Time Capsule: If Nurse Shortages Require a 50 Percent Labor Reduction, What Technology Will You Install (or De-Install)?

I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).

I wrote this piece in December 2007.

If Nurse Shortages Require a 50 Percent Labor Reduction, What Technology Will You Install (or De-Install)?
By Mr. HIStalk

The recent CDW Healthcare nurse survey about IT is both fascinating and sobering. Nurses are too busy with patient care to get application training or participate in IT projects. They continue to believe that IT can improve their jobs, even though current systems involve frustrating duplication. They also think that applications bought on their behalf are ineffective and unreliable.

“Nursing systems” really aren’t that at all. They are really “systems to get nursing to do stuff that someone else wants.” Electronic charting, medication administration, order entry, bedside barcoding, and patient assessment: none of these save nurse time. They may have an impact on quality (slight or otherwise) and they may create an impressive-looking electronic record for other people to read. What they don’t do is make it easier for nurses to finish their work by shift’s end.

Here’s an exercise to ponder. The hospital CEO comes to you and says, “Mr. or Ms. CIO, our RN shortage is serious this time. There’s no solution in sight. We have no choice but to use just half the nursing hours we have available today. You heard me right — I said half. Quality cannot suffer. You have an unlimited budget to implement whatever technology you can find that will deliver that result. Do that and you’ll get a nice bonus — I’ll let you keep your job.”

Let’s say you receive that ultimatum. Would you recommend clinical documentation systems or bedside barcoding as a way to survive on 50 percent fewer nursing hours? I’m pretty sure you wouldn’t. So what would you recommend?

You’d first need to find out how nurses spend their time. That’s a simple observation study, easily done by data-driven IT types, engineers, or quality experts.

Then, you’d push tasks that add minimal value down the food chain to cheaper and more readily available employees. That assumes you have those, of course. Many hospitals inexplicably got rid of LPNs and nurse aides years ago, using expensive and hard-to-find RNs to pass meal trays and give baths. Didn’t all those hospital suits learn anything about labor management in their MBA programs?

Then, you’d automate where you could to improve efficiency. Buy more PCs and Pyxis machines so nurses don’t wait in line. Provide portable communications devices. Have all drugs and supplies delivered to an in-room cabinet for each patient. Let someone else reconcile narcotics counts and give report. Integrate nurse call systems with other communications.

Maybe you’d even de-install some of those applications that quietly eat up nurse time because of poor design. Watch the kid at McDonald’s ring up your hamburger. Now imagine what the screen would look like if your current clinical systems vendor designed it. Real estate sales would skyrocket because every McDonald’s would need another mile of drive-through lane to hold the angrily waiting customers.

Maybe the RN shortage isn’t that severe at your place (so far, anyway). Still, you should make sure that IT systems aren’t contributing to it. When installing new systems, practice “first do no harm”: will they require more nurse time? Any answer other than “no” is unacceptable. And if you’re convinced that technology saves time, this is a great opportunity to prove it.