Nurses say that they or their nurse managers are unlikely to be involved in the IT selection process . Only a little more than one-third indicate that nurses at their organization participate in choosing IT systems. Still, they may fare better than physicians. Nurses report that only 14 percent believe that physicians at their institution are consulted about the use of IT.
Study: Nurses Not Trained for IT
By Stacy Lawrence , Ziff Davis Internet
September 6, 2006
With health care organizations investing millions into IT, it may seem a little strange to find that most nurses receive little or no IT training. But that's exactly the result of one of the most comprehensive surveys to date about nurses and their IT work environment, conducted by health IT provider CDW Healthcare.
One of the most surprising findings was that one-quarter indicated they had received no IT training on the job over the last year, while another 56 percent said they had gotten only between one and eight hours of IT training.
It's not surprising to those in the Medical Informatics field. Health IT is somewhat a backwater. What is strange is that healthcare is one area of IT that should be a shining star; an environment where the highest of rigor is exercised.
... When asked what would have the greatest impact on improving their use of IT in their job, 55 percent responded that more training would help. This survey consulted nurses in a variety of care settings, but those in organizations with nursing informatics positions are the most likely to have adequate training. Only about four out of ten organizations had such a position, but if they did they were twice as likely to offer more than 16 hours of IT training per year.
Such positions are often deemed a frill, cost-ineffective, or even a territorial intrusion by the IT departments.
... Nurses say that they or their nurse managers are unlikely to be involved in the IT selection process. Only a little more than one-third indicate that nurses at their organization participate in choosing IT systems. Still, they may fare better than physicians. Nurses report that only 14 percent believe that physicians at their institution are consulted about the use of IT.
If this is true, it rises to the level of healthcare mismanagement on a national scale.
"If a decision is coming down from a C-level executive and there's been little involvement from the nursing and physician constituencies, it's pretty tough to force doctors and nurses to use the IT systems that are being put in place," said Bob Rossi, general manager for CDW Healthcare.
My money quote: Why do statement like this still need to appear in print in 2006? It's as if the New England Journal of Medicine still published articles on the value of sterile technique in the surgical suite.
Despite this potential disconnect, nurses spend a significant amount of time each day working with IT. Of the respondents, 44 percent said they spend three or more hours daily using some IT device. The most common device, by far, is still the desktop computer, which 89 percent of them use, while 21 percent employ a laptop, 16 percent use computerized diagnostic equipment, 9 percent use a handheld device and only 3 percent use PC tablets.
Imagine as little training in the use of more "standard" medical equipment and devices. It is simply inconceivable.
Beyond lack of training, other chronic frustrations are nagging nurses in their IT use. Chief among these issues are incompatible systems, unreliable systems and limited access to necessary systems.
Interesting how such statements are often presented impersonally, as if these systems sprout and grow randomly from seeds. In fact, someone is behind the development, engineering and (mis)integration of these systems, and it isn't medical personnel.
More than one-third of nurses surveyed complained that each of these issues were a major barrier to their IT use. Lack of nurse training and the need to spend too much time helping doctors on the systems were among the most frustrating problems for about one-quarter of nurses.
This only adds to an already bludgeoning workload.
Still, nurses are relatively optimistic about IT in their workplace. Eighty-six percent indicated that it has the potential to improve the quality of patient care. And most are happy with their IT group; nearly six out of 10 gave their IT team a high mark.
Which means four out of ten didn't. In any case, I often am amazed about how often IT manages to get such a pass. I have seen it with my own eyes and it is a truly remarkable phenomenon. If clinical personnel had such failure rates, they'd be removed. IT seems steeped in mysticism, even in the age of commodity computing where most IT concepts can be understood (and often are, to the consternation of IT directors) by teenagers.
It has been said by IT personnel that clinicians are unreasonable, "a pain in the ass", "impossible to please" and so forth.
This is an irresponsible critique. From an end-results perspective, there is a great asymmetry regarding IT/clinical relations. When clinicians give IT people a "hard time", it is often for good reason, and can inconvenience the IT department (at worst) with regard to their budget and timelines. The clinicians may be overruled on such a basis. When IT people marginalize clinicians, on the other hand, it can and does decrease quality of patient care, or even cause outright errors through deficient applications (e.g., as in Ross Koppel's provocative JAMA article Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors.)
These results were based on an online survey of 559 nurses working in a wide range of settings, including large hospitals and medical centers, clinics and physician offices, long-term care facilities, home care, visiting nursing associations, public health organizations, insurance companies and corporations.
We need many more such surveys to be adminsitered and acted upon if a U.S. national initiative in EMR is not to go the same route of its British counterpart, now in considerable turmoil.
While such turmoil might represent a windfall and job security for insiders and consultantcy companies who have to clean up the mess, it represents a terrible economic calculus for healthcare. One sometimes wonders if a strong disincentive to get IT "right the first time" is built into the information technology culture.
-- SS
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