Time Capsule: Vendors Should Make Software That Crusty Night-Shift Nurses Can Love

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 May 2006.

Vendors Should Make Software That Crusty Night-Shift Nurses Can Love
By Mr. HIStalk

I wasn’t surprised by a recent study’s seemingly conflicting results. Nurses see themselves as key players in patient safety, yet admit that they often break the very rules created to keep patients safe, such as checking a patient’s identity by two methods before giving meds.

Nurses continually amaze me in two ways. They are stunningly caring and comforting to the frightened and hurting patients under their care. They are also terrible computer users.

Before I get lynched by nurse readers, allow me to present my flimsy and anecdotal evidence. I’ve known at least 500 nurses over the years in my clinical and IT roles. Almost none of them were interested in programming or were capable of fixing basic PC problems. Looking over their computer shoulder is like watching your kid play tee-ball – you try to help them by sending powerful telekinetic messages (“Press Shift-Tab … Shift-Tab”) or with surreptitious body English.

It just doesn’t come naturally. The “caring” part of the brain has some sort of limbic dominance over the “nerd center.” That’s quite unlike lab techs, pharmacists, and physicians, who love creating databases and playing around on the Internet.

It’s great news as a patient that few nerd nurses are out there comforting the dying and cheering up sick kids. It’s not so encouraging to systems vendors.

Nurses don’t think in black and white. They bend or break the rules whenever it makes sense. Their numbers and organizational structure ensure they’ll be hard to reach and harder to convince, especially when they’re being asked to change their routine. They know they’re in short supply, so you can’t scare them into compliance.

Along comes software, which is about control, reduction in variability, and elimination of individuality (management in a box, in other words). Nurses hate that stuff. For example, the No. 1 problem with bedside bar-coding systems is nurses who copy patient wristbands so they don’t have to scan the real thing before giving meds. (I don’t get it either, but I’m sure there’s a reason on the front lines.)

The primary users of our clinical systems are nurses. Nerd-designed systems don’t make sense to them, even if slightly higher nerd-center developed nurses (a.k.a. informatics nurses) advised them.

Few industries have professionals on the front line, and even fewer expect them to be competent users of a wide variety of software and technology. We roll out software with poor user design and “in your dreams” workflow. We cut training because we can’t spare the time away from patients. We use software as an enforcer of rules already being ignored, then we throw in a few new ones because that’s what software does. The end result is an application that’s underused, misused, and blamed for a reduction in quality.

Providers are unlikely to hire nurses based solely on computer skills or willingness to follow orders (software or otherwise). For that reason, software needs to be designed for the average nurse, paying attention to usability and task-based design.

Instead of the friendly audience of IT or management nurses, vendors and providers should seek counsel from the crustiest, most cynical night-shift nurse who just wants to be left alone to care for patients and then go home to lead a non-computer lifestyle. Maybe the end result would be software that even a nurse could love.