Image by mcmurryjulie from Pixabay
Our December issue is out, but before we move on from the November issue I want to highlight the Viewpoint, “Advocating for HIT That Captures Nursing Process.” It’s about something that greatly affects nurses’ work, seems to be the bane of all clinicians, and, I think, often prevents individualized patient-centered care.
I’m referring to the electronic health record (EHR), a system built to capture data important for billing and tracking aggregate patient outcomes—but arguably not designed for what clinicians deem as most important for understanding and documenting patient care.
Dylan Stein and colleagues Jasmine Travers and Jacqueline Merrill write what most nurses know about EHRs:
“The nuances of our care get lost in task-oriented, quantitative drop-down menus and checkboxes, while the qualitative value of our interventions and impressions are not encoded in a useful way.”
Nursing notes devalued.
In the old days BC (before computers), clinicians used some checklists for charting but also relied heavily on narrative notes to describe the patient’s individual story. While there are areas one can add notes in an EHR, nurses tell me that it’s not very easy to do so and that no one really reads them because they’re not easily accessible.
EHR redesign, with nursing input.
I’m not advocating for a return to the old systems, but, as the Viewpoint authors note, there needs to be a redesign of EHRs to better capture what nurses do and how it contributes to patient outcomes. Staff nurses can work to make EHRs more clinician friendly by speaking up and noting where charting systems hinder communication and can lead to errors in practice (that will help garner attention!). They can also volunteer for committee work that aims to review and update systems, and if newer systems are being planned, advocate for staff nurses on the selection team. Nurse managers can support and encourage staff involvement by providing time for research and review of EHRs and helping to champion staff nurse involvement in system choice and design.
We know the oft-repeated phrase, “if it’s not documented, it wasn’t done,” which nursing instructors drilled into us in school. I think it applies to the EHR—if nursing care and observations are not captured in the record, how will this affect patient care, and how will we show our contribution to the patient’s outcome? And if we can’t show the value of what we do, what will that mean for allocation of resources and staff?
(Viewpoints are free to read.)
Shawn, I heartily agree. For numerous reasons, some of them fair and good, the patient’s chart is quickly becoming a documentation source for billing and accreditation data collection. Narrative information about why a patient needs certain services, their status of obtaining them, communication modes, and what motivates them to participate in their care, for instance, fall to the wayside, unread. While difficult to quantify as a metric, in my opinion this information is at the heart of nursing care. Nurses certainly need to voice our concerns to help improve EHR and preserve patient-centered care.
Shawn, This is such an important article!! I have long lamented the loss of the essence of nursing care in the age of bedside computers, drop-down menus in EHRs, survey-based patient satisfaction instruments, and the use of quantitative methods in nursing research. Simply stated, it is virtually impossible to capture nursing using the these practices! This is not to say that these practices aren’t relevant, or important to patient care–but they have been wholehearted accepted without thinking of what is lost in the process. I fear that in the age of big data, quality ursing care is at great risk. Thanks for sharing this. Shawn Pohlman RN, PhD