Nursing: The business of caring, not the business of data entry
As the Nursing Director of a behavioral health inpatient unit, I lead a team of nurses who are dedicated to caring for some of our most vulnerable and challenging patients.
My nurses are great! They provide kind, compassionate, high-quality care to our patients. My nurses are also inspired, want to learn, and strive to improve their practice. Being able to provide relevant educational programming to develop nursing practice should be a primary focus of nursing leadership. But instead of allocating time to help nurses learn and grow in practice, I spend time teaching nurses how to navigate an electronic health record and how to document so that their care is reflected accurately in the electronic record.
I meet with each nurse individually. I post reminder notices. I send emails. I cajole. I instruct. I remind. I get frustrated that our care—our excellent care—fails to be adequately captured in our electronic health record, all while I badger nurses to be sure to document where and how they should in an electronic health record that is no more than a massive database of entry fields that nurses must learn to search, find, and fill.
As electronic health records become more complex, capturing and storing more information, why hasn’t its software interface advanced to be a driver of practice rather than a deterrent from it?
But what if…
In a perfect world, no one would document at all. Everything nurses do whether procedural or educational would be recorded seamlessly by technology and placed perfectly in each patient’s record without nursing having to divert a moment from the care of the patient. Since technology hasn’t made that leap yet, it’s up to nurses to continue to put pressure on the software industry to improve its interface to be at the service of nursing rather than nursing serving its technological master: the electronic health record.
Imagine a world where nurses couldn’t sign off at the end of their shift with documentation incomplete or with a critical assessment left undone; where a novice nurse has ready access to guidelines for their practice; and where nurses again focus on learning and growing their practice rather than learning and growing their expertise in documenting in an electronic health record.
Surely an electronic health record is not more complicated than our American tax system. Yet software for tax preparation has an interface that allows our population to prepare their taxes with ease. People don’t have to search the tax software database to find what to add and where to enter that US $10 donation. The software interface does that for them. And when taxes are submitted, the software won’t allow a submission with fields that need to be filled. Simply put, you can’t submit your taxes unless the software checks to make sure the form is complete.
Make it work for nurses, not against them
Our deficiencies are measured not in our care, but in our documentation. That old nursing adage “if it isn’t documented, it isn’t done” has become not a friend of nursing, but a foe as it places the blame for deficiencies in documentation squarely on the backs of nurses when it is at least equally shared by software developers. The electronic health record should be preventing deficiencies by requiring the documentation to be completed. Rather than forgetting to document a patient’s tobacco use, the software should remind nurses to document and in best practice, to complete care associated with the assessment. Software should be calibrated for different nursing skills areas and for different levels of experience, from novice to expert. The software should learn with each nurse and present reminders and education based on that nurse’s experience and history.
If it isn’t documented, maybe it isn’t nursing’s fault. And maybe it really does get done. That’s nursing’s job: caring for patients. And as a nursing leader, that’s how I want to help my nurses grow: through the business of caring and developing their practice, not through computer data entry.
Use your voice to influence change
As the electronic health record overtakes nursing practice, instead of caring for patients, nurses have to care for computers.
Instead of nursing practice driving the development of software, software is driving the practice of nursing.
Collectively though, we can influence change. Nurse leaders, partner with your chief technology officer to make sure our electronic health record providers hear our requests for improved software interface for nursing. Bedside nurses, advocate through shared governance and/or professional practice for a voice in technology purchasing. While adoption of the electronic health record may have been a federal mandate, nursing is one of the largest users and should have one of the strongest voices in what is purchased and used in hospitals. Let’s demand that the software interface for the electronic health record develop and improve along with the continued expansion of the data stored in the record itself. Software should support nursing practice rather than nursing practice supporting software.
Karen O. Dorr, DNP, RN-BC, CARN, is a nursing leader in behavioral health and a member of Sigma’s Omega Zeta Chapter at James Madison University School of Nursing in Harrisonburg, Virginia, USA.