Hey! IT departments, CIOs, CNIOs! Did you know that your nurses are NOT happy!?! The results of a survey by Black Book Market Research were just released and it isn’t good. More than 13,000 nurses were surveyed for Black Book’s EHR Loyalty Poll and, I’ll warn you, what they had to say may be very tough to hear.
Nurses’ dissatisfaction with their electronic health record system is at an all-time high with 92% saying they were unhappy with the EMR system in their healthcare facility. That’s a shockingly high number!
Why are they so unhappy? The survey sheds some light on that. 98% of RNs said they “have never been included in hospital technology decisions or design”. 98%!! Nurses complete 80% of documentation in the patient’s record and are the largest group of end-users. Why would any organization not include them in the selection, building, and implementation of one of the largest investments they will ever make? Maybe they were willing to help but were not given time away from their normal work duties to make it possible. Maybe they were asked, but just didn’t step up and participate. Or perhaps they were never asked.
Doug Brown, Managing Partner of Black Book Market Research, said “Technology can help nurses do their jobs more effectively or it can be a highly intrusive burden on the hospital nurse delivering patient care. Many compounding nurse productivity problems can be sourced to the failure of those selecting and implementing an EHR to involve direct care nurses in the process.”
Ideally, the clinician should be able to do all necessary documentation in the most efficient manner possible. In other words, the best documentation systems are designed so we can get in, do what we have to do, and get out and back to our primary focus—the patient.
Undoubtedly, documentation is important but it should be balanced with patient care. The survey revealed that 84-97% of nursing administrators felt “the impact on nurses’ workloads including the efficient flow of direct patient care duties were not considered highly enough in their administrator’s final EHR selection decision”. Documenting our care should fit in to the natural flow of our work, not create speed bumps that slow us down diverting our attention from caring for patients.
Another startling finding: when nurses were asked to describe their IT departments, 69% said they were “incompetent” in their level of knowledge and expertise regarding the EHR software. Whoa! As a nurse who also worked in IT, that hurts! And it should make all IT professionals cringe.
If I may be so bold, I would like to offer some advice to my fellow IT professionals:
- When embarking on the daunting task of choosing and building a new EHR, ask yourself who is going to use and interact with the system every day? Who is your end user? Who is your customer? What is the ultimate goal/purpose? You may spend months building out the documentation, but it will be the end users, primarily nurses, but also respiratory therapists, patient care techs, physicians, and other hospital staff, who must live, work, and interact with it every day—hundreds of times throughout their shift. So, please, PLEASE, include them in the planning and building of the system!
- Bring together and meet with end users regularly throughout the build process. Ask them what they’d like to see and show them what you’re building to get their opinion on how it will work for them. They have the real world experience. They know the workflow of each of their units. They are the experts! And it’s far easier to make changes during the build phase than it will be after go-live. To find the best candidates, ask the leaders in all the different areas. They know who of their staff will be best for the project. Also ask the nursing leaders to allow these people time away from their typical duties to fully participate.
- Don’t forget your “customers” after go-live! Keep in touch and meet with them periodically to continue to ask for their feedback. What’s working well? What could be improved? Are there new elements or additional items they need to document?
- Rounding—Don’t be afraid to get away from your desk and walk through the units you help support and talk to the nurses! You’ll find out about issues they find aggravating but might not be important enough to take the time to call into the IT help desk. Many times a little tweak can fix it. This is a BIG staff satisfier! They will quickly recognize you really care about what they have to say and it will elevate their opinion of the IT or IS department.
- If you do receive a problem call, do your best to take the least amount of time necessary with the nurse to get the information you need to start to solve the problem. Remember, they are VERY busy! Their main focus is taking care of their patients! They don’t have time to take away from patient care to stay on the phone with you as you try to troubleshoot the problem. If you think it will take an extended period of time to gather the information you need, ask if they have time. If it’s a bad time, find out if there is a better time to call back. I’ve even given out my personal phone number so they could call me back when it was a better time for them. Please understand, if they have a patient who is going downhill, it is NOT a good time!
- Device integration is also a great way to help streamline the documentation by clinicians as well as provide more accurate and timely data capture. Has your organization implemented device integration? If so, do you have all of the devices capable of “talking” integrated? If not, please consider doing so. Auto-gathering of data from physiological monitors is a great start but how about ventilators? Dialysis machines? Balloon pumps? All of these devices output a huge amount of data that takes precious time to document. Again, this is a BIG staff satisfier and allows them to take the time used to manually key in this data and reinvest it into doing what they do best, caring for patients.
Okay, I’ve said my piece and will step off my soapbox for now. I know it can be difficult for those in IT to comprehend how much their role contributes to quality patient care. In the best healthcare organizations, IT and clinical staff are partners in achieving the best care possible for the patient, leading to happy nurses and, ultimately, happy patients.
Here’s a link to the survey results if you’d like to see the rest of the findings:
Does your organization invite nurses to participate in technology decisions?