamine in 250cc, how many drops per minute equals 10 mcg/kg/min? Computers have saved me an awful lot of time that I used to spend hovered over a paper towel with a pencil, scratching out formulas. Time that I could have spent bathing my patient, or holding her hand.

The thing is, I'm not noticing that folks spend the time they're saving bathing the patient or holding her hand. Instead, I notice 3 or 4 nurses in the break room, and bunches more at the nurse's station.

I worked a travel assignment earlier this year. That ICU charted on paper. The nurses were rarely visible in the nurse's station or the break room. Where were they? With their patients.

Dixielee, BSN, RN · Sep 28, 2004

Thank you Karen for finding this article. It says exactly what I have been saying. Since we implemented the computer charting, care of the patient is only incidental, something we do IF we have time. Our real focus is care of the chart and the computer. Our wait times in the ER are up exponentially, our frustration is even higher. I long for the day when I could work for a doctor who sterilized his glass thermometers in alcohol! Signed.....drug into the 21st century, kicking and screaming!

DutchgirlRN, ASN, RN · Sep 28, 2004

We are computerized and have bar coding and scanning for the meds as well. Our usual assignment is 6 patients. I wish I had time to be at the station. On a 12 hour day shift if I get a 20 minutes uninterrupted lunch I consider myself lucky. Years ago I worked in a hosp that wasn't computerized and I agree my butt was in the chair most of the time. How things have changed!

oramar · Oct 3, 2004

No, I find crashed computers a real impediment to patient care. It uses up to much time when they don't work correctly. The answer to a system wide problem the other day was that I had to leave the bedside and reboot 9 computers. Much to much time consumed doing that. Not to mention problems with jammed printers. The list goes on and on. The IT people that are supposed to be around on the off shifts are shaky at best, sometimes it seems like they have never seen a computer in their life. That is when you can find them and frequently you can't find them. My advice to managment it tell the IT people to get off there butts and fix the problem and leave nurses at the bedside. Another thing I resent is spending 60 min. on the phone with a IT person, having them talk me through a problem only to find the next day that the daytime IT person nixes the whole fix.

mattsmom81 · Oct 7, 2004

And don't ya'll hate it when the computer goes down...and suddenl;y we have to go back to the 'old way' of paper ordering everything, etc" Wer have to backtrack all our orders from the past 24 hrs at night and rewrite them and hand deliver them. GRRR.

Everyone IS happy about doing the old nurses and ROS notes in ICU...much quicker than in the computer actually.

THEN after you've done everything by hand...the computer miraculously comes back online at shift change...and the IT people demand we go back and reenter it all.....

I've gotten so I flat say NO. I will do it one way or the other, never both ways.