Crowe, H. (July, 2016). How has Nursing Informatics changed my nursing practice since graduating from nursing school in 1993? Online Journal of Nursing Informatics (OJNI), 20 (2), Available at http://www.himss.org/ojni
The first major change related to nursing informatics occurred when I started teaching nursing clinical rotations in the early 2000’s. At that time, the nursing school where I taught was introducing NANDA, NIC, and NOC as a model for all future care plans taught to their nursing students. As a nurse who graduated in the spring of 1993 I had no idea what NANDA, NIC and NOC were. Since this nomenclature was developed in 1992 it had not been incorporated in my formal education. I also did not see why changing our current nursing diagnosis process to a more standardized language was necessary at the time. Now years later as I use care plans on the computer I see the importance of a standard language. A standard language allows anyone to recognize this is a nursing process and not a doctor process. It also allows programmers to incorporate standard care plans that can apply to many individuals. Ideally, standardized nursing languages allow information technologists to aggregate data on nursing outcomes and processes. Without a standard language, nursing data is difficult to locate and track in the computer system thus making it difficult to verify nursing outcomes and to develop evidence-based nursing practice standards (McGonigle, & Mastrian, 2015).
The second major change noted in my practice is when my employing hospital adopted a computerized charting and order entry system. Gone was the paper charting of my schooling. I was introduced to a world of computers where all information was placed in data fields. I became a date entry professional in addition to being a nurse. With this change some major benefits were realized immediately. The most memorable to me was no longer having to interpret handwritten doctor orders and progress notes from all disciplines. I certainly do not miss trying to figuring out illegible doctor orders. Gone are the days of having to call the doctor who was insulted that you could not read their order.
The third major change I have witnessed is the replacement of written medication Kardexes to an all computerized medication administration system, where medications are scanned and coded in the pharmacy, then sent to nursing units and place in a computerized Omnicell which keeps medications locked and secure on the units. The Omnicell machine tracks where a medicine is dispensed, returned, or wasted. This machine interfaces between the nurse’s computerized charting system and the pharmacy medication manager system. Medications removed from the Omnicell are taken to the patients’ rooms where the medication’s barcode is electronically scanned and compared to a patient’s armband. The five rights of medication administration are now done electronically in tandem with the attending nurse’s five rights check. This process has reduced medication errors. Like the old saying “to err is human” - even with a nurse performing the five rights check, errors can and do occur. What I noticed as an improvement with medication scanning was the computer alerted me when I had made a potential error. The computer would highlight in red when something did not match such as either the wrong patient or wrong IV bag. Hopefully I would catch the error with the traditional checking of the five nursing rights. But this system with red warnings alerted me to how often this type of error had the potential of occurring. In the field of nursing with all of the constant interruptions of the day the risk of making med errors is prominent. A large percentage of medication errors occur at the time of administration. The use of a barcode scan adds another layer of protection to the patient. I really love this new technology.
The last major change I noted was when I returned to teaching clinical after a four year hiatus. When I came back to the field of education, gone were the days of transporting student care plans home for grading and then returning paperwork to the students the following week. Now the college had instituted electronic grading and submissions. This made the students’ homework accessible at any time at any place via a computer. No longer does a student have to wait a week to get a care plan returned for revisions, and then the clinical instructor had a week for student to return their revision, and then student to wait another week to get their final graded work back again. This change in practice has helped to reduce delays in grades and incompletes and has reduced the paperwork instructors have to lug back and forth to the clinical site.
Another change made was all students and staff were reachable by email. Announcements to students can be made directly through a Blackboard learning management system. No longer is the student or the instructor unavailable. This unrestricted access to each other is viewed as beneficial by some and by others as intrusive.
Over the years the computer has become more and more a part of my everyday practice. At the beginning of my career computer technology was utilized less than 25 % of my day. Now in 2016 I am utilizing the computer or technology over 75% of my day. Access to information is now available at my fingertips within minutes, which in the past could take days or hours to obtain. The changes I have experienced as a nurse in the last 20 years is amazing and I cannot wait to see what the next 20 years has in store.
McGonigle, D. & Mastrian, K. (2015). Nursing informatics and the foundation of knowledge. (3rd ed). Jones and Bartlett: Burlington, MA.
Heather Crowe RN BSN graduated from Oakland University School of Nursing with BSN in 1993. Employed at St Joseph Mercy Oakland Hospital since 1991. She is a current practicing bedside nurse on the Pediatric floor. Has been a clinical instructor since 2001 for ADN and LPN students in their pediatric rotations. She has worked for Macomb Community College, Oakland Community College, and is now currently working for Baker University as an adjunct faculty member. Heather is also actively pursuing her Master in Nursing Education online through Baker Online Graduate Campus of Flint, Michigan.