NUR 307 Module 8 Journal Example

Module Eight Journal

The Box I Stopped Clicking: From Using Technology to Shaping It

At the start of this course, I wrote in a discussion post that technology is something that happens to nurses. New systems arrived on my unit with a training module and a go-live date, and my job was to learn where to click. I meant it as a complaint, but I also believed it. Eight weeks later, I think that belief was the real problem, and several assignments changed my mind.

The first was the decision support paper. I chose the mobility alert that I dismiss many times a shift, expecting to write about how annoying it is. Instead, I found evidence that the goal behind it is sound and research showing that clinicians accept fewer alerts as they receive more of them, especially repeats (Ancker et al., 2017). The alert was not failing because nurses are careless. It was failing because nobody who designed it had asked when in a nurse's shift a mobility decision is actually made. That is a question I can answer better than any analyst.

The second was the pump-tracking proposal. Our practice council's audit showed nurses searching for pumps well over a hundred times in two weeks, which fits what Hendrich et al. (2008) found about how much of nurses' time goes to work other than direct patient care. Writing the implementation plan, I used the sociotechnical model of Sittig and Singh (2010) and discovered that most of the work had nothing to do with the tags. It was about who owns the system, how environmental services marks a pump clean, what policy protects staff from being tracked and how we would know it worked. Nurses have knowledge about every one of those dimensions.

The third was the smaller paper about a patient's smartwatch screenshots arriving in the portal on a Friday night. Nobody had decided who should read them, how quickly, or what to do next. The nurse who opened the message on Monday handled it well, but only because that nurse chose to pick up the phone. Writing that paper, I realized how many of the gaps I complain about at work are not failures of any single nurse but decisions no one ever made, and that nurses are often the only people in a position to notice them.

My two commitments follow from this. First, I have joined our hospital's clinical informatics council as the unit representative, and at my first meeting I brought the mobility alert data. Second, whenever a new system is announced, I will ask two questions out loud: which nurses tested it before go-live, and how will we know whether it helps. Asking those questions is a small act, but it is the difference between technology that happens to nurses and technology nurses help build.

References

Ancker, J. S., Edwards, A., Nosal, S., Hauser, D., Mauer, E., Kaushal, R., & HITEC Investigators. (2017). Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system. BMC Medical Informatics and Decision Making, 17, Article 36. https://doi.org/10.1186/s12911-017-0430-8

Hendrich, A., Chow, M. P., Skierczynski, B. A., & Lu, Z. (2008). A 36-hospital time and motion study: How do medical-surgical nurses spend their time? The Permanente Journal, 12(3), 25-34. https://doi.org/10.7812/TPP/08-021

Sittig, D. F., & Singh, H. (2010). A new sociotechnical model for studying health information technology in complex adaptive healthcare systems. Quality and Safety in Health Care, 19(Suppl. 3), i68-i74. https://doi.org/10.1136/qshc.2010.042085