The U.S. health care industry is facing a nursing shortage crisis driven in part by burnout and technology burden, which was further emphasized by the COVID-19 pandemic. To improve working conditions for nurses and drive quality patient care, industry leaders must prioritize implementing technologies that support the nursing workforce and care delivery.
I practiced earlier in my career as a critical care nurse at Boston’s Beth Israel Deaconess Hospital. From this experience, I understand the essential role that technology plays in both streamlining nurses’ workflows and creating visibility into the organization to minimize safety incidents. Nurses are part of a team-based approach, and when something goes wrong, everything must be examined to include the “what” and the “why.” This evaluation will consist of understanding the acuity of the patients, the case mix, the staffing available on the unit, the degree of experience and training as well as the time of day and day of the week. These insights will raise further questions about whether the proper equipment was available, if the equipment was fully functioning and if the right staff with the appropriate experience were managing the care of the complex patient load on this unit.
Just like the patients we serve, we are only human, so we must work to reframe the narrative by implementing a proactive approach to safety that is informed by data from previous safety incidents to improve care. Integrating operations technology across departments, such as risk and safety, credentialing, workforce management and more can enhance our workflows and improve the way we deliver care.
Promoting a culture of safety
On average, 15 percent of hospital and health system expenditures are driven by adverse events, 25 percent of which are preventable. With this overwhelming statistic in mind, organizations should work to promote a culture of reflection and correction through operational practices. Nurses and clinicians should feel empowered to speak up when systems are not working. By informing leadership of these hazards, updated practices can be implemented to improve safety and empower providers.
For instance, safety event reporting allows all clinicians to bring forward systems and processes that are broken before an incident occurs, not just reactively. Functional tools are needed to deliver safe and high-quality patient care, so upholding systems for event reporting indicates a strong culture of safety within an organization. Leaders should emphasize that more reporting does not mean more harm is being done, but rather voluntary reporting is a sign of a healthy safety culture. In addition, Good Catch programs are a common example of ways that health systems celebrate individuals who bring forth a flawed system or workflow. The transparency good catch programs promote allows a problem to be fixed before someone is hurt and empowers others to speak up by seeing their colleagues celebrated.
A fear of retribution can be a strong deterrent to reporting safety incidents and near-misses and creates an atmosphere of anxiety that contributes to burnout. Yet with open communication and robust incident reporting, hospitals and health systems can learn from mistakes and implement processes that improve safety. Cultivating a culture of shared responsibility for both failures and successes and commending rather than penalizing nurses who report safety incidents is key to achieving safer care.
Delivering safer patient care
Every day, patient safety incidents such as falls, medication errors, and infections occur that go unrecorded. Leading contributors to patient harm within hospitals and health systems are workflow, technology, and human behavior – all areas of care that can be improved through implementing the right tools. Technology can contribute to patient safety initiatives by providing pathways for better reporting and enabling leadership to zoom in on where things are going wrong. By arming nurses with a solution that connects data across the organization, they can easily report situations and predict potential outcomes to improve patient care.
For example, if a patient is admitted to the emergency room due to an overdose, a nasogastric tube is often inserted into the stomach, but a safety event could occur when it’s wrongly inserted into the lungs. This, in turn, may cause respiratory distress that warrants the need for the patient to be admitted to the facility’s intensive care unit. Safety reports would include an analysis of the policies and procedures surrounding the nasogastric tube insertion, the time of the day and day of the week of the occurrence, the number, and more importantly, the experience of the staff working at the time of the incident to better understand the causal and contributing factors that led to this event.
Addressing technology fatigue
Technology fatigue is a primary frustration nurses face as they deliver care, inhibiting their ability to focus on the patient and the next steps in care coordination. In fact, inefficient health information technology has been linked to emotional exhaustion and burnout among health care workers. Disjointed solutions often delay the care delivery process, preventing nurses from moving the process forward and patients from returning home.
A key area that can assist in augmenting more tedious tasks in a clinical setting is artificial intelligence (AI). Although AI has not been universally adopted, its potential to aggregate data and insights from patients to inform future care delivery proves the value it will bring. AI is not visible to nurses at the bedside, but the decision-support it enables and how it can impact care plans and delivery moving forward will help alleviate the technology fatigue that stems from decision-making with outdated systems. It serves as a surveillance system inside medical records with the ability to highlight potential incidences well before a human recognizes it. The more data there is available, the more an organization can utilize AI to draw insights and implement processes to make nurses’ jobs easier.
No one shows up to work intending to cause harm, but the flawed systems they work with are what lead to poor outcomes. Many operational tools used within hospitals and health systems exist in isolation, and that burden falls on providers to toggle between them as they treat patients. By involving nurses in technology integration and adoption conversations, leadership can gain more perspective on what will be most beneficial to both operational efficiency and patient outcomes. Investing in an interoperable technology platform to help nurses deliver care will enable safer and quality care for patients and standardized practices for caregivers. Utilizing interoperable solutions makes accessing data much easier. Although nurses do not directly interact with these backend processes, the clinical decision support they receive is significantly enhanced by having readily available data stemming from multiple departments or even organizations that a patient’s data has crossed.
Looking ahead
Nurses serve as a pillar of the health care ecosystem, and integrating streamlined technology is pivotal in reducing administrative burden and increasing the amount of time we spend with patients. By embracing connected solutions and prioritizing human-centric design, health care organizations can empower nurses to work smarter, not harder, enhancing patient outcomes and promoting well-being.
Ann-Louise Puopolo is a nurse executive.
