By Suneel Dhand, MD
Nurses are the very heart of health care. These wonderful professionals work tirelessly for the good of their patients, spending the most time with them and often being their biggest advocates and best friends during what is a frightening experience in the hospital. In my career, I’ve worked with some truly magnificent nurses, who would be an asset to any organization. Every practicing doctor has also been in situations where it’s the nurse who has picked up on a subtle clinical finding or piece of information that has led to the diagnosis. That’s why I feel personally bad when I sometimes see them being treated with disrespect — whether by patients, doctors, or administrative staff. Sadly, their great daily work often goes unnoticed by those in the perceived higher echelons of our health care system.
According to the latest estimates, there are a staggering 3 million nurses in the United States — about 1 in every 100 people. It’s one of the most vital jobs in any society. If we’re talking about trustworthiness, public opinion polls consistently rank the profession the most trustworthy of all — above doctors. This noble profession that follows in the footsteps of Florence Nightingale is as important today as it ever has been (for anybody who isn’t familiar with the full story of Florence Nightingale, the founder of modern nursing, I’d suggest a read about who she was — it’s quite an inspirational story).
Having said all this, the very notion of the traditional bedside nurse as we know it is under siege right now. Not from excessive clinical demands, poor working conditions, or insurance bureaucracy; but actually from modern technology. I’ve written a lot about the impact that computers are having on frontline clinical care, focusing mainly on the doctor-patient relationship. In actuality, however, it is nurses who struggle the most with this at the frontlines. Over the last several years, computers have become the mainstay for nurses entering clinical data and recording medication administration. There’s little doubt that this has positive benefits in terms of patient safety, but the downside is that it has somewhat transformed our fine nurses into data entry robots.
Look down any modern-day hospital floor, and you will see nurses frantically wheeling around their portable computers, glued to their screens and clicking away. They spend most of their day doing this. A recent study showed that medical interns now spend only 12 percent of their time in direct patient care and 40 percent with computers. I would hazard a guess that such a distorted and crazy ratio also holds true for nurses (I’m waiting for the studies to come out). How did we get ourselves to this point? A huge part of the change over the last few years has been because of policies such as Meaningful Use, the government’s incentive for health care organizations to become fully electronic.
These may be very well-intentioned, but are often not implemented correctly by hospitals and health care organizations. I remember one hospital I worked in where nurses were reduced to tears when the new electronic systems were introduced. These were not the tears of lazy workers resistant to change. These were tears of dedicated and caring people who found that they could no longer spend adequate time with their patients — in other words, what they had trained for. To be fair though, it’s not entirely the fault of hospitals either, because the optimal IT platforms don’t yet exist. To draw an analogy, it’s like investing in the most amazing railway imaginable and planning a national rail network, but not having the appropriate high-speed trains to run on them. (Anyone for a trip on a 1850s steam train instead?)
Even as the technological revolution accelerates, nurses still need to be able to spend adequate time with their patients: talking, understanding, and actually looking at them. We cannot have situations where nurses are spending a tiny minority of their day in direct patient care, and a massive majority clicking away on their computers. It does our patients a great disservice if this happens. Considering too that we are living in a time of increased focus on patient satisfaction, HCAHPS scores, and delivering an excellent health care experience, has nobody stopped to think that if nurses are not spending meaningful time with their patients, how can they possibly be happy with their hospital stay?
The answer to this problem doesn’t lie at all with running away from technology. Far from it. It lies with designing more brilliant technology that is quick, easy to use, and fully integrated with frontline clinical workflow. Technology that allows nurses to do what they should be doing: providing direct patient care. The traditional image of the nurse as the patient’s most important companion, sitting by them, comforting them, giving them medicine — must remain. We can’t allow it to be replaced by the nurse who is transfixed on their computer screen instead. The fight is on, as the time-honored role of the good bedside nurse slips away. We are at a defining crossroads at this time of amazing technological change. We should all remember the real meaning of medicine and health care. The human side that no computer can ever touch. Florence Nightingale wouldn’t have had it any other way.