Tuesday 18th November 2008
Technology is changing the way nurses work, with mixed results. No one doubts the value of a defibrillator or any life-saving device, but technology is also adding complication and further workload to nurses’ jobs.
Technology was supposed to make our lives easier. The 1960s cartoon The Jetsons revolved around a family who have become lazy because technology has made their lives so easy – George Jetson’s only job is to push a red button for three hours a day, and the family has a robot maid to do all the housework. In 2008, that seems laughable. Technology hasn’t liberated us from work at all: even when we finish a shift it seems the computer is always on, and the mobile phone is always ringing.
Technology has encroached on nursing with mixed results. No one is going to argue against the value of a defibrillator or any life-saving device, but some of the technology nurses now have to use is changing the way we work.
Katrina Skylas is an ICU nurse at RPA and has seen a massive increase in the amount of technology in her work since she began nursing in 1994. ‘ICU is especially technology-based. The technology has changed quite significantly, it’s become extremely sophisticated. It certainly increases your workload,’ she said.
Whether you’re working in ICU with complicated machines or simply have to access your email every day, technology can create more work. Continuous renal dialysis machines require a lot more knowledge and precise understanding of technology than ever before, and it means you have to monitor a machine as well as a patient. In many cases, technology doesn’t mean less work for nurses, it means more.
‘With the increase in technology there’s a lot more intervention at the bedside and it’s a lot more work for the nurse at the bedside. There are more things you’ve got to be accountable for and take into consideration,’ said Katrina. ‘Working with technology is part of working in ICU, but nursing care is fundamental.’
In some US hospitals, patients have been given barcodes in an attempt to reduce errors. At Boston’s Brigham and Women’s Hospital each patient was given a wristband barcode with their patient information on it, which nurses had to scan with a handheld device before they could give the patient any medication. The system was supposed to prevent nurses from giving incorrect medications or doses by mistake. But in the first trial of the system, nurses found many of the patient’s barcodes had the wrong information. The barcodes and cumbersome scanners simply created more work, stress and bureaucracy. Nor did the system prevent errors like a doctor prescribing the wrong drug or a drug a patient was allergic to. ‘The system can never replace a nurse,’ one nurse told The Boston Globe newspaper. ‘The nurse must still use her brain and know why she is giving a particular drug to this patient.’
A team from the University of Pennsylvania studied the barcode system, after it was introduced in five US hospitals, and found that 99% of errors were made by the barcode system, not nurses. Nurses frequently had to override the system, and the machines made some hospital rooms crowded and difficult to work in.
‘The surprising result is that the design and implementation of the technology, which is often relied upon as a cure-all for medication administration errors, is flawed, and can increase the probabilities of certain errors,’ wrote the researchers. ‘Equally surprising is the urgencies of care and the ingenuity of nurses to cope with these shortcomings.’
Any new technology also means you have to learn how to use it, which can be especially challenging for new grads. ‘It’s a lot for new grads to take on board – they’re quite big concepts to absorb. There’s a lot of technology that’s quite advanced. You need a lot of clinical knowledge to use some of it. Someone who’s new to the job can’t use the more complicated equipment – they need to have been around for one or two years,’ said Katrina. ‘So it’s also part of the job to provide education and training around new equipment.’
A study called ‘What Do Nurses Have to Say About Information Technology in Their Workplace?’ asked 1,000 registered nurses in Queensland what impact they feel technology has on their job. The researchers concluded that the nurses ‘range from feeling indifference at one end of the spectrum to often feeling exhausted and stressed out after dealing with it in the workplace. The concluding result from this research also demonstrates that there are many humanistic features in caring that were not considered by the IT industry when health information systems were developed or implemented.’
It’s possible to train a technician to use a particular machine, but that will never replace the real live knowledge and experience of a nurse. ‘Anyone can be a technician,’ said Katrina, ‘but to be safe you need to be a clinician using the equipment with the understanding of why you’re doing something and how it’s impacting on the patient. A nurse is not a technician, they’re a clinician using the technology.’ While a technician might only know how to use a machine and which buttons to push, a nurse will know how and why that machine is working, and exactly what it is doing for the patient.
Perhaps the biggest problem with technology is that it can be an illusion – machines will never replace nurses or human judgement. ‘A lot of technology is taking over nursing, but it doesn’t replace the nurse. With increasing technology, people forget about touching the patient. With dialysis you could focus on the machine and forget there’s a patient attached to it,’ said Katrina. No machine will ever replace the fact that, at the end of the day, in nursing we deal with people, and they need other people to provide their care.
‘There’s a patient attached to every piece of technology,’ said Katrina. ‘It doesn’t matter how much technology you have, you still need to care for the patient. There’s a pulse under all that technology.’