Creating freedom for the nurse: 4 principles for using technology as an enabler

Ask a nurse why she or he chooses to be a nurse. The answer will usually include responses like, “To help people.” “To make a difference in people’s lives.” “To be there for people when they’re going through hard times.”

For many, nursing is a calling.

Rarely, if ever, will the answer be, “For the admin.” “For the data.” “For the documentation.” Of course, most nurses recognize the importance of these things. Nursing is also a profession, which comes with bureaucracy, stress, and the risk of burnout.

In fact, many nurses have never been more burned out. Today’s nurses are caring for a growing and aging population, responding to the requirements of more empowered patients, and expected to be proficient in the latest medical information and health technologies — all in the face of years of underfunding, workforce shortages and low morale.

Technology has the power to alleviate these problems, and many solutions are being deployed with the aim of supporting nurses in their tasks and decisions. However, according to Elsevier Health’s Clinician of the Future survey, 69% of clinicians believe that digital health technologies will be a burden throughout the next 10 years.

This is in part because many of today’s nurses are feeling overloaded by data, stuck with wearisome administrative systems, and struggling to keep up with the rise of digital health. Given our advancements in medical research, IT infrastructure, data management, big data analytics, and knowledge engineering, providers of digital health technologies can do better.

In the spirit of getting back to basics, here are four principles for guiding healthcare technology companies as they design and create solutions for nurses:

1. The nurse-patient relationship is a caring interaction that compels a person-centered approach

Nursing is defined as the care of a person. The nurse is motivated by care: she or he cares for a person because she cares about the person. (She also cares about their family and friends and about her colleagues.) Many nurses are driven by altruism, empathy, authenticity, compassion and human dignity. This intrinsic motivation happily and inexorably leads to a holistic, individualized, respectful relationship with a patient. It is always personal, almost always intimate; it really cannot be otherwise.

For this reason, the nurse-patient relationship is foundational to healthcare, and nursing is arguably the most trusted profession in the world. Technology applied to the nurse’s experience should create freedom and empowerment for the nurse to be who she is: a caring person caring for another person.

2. The patient must be the focal point of the decision-making process, not the IT system

Many electronic medical record systems in use today were designed for billing and documentation and to facilitate standardized medicine. These things are interrelated and important, but they should be means to an end, not the goal. The goal of care describes what the patient (or surrogate) wants to achieve within the context of their clinical situation, informed by their values and priorities.

For this reason, the nurse rightly and intentionally focuses on the patient when making decisions. The IT system should be designed to support this decision making by enabling communication with the patient, collaboration with the care team, and access to evidence-based knowledge.

It should be noted that, for a healthcare institution, process outcomes are indeed an intrinsic goal (not simply means to an end) in addition to health outcomes, reflecting the quality and equity of the institution’s responsiveness to the needs of the population it serves. But even process outcomes are driven primarily by interactions among people, the human need for connection, and personal notions for what makes an institution “good.” The patient as the focal point is foundational, always, to meaningful outcomes, whether in health or procedure.

3. Clinical decision support (CDS) must address the nurse’s and patient’s choices as well as variations in clinical practice

Care standardization is crucial for both quality and equity of care and for controlling costs. Although many nurses agree that it can increase patient safety and efficiency, critics of standardized care argue that it promotes “cookie-cutter” medicine. This was never the intent and is not true, but one could argue that many health IT systems in use today perhaps inadvertently (dare I say carelessly) appear to force what feels like cookie-cutter medicine to exasperated clinician users, since these systems were designed primarily as databases that help maximize payments and mitigate legal perils.

Even if these systems had been designed for the express purpose of standardizing care, this may have been the right priority, let’s say, 30 years ago. Given the subsequent advancements in data integration, exchange and analytics, declarative artificial intelligence, and other technologies, care standards can now be both the bedrock and springboard for personalized care. Effective clinical decision support enables a person-centered approach grounded in evidence-based knowledge.

4. CDS must solve the problem of the nurse’s cognitive overload and create freedom for critical thinking and decision-making

Many things, good and bad, are causing nurses to experience cognitive overload, driving them to exhaustion or burnout and even away from the profession. While clinical documentation is essential for continuity of care and protection against legal risk, it is easy to see how it could take over the job, especially when goals and processes are not well defined and when administrative and medical record systems are not well designed.

Documentation is not the problem but rather part of the solution if done well. Nurses rely on documentation to understand the situation for the day, plan activities for the shift, make decisions during the shift, and communicate with colleagues, particularly during the handoff. If care standards can underpin personalized medicine, clinical documentation can be a haven for ingenuity and resourcefulness. Effective clinical decision support makes documentation easy, clean, meaningful, and impactful, creating space and boundaries for patient-focused decision making.

Think of the nurse

The nurse, animated by her motivation, commitment, knowledge, training and experience, comes to the patient: she knows the questions to ask, understands the situation, perceives the risks, rationalizes and makes decisions, gives information and comfort: all come together for the sake of and with aim of providing the best care to the patient.

Trying to fit this into a health IT system is leading to tension, frustration, inefficiencies and sometimes mistakes. In Part 2, we will explore the attributes of next-generation clinical decision support, reflecting the four principles for using technology as an enabler. Let’s give nurses the tools, confidence and freedom to do what they love.