The Future of Nursing and Health IT

The Quality Elixir

Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN

Disclosures

Nurs Econ. 2011;29(5):286-289. 

In This Article

Health IT: A Crosscutting Strategy For Transformation

Technology has transformed almost every aspect of our daily life. Personal digital assistants, smart phones, and pocket-size computers bring digital capabilities to our fingertips which keep us organized and in touch with our world. We shop online 24 hours a day, and transact most business activities from our home or automated machines. Smart systems operate our cars, monitor elderly parents at home, and warn of pending disasters and epidemics. In health care we have experienced an explosion of technologies, yet we are still catching up to other industries. As nurses embrace a leadership role in transforming health care, we also embrace technology. Each of the recommendations in the Future of Nursing report has opportunities to advance the use of health IT.

Recommendation 1: Remove scope-of-practice barriers. All nurses and other health care providers must be able to practice to the full extent of their education and training. This means reforming practice acts, extending authority for care as well as reimbursement under Medicare. Nurse midwives and nurse practitioners may be eligible to receive incentive payments from Medicaid for meaningful use of electronic health records (EHR) provided by the Health Information Technology for Economic and Clinical Health Act, part of the American Recovery and Reinvestment Act of 2009. Classified as eligible providers, or "EPs," these advanced practice nurses can demonstrate use of EHRs for collection and exchange of data, and eventually for improving care and outcomes. All nurses should engage their organizations to use health IT tools to collect, synthesize, and analyze quality data about nursing care. Building evidence that demonstrates nursing's contributions to quality outcomes is an important step for asserting greater influence in care delivery.

Recommendation 2: Expand opportunities for nurses to lead and diffuse collaborative improvement efforts. Nurses are great team players but it is time to step up to being the leader among members of the health care team. This means nurses must assert their roles to conduct research, redesign practice environments, and share best practices. When testing new models of care, or deploying new technology, it is important to measure the impact on care as well as nursing workflow, productivity, and satisfaction. One of the explicit strategies in the report is for organizations to engage nurses along with other direct care staff in all the steps related to acquisition and implementation of health IT products. That means everything from working with developers in the design of products, to the purchase, implementation, and evaluation of health IT devices and systems that enable care. Also, when manufacturers want to test new products, nurses can insist on a formal role and attribution for having helped in the testing and improvement process. Nurses can and should contribute to the study of effectiveness of health IT. We need to add to the rather limited body of evidence that describes how health IT improves the way we deliver care and the impact on outcomes (Murphy, 2010).

Recommendation 3: Implement nurse residency programs. Moving into a new practice area or role upon initial licensure, as well as after earning an advanced degree, or other significant change in responsibility, requires successful application of new knowledge and skills. The time, methods, and experience to achieve a new level of competence extend beyond typical orientation programs. Fortunately there are many health technologies that assist the nurse in transition to a new role. Electronic tools for simulation of patient experiences requiring decision making, psychomotor skill application, practice demonstration EHRs, and knowledge testing are readily available. Skills inventories, knowledge assessment tools, and transitions surveys can be used to demonstrate effective learning and progress in a transition program. Sharing outcomes measurements of the programs will help build evidence around best methods to help improve transition-to-practice programs.

Recommendation 4: Increase proportion of nurses with BSN degree to 80% by 2020. A 30% increase in baccalaureate-prepared nurses by 2020 is intended to improve the overall knowledge base and diversity of the workforce to better serve diverse populations in the future. While distance education has long been a staple for nursing education, there are opportunities to reach more students and pool faculty resources. The more education can be packaged, the greater the economy of scale in delivering the offerings. Today nurses seek asynchronous, self-paced learning to accommodate their busy schedules. Many colleges and universities offer programs with significant online content. Nurses often cite the direct and opportunity costs as barriers to advancing their education. Employers can help by bringing programs on site and providing classrooms equipped with technologies such as direct-broadcast satellite, Internet radio, and live streaming.

Recommendation 5: Double the number of nurses with a doctorate by 2020. There is an acute awareness of the growing faculty shortage in U.S. nursing schools. The critical need for more nurses with doctoral degrees to fill this void suggests a need to accelerate the process for completing a degree. Technology is helping by providing more rapid access to information and online curricula. Technology also enables networks of faculty, researchers, and students that can support one another's work, provide for collaboration, and remove some of the barriers traditionally encountered in managing data sets long distance. The savvy doctoral candidate is also one who is technically savvy.

Recommendation 6: Ensure that nurses engage in lifelong learning. As technology and computing become ubiquitous, all nurses will need to demonstrate competencies to maintain cutting-edge practices. The use of health IT is already essential to delivering care, recording data, and measuring care. Undergraduate and graduate curricula, as well as many certification examinations, include content around essential competencies in the use of health IT. Nurses will continue the process of learning to leverage the power of evolving technologies to deliver safer and more efficient care. For some time, technologies have allowed nurses to access just-in-time learning, essential reference resources, and continuing education. In the clinical setting, or on the go, nurses can expect to use technology to meet these learning needs well into the future.

Recommendation 7: Prepare and enable nurses to lead change and advance health. Nurses can maximize the use of technology for personal and professional growth, and to stay connected and informed. Just as the doctoral student must be savvy in technology, so must all nurses in leadership positions. It is not sufficient to delegate responsibility for implementation of health IT systems to technically competent staff. Leaders with fiduciary and strategic responsibilities are positioned to ensure the right technology is put in place, and the organization is using it to its capacity. The Future of Nursing report asks if all types of nurses will "hear the call" to lead change. One group answering the call is nurse informaticians. There is a growing need for a nursing informatics executive who fulfills a strategic and operational role. Leaders with expertise in informatics are essential to bridge the digital divide between clinicians and technology, as well as education and research. Leading change means redesigning workflow before adoption of new technology. It is a change management process intended to improve quality. The nursing informatics expert is well equipped to lead delivery model transformation through application of health IT.

Recommendation 8: Build an infrastructure to collect and analyze heath care workforce data. Without adequate data we cannot have information, knowledge, or wisdom. Using antiquated or incongruous data can be just as ineffective as having no data. The profession needs timely data that inform us and the public about current practice patterns, and help anticipate future needs. Technology is the key to employing a minimum data set across the country and professions that yield the capacity to understand the workforce and make course corrections with policy decisions. Technology can provide powerful analytics to mine data repositories that will measure and project nursing workforce requirements in new ways.

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