Sharon Pappas, RN, PhD, NEA-BC, FAAN, Chief Nurse Executive, Emory Healthcare
Katherine Virkstis, ND Vice President, Clinical Advisory Services, Get Well
In our series inspired by the recent article, Leading with Hope, by Katherine Virkstis, Get Well’s VP of Clinical Advisory Services, we delve deeper into each of the 7 insights from Get Well’s recent CNO Council on the Future of Digital Health. Today, we focus on Insight #2: Empower nurses with technology that eases cognitive burden, and Insight #3: Never make a patient care technology decision without involving direct care nurses.
The multifaceted nature of nursing
Nursing practice is complex. It comprises four types of work: physical labor, emotional labor, cognitive labor, and organizational labor. Physical labor involves tasks such as lifting and moving patients and remaining on their feet for long periods. Emotional labor refers to managing emotions, even projecting something different from what is felt, in order to display those emotions appropriate for the work environment. Cognitive labor includes critical thinking, clinical reasoning, and the continuous management of competing priorities. Organizational labor involves the structure of work, documentation, regulatory requirements, consultations, and managing the intersections of the inputs to patient care.
The practice of nursing today demands a balance of these interactive elements, often under high pressure and with little margin for error. As patient volumes surge, driven by an aging population and increasingly complex care needs, the cognitive demands on care teams intensify. Nurses are not only caregivers but also critical thinkers, problem solvers, and patient advocates, all while managing a growing array of care responsibilities.
Rising patient volumes and complexity
The growing challenge of high patient volumes is a pressing issue. As our population ages, the number of patients with multiple chronic conditions is on the rise. These patients require intricate and coordinated care plans, demanding that nurses manage a complex array of treatments, medications, and therapies. The cognitive demands are immense, requiring nurses to integrate vast amounts of information and make rapid decisions, all while maintaining the highest standards of care.
The impact of short-staffing
Short staffing has unfortunately become the norm, leaving nurses stretched thin. The shortage of nursing staff is a chronic issue in healthcare, and its effects are felt acutely in both inpatient and ambulatory settings. Nurses often find themselves at the vortex of clinical activity with the accountability for positive patient outcomes, and staffing shortages impact it all. This isn’t just a numbers game; it’s about the emotional and physical toll on dedicated professionals. The exhaustion is real, and it impacts not only nurses’ well-being but also the quality of care they can provide.
The consequence of interruptions and “stacking”
Interruptions are a constant in acute care environments. On average, nurses switch tasks nine times per hour. These interruptions arise from unscheduled work such as answering call lights, responding to alarms from IV pumps and monitors, assisting colleagues with urgent needs, managing calls from family members, and communicating with Case Managers or Social Workers. Additionally, nurses must handle medical crises, stabilize patients, update EHRs, manage equipment failures, and more. These interruptions come from all directions—patients, families, physicians, and administrative demands. Each interruption requires a cognitive shift, pulling the nurse’s attention away from their current task and increasing the mental load required to resume it. One nurse put it succinctly: “I just want to take really good care of my patients. But something comes up. And something comes up. And something comes up.” Without mindful intervention, cognitive load can escalate, leading to overload, strain, and potential care delays.
As a result, the duration of each element of work increases, creating a domino effect that causes delays and increases the risk of errors. Nurses struggle to keep up with their workload, often skipping breaks and postponing tasks they deem deferrable. They sacrifice their own well-being, working through fatigue and hunger, to ensure their patients are cared for. But this continuous strain leads to “stacking,” where tasks accumulate and become overwhelming or are lost from memory.
Stacking is more than just a backlog; it’s a cognitive burden that makes prioritizing difficult. When nurses are buried under a long list of competing priorities, their efficiency and ability to provide safe and effective care suffer. The consequences are significant: delays in addressing time-sensitive needs, reduced therapeutic interactions, missed documentation, reduced surveillance, missed care, and ultimately, errors and preventable sentinel events.
The role of technology in easing cognitive burden
Technology has the potential to be a game-changer, but only if it’s designed to ease cognitive burden rather than add to it. Introducing intuitively designed technologies can streamline the varied aspects of nursing work. By leveraging technology that simplifies documentation, enhances communication, and supports clinical decision-making, we can empower nurses. These tools make their work manageable, enabling them to focus on what truly matters: providing exceptional patient care. However, it’s crucial to involve direct care nurses in the decision-making process. Their insights and experiences are invaluable for designing and implementing new technologies that are practical and beneficial.
Never make a patient care technology decision without involving direct care nurses
Primary users must be included in the design process of technology solutions to improve user acceptance, implementation, and adoption. Engaging nurses in the design process ensures that the technology is user-friendly and seamlessly integrated into daily practices. This collaborative approach increases the likelihood of successful adoption and sustained use of new technologies.
When technology is implemented without the insights of its primary users, it often fails to integrate seamlessly into daily healthcare practices. The RHIP framework, developed by Michaela Kerrissey of Harvard TH Chan School of Public Health, offers a thoughtful approach to understanding the human factors that influence individual behaviors and adoption of technology in healthcare settings. This framework helps identify the barriers and facilitators to technology adoption, ensuring that new solutions are effectively integrated into clinical practice. The RHIP framework emphasizes four critical areas:
- Risks: Identify the perceived risks or fears users might have about implementing new technology. Proactively addressing these concerns can ease anxieties and build trust.
- Habits: Recognize which habits need to change for widespread adoption. Providing support and training can help users transition smoothly.
- Identity: Consider how technology impacts users’ identity. Ensuring that technology either preserves or positively reimagines users’ roles can enhance acceptance.
- Power: Reflect on how technology changes users’ sense of empowerment. Establishing guidelines that maintain or enhance autonomy is crucial.
Addressing these areas allows us to better understand and manage the factors that influence technology adoption in healthcare. The tool, Clinical Leader’s Blueprint for Digital Change, designed by Katherine Virkstis, aims to help leaders apply the RHIP framework. By systematically addressing each component—Risks, Habits, Identity, and Power—leaders can develop strategies that support successful technology implementation and adoption.
Creating a Supportive Environment for Nurses
Inviting direct care nurses to share their perspective makes technology solutions more practical, user-friendly, and truly aligned with the needs and workflows of care teams. Engaging nurses in the design and implementation process ensures that technology serves as a valuable tool in their daily work, enhancing patient care and reducing cognitive load.
Easing cognitive burden in nursing is crucial for improving both nurse well-being and patient care quality. By thoughtfully integrating technology solutions designed with input from direct care nurses, healthcare organizations can create supportive environments that empower nurses to provide the highest standards of care. To learn more about Get Well’s Point of Care Engagement solution, click here.
Sources:
1 Jackson J, Anderson JE, Maben J. What is nursing work? A meta-narrative review and integrated framework. Int J Nurs Stud. October 2021. Accessed June 22, 2024 at https://pubmed.ncbi.nlm.nih.gov/34325358/
2 Guo J, Fountain N, Romer K, Yellowhorse Kessler S. “Why do doctors still use pagers?” Planet Money, National Public Radio, December 8, 2023. Accessed April 20, 2024 at https://www.npr.org/2023/12/08/1197955913/doctors-pagers-beepers.
