From the frontline

The procurement of electronic health records by a variety of large trusts was a feature of news articles in eHealth Insider last year.

For the past 18 months, I have taken part in such procurement – eHospital – for Cambridge University Hospitals and Papworth Hospital NHS foundation trusts.

I believe that eHospital will bring about significant, positive, change in the way that healthcare staff provide care and the way that our patients and their families are cared for.

As a nurse working as an emergency nurse practitioner, and as IT lead for the emergency department, I want to make sure that the system we choose not only places patients and clinicians at the centre of all that we do, but also recognises the unique role that nurses contribute to patient care.

However, during my involvement in the procurement process I have been aware that nurses have not always put themselves in a position of influencing the decision making process. This is in stark contrast to my medical colleagues – who have been represented across many specialities.

Nurses missing in IT action

The difficulty of getting nurses involved in healthcare IT is not unique to eHospital, or to the trusts involved with it. In purely numeric terms, nursing representation in NHS healthcare IT generally should be much higher than it is.

Census information for 2011, released by the NHS Information Centre, shows that nurses make up 47% of the NHS workforce as a whole; so why are they not better represented, more involved and more interested in the procurement of vital information systems, which they may find themselves using every day?

When I have discussed this with my nursing colleagues, several reasons have been put forward. One is that nurses see health IT as a low priority; they see little value in it and believe that it has very little impact on how they nurse individual patients or clients.

As a professional group, nurses are very focussed on providing hands-on care. The nurses I have spoken to say: “A PC won’t change a wet bed or offer reassuring words to a confused person.”

This kind of scepticism is not helped by the view of some influential senior nurses, who say that time spent looking at computer screens is time not spent with patients.

Another reason is that nurses feel disengaged and powerless in the way in which the NHS delivers healthcare IT. Poorly designed and implemented systems have disengaged them, and they now accept whatever is handed down to them.

For whatever reason, nursing doesn’t appear to embrace information technology and may even be suspicious of it. But if nurses don’t involve themselves in healthcare IT, they will have no part in shaping the way it is used to deliver the information that is needed to enhance nursing care.

Education, education, education

I believe that there is another factor that plays a part in limiting nursing involvement in healthcare IT. My experience has shown me that many nurses have had little or no training in how IT systems can be used and the benefits they can bring to patient care.

Nurses have insufficient knowledge and understanding of how nursing informatics – the combination of nursing, computing and information – can be integrated into direct nursing care.

This is more than unfortunate, as nurses are facing a tsunami of IT. As the NHS reconfigures itself to increase performance year on year, which coping with (real) reductions in funding, it will increasingly look towards IT to deliver safe, cost effective and sustainable care.

Nurse leaders in clinical roles need to identify and develop skills to bring about a complete transformation of nursing engagement in healthcare IT as a matter of urgency.

This has achieved some recognition within the NHS IT hierarchy, with a start being made by The Leadership for Informed Practice Programme, facilitated by the Department for Health Informatics Department.

The programme set out to cultivate the skills that nursing leaders need in the management and use of information technology.

Those who participated on the course were taught how to develop strategies to deliver nursing care using information technologies, meaningful use of data and development of informatics.

Although this was a one-off programme, its lasting contribution will be to develop a network of nurse leaders who can be at the forefront of bringing nursing informatics to nurses on the frontline.

The importance of this programme was recognised when it won the CCIO Award for Clinical IT Leadership at the EHI Awards 2012 in association with BT.

Nursing and nurses are the one constant in many patient contacts with healthcare. Success in the implementation of health information technology needs the inclusion of nurses from design and procurement through to training and delivery.

The LIP is a start, but more innovative ways need to be found to engage frontline nurses in this process… I am open to suggestions!

About the author: Andrew Carr is an emergency nurse practitioner working in the emergency department at Cambridge University Hospitals NHS Foundation Trust. Andrew has worked in emergency care for 25 years, and for the past four years he has been clinical IT lead for his department.

Andrew is passionate about delivering information technology to frontline staff enabling them to deliver safe, high quality care efficiently and effectively. He has recently developed ED clinical dashboards and waiting time information displays.

He is also participating in an eHospital programme that will see all clinical IT systems across the trust replaced by a single hospital information system in 2014. As a former head of IT once told him “if an IT system can work in the emergency department it can work anywhere!”