National Nurse Week has begun. Last week, I did a 4-hour shift shadowing a nurse on a busy inpatient unit with cardiac surgery patients. I was taking part in the “Walk in My Shoes” program at Stony Brook Medicine, where I currently serve as interim CIO.
All the executives were asked to block out 4 hours to shadow a nurse. I looked forward to my shift despite the other work on my desk. And as I told the nurse I shadowed, spending time on their unit was more fun than some of the problems I deal with as a CIO.
But I wasn’t there to have fun. I was there to understand what a nurse’s day is like and find ways that administration can help. And as the CIO, I wanted to understand how they use the systems we support and to find opportunities to improve them.
I donned a pair of scrubs — the universal hospital uniform and a fashion neutralizer. It’s amazing how different it feels to be on a nursing unit in scrubs compared to being a “suit” who periodically does rounds with a bunch of other “suits.” The staff seemed more willing to just tell it like it is when I encouraged them to be candid with me.
As soon as got to the unit, a nurse realized I was from IT. His first thought was that I was there about a system problem that had been reported in the patient safety system. I introduced myself and my role as interim CIO. I told him that while I was there to shadow another nurse, I wanted to hear about their IT issues. This was my “gemba” walk with a group of nurses.
We expect a lot of nurses. They need to be clinically sharp while being compassionate and caring. They must master all the medical technology and information systems we put in front of them. They need to be able to focus on clinical details and their next set of tasks while blocking out the noise around them.
Watching them carefully review the meds they are about to give a patient with activity and noise all around them, I vowed to myself that I’ll never complain about too much noise outside my office when I’m trying to compose an email on a difficult subject. Nurses juggle many tasks at once, but seem to never forget everything they must do. If I don’t write down my “to-do’s” they don’t get done.
I shadowed Ginny, who has been a nurse for over 20 years. I interacted with her colleagues — other nurses, nurse practitioners, physicians, clinical nurse specialists and unit clerks. The sense of team on a nursing unit is unique. They work closely together for 8 or 12 hour shifts in shared space and are in and out of patient rooms. Their work environment is very different from my IT management experience in an office and cubicle environment with staff.
I watched Ginny administer medications for very sick and somewhat confused elderly patients who don’t want to take them or have trouble swallowing big pills. She did it all with grace, warmth and patience. She made each patient feel as though there was no one else around who may need her though she had other patients to care for.
I watched Ginny coordinate with transport staff to prepare two of her patients to leave the floor for procedures. She ensured all clinical prep was complete and the “trip slip” was filled out and affixed to the paper chart that went with the patient.
As she documented online, I saw firsthand some of the extra steps and barriers to efficient documentation we need to address. Together we looked at the new electronic whiteboard and ways to improve it. As they reminded me more than once, technology should make it easier, not harder to do their jobs.
Nursing is a team effort in many ways. They learn new systems together and teach one another. They back each other up during breaks. They review together and co-sign when smart pumps need to be changed to ensure there are no errors that could harm the patient.
I heard that they think training is inadequate for some of the new tools they are expected to use, especially the ones they use infrequently.
We looked through the paper chart. It’s organized into standard sections, most of which are empty since it’s almost all online. The few sections with paper included consents, patient property list, and an insurance form needed at discharge; these are either not yet electronic or will never be.
I had a list of follow-up items for my IT team when I finished my time on the unit. I reviewed the ones the CNIO needed to know that afternoon. By the next day she had initiated follow-up on all of them. My CTO also did a shift this week and has yet another list of opportunities. We need to compare notes yet. And I look forward to debriefing with our CNO on the overall experience as part of hospital administration.
Whether you work in health care or not, we all know a nurse or may even be fortunate to have one in our family. Be sure to thank the nurses you know for what they do every day — don’t just do it this week! And if you work in health IT, don’t just thank them, keep finding ways to make their jobs easier.