By Victoria Wolfcale, BSN RN CHPN
CITATION: Wolfcale, V. (Fall, 2019). Dinosaurs, Data and Lists. Online Journal of Nursing Informatics (OJNI), 23(3). Available at http://www.himss.org/ojni
I am a list person. I like having a piece of paper and a pen, as well as the ability to write tasks down and then strike them off my list. I like walking through the school supply aisles of the stores each fall and experiencing the associated smell of paper, notebooks and No. 2 lead pencils. You can call me old school, I would not mind a bit. Even now, when I journal or jot down my thoughts, I do it on a Steno before transcribing to my laptop and hitting send. I am a dinosaur.
My oldest son once said to me, “I cannot think of any reason I would need a piece of paper and a pen!” He uses his phone or computer calendar to organize his life and give him reminders; he can listen to music and make grocery lists and appointments. We live in an electronic age. The age of data. Welcome to the 21st century.
You would think that hearing all of that, I would have had more trouble adapting to the changes in the field of healthcare. When I started my profession of nursing, I worked nights. I remember so many mornings sitting at the nurses’ station, completing my documentation, writing in chart after chart. The next transition was documenting at a small desk with a gigantic computer screen and keyboard on it. With lightning speed, the healthcare field has transitioned to a world of informatics that I could never have imagined. Diagnostic tools have the ability to image in 4D. Physicians can view and spin images via computers from every angle from virtually any location. An expert opinion from the global medical community is merely a click away. Nurses have access to patient medical records and medication records; they document and push orders through completely electronically. With just a few quick keystrokes, patient data in an electronic record can be tracked, trended, audited and correlated.
The incredibly positive outcome of all of this explosion of informatics is data. Data that allow clinicians to make best practice decisions in an evidence-based environment. Data that can be assimilated, sorted and reconfigured to make educated assumptions regarding outcomes. Data that escalate the ability to deliver excellent patient care, data to drive process improvement. Data that help nurses become better diagnosticians. Unfortunately, the negative outcome is also data. Just because a system is capable of generating a report does not mean it is providing relevant data. This phenomenon bombards us with reports and we, as human beings and critical thinkers, have to determine what is actually meaningful to our objectives and what is just white noise. We have to prioritize our days filled with email distractions that sometimes make it difficult to complete meaningful work. Moreover, in the midst of all the evolving informatics, we cannot lose sight of the patient. Data are meaningless if not used to improve patient care and positive outcomes.
I love the data, specifically because I am a quality assurance nurse. Reports, outcomes, best practice and patient satisfaction are embedded in my job description, but it is how my brain works as well. I have adapted well to the changes because ultimately, the patient is the driving force behind all any nurse does. I can document on paper or electronically. I can view patient reports and gather data in ink and paper or on a screen. How I do what I do has changed and evolved tremendously, but the driving force behind it all has not. Maybe I am a dinosaur that has merely adapted to a new healthcare climate, but I have not forgotten why I am here.
My name is Victoria Wolfcale. I graduated from nursing in 1986 with my BSN and shortly thereafter began my family. I have worked as a med-surg nurse, triage for an HMO and finally landed in hospice. Hospice is my home. I love it and I find it to be a privilege to work with families at such an intimate time. Currently, I am the Quality Assurance Performance Improvement (QAPI) nurse with the same hospice organization I was full time on call nurse for 2.5 years. I have been QAPI for about a year and I am very much enjoying everything about it! Even the surveyors!