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August 7, 2019

By: Fidelindo Lim, DNP, CCRN

Downtime: The time to nurse

Not long ago, I walked down a hospital corridor of a medical-surgical unit and found all the work stations on wheels (WOWs) flush to one side, with nurses sitting in front of a blank computer screen, tethered to their cell phones. The sight reminded me of a bumper-to-bumper traffic jam of single-occupancy cars descending into a tunnel. As I passed by, I saw a nurse maniacally trawling social media. On another cell phone screen, I saw a colorful display of footwear. The nurse was shopping for shoes too uncomfortable for a job that requires miles of walking! Nosy as I am, I asked, “What happened? How come everyone is in front of the WOW?” Someone curtly replied, “The system is down. We’re waiting for it to come back up.” It was 9:30 in the morning.

As I walked along, I thought, What if the system doesn’t come back up for hours? What if, for some apocalyptic reason, the system never comes back up? What would happen to nursing care? These seemingly rhetorical questions are worthy of consideration as the dominance of technology becomes intractable in healthcare. Computer literacy and technological dexterity are now proxy measures of nursing competence. Computers are so inseparable with clinical nursing work that the staff feel they can’t “work” without them. Here’s a thought: When we can’t “work”, it is time to “nurse” the patient.

When the system is down, the patient is up!

As a nurse of a certain age (I was born years BC [before computer]), my caring ethics and work ethic blossomed, unfertilized by feeds from the internet. This is not to say that I am anti-technology. Like the rest of humanity, I’m grateful for such technological advances as indoor plumbing and air travel. However, as a nurse and future patient, I ponder about how technology might be (if it hasn’t already) changing nursing from a vocation to simply “work”—a series of tasks punctuated by “tap, tap, tap …” of the computer keypad. Loss of system access provides an opportune time to pause and rediscover the primacy of the patient. Wouldn’t it be sublime if the nurses who were waiting for the system to return would visit patients and hold their hands, instead of being completely absorbed by their hand-held gadgets? Or simply stop by the bedside, unsummoned by a virtual call or a text message?

The prized virtues of meaningful patient care such as attentiveness, compassion, kindness, and grace, are often found without the assistance of a GPS. The challenge these days for clinicians is cultivating presence at the bedside and switching off personal devices while at work. Some hospitals have a policy for nurses to sit down with their patients a few times during the shift to connect, simply talking with them. What greater good can be accomplished if a nurse enters a patient room, pulls up chair, and be authentically social with the patient? One can only imagine the amount of patient care hours lost to incessant curating of staff’s personal social media while at work. But all is not lost.

 And there was music

 A few years ago, I was facilitating an end-of-life high-fidelity simulation with a group of nursing students. Those who are familiar with high-fidelity simulation will agree that technology (a lot of it) makes it all possible. The patient I was portraying was a person who was dying of terminal cancer, in his last days, if not hours. Behind the one-way mirror of the simulation room, I spoke for the static mannequin. When the student held the mannequin’s hand, I was quick to say “your hand is cold.” The student had a perplexed smile on her face knowing that a rubber dummy has no tactile capability, but she then rubbed her hands together and squeezed the mannequin’s hand anew. I responded, “That is much better.”

It’s not easy to make small talk with the dying, but the student and the “patient” continued to chat. At some point the student asked what the patient’s favorite music was. Coming out of stupor, the patient said he likes classical music. Confidently, the student pulled out her cell phone and with a few taps, soft classical music started to play out of the phone. With the subtle elegance of a conductor about to beckon a section of an orchestra, the student placed the cell phone on the patient’s pillow, near his ears. Shortly, the patient passed away. The mannequin couldn’t hear the music, but in this exercise, technology was transformative and we all listened with our hearts. Death was simulated, but the students’ and my tears were real, and so was the music. When life can no longer be prolonged, technology can enhance its meaningful end.

Drop-down. Drop by

In computer language, a drop-down menu is a horizontal and vertical list of options that contain choices or functions. Here, I would like to propose a different interpretation, to imagine drop-down as a moment for nurses to drop by the bedside for an old-fashioned visit, sans computer (i.e., figuratively drop the computer down). Healthcare will continue to depend on meaningful use of technology to save lives, but we also need reminding that our worth as professional nurses cannot be measured through technical proficiency alone. Like any skills, caring competencies can be developed with repeated visits to the bedside. Downtime means time to visit the patient.

Virtually irreplaceable

During a training on using electronic health record, the product representative explained that in spite of its endless functions, the computer can’t give the patient a bed bath. The core values of nursing such as empathy, altruism, and trust also are irreplaceable by computers. Emoticons will never be a stand-in for the true communion of human feelings that only mindful and intentional nursing can achieve. When the system is down, it’s a litmus test for the nurse’s mettle. What better place to start than at the patient’s bedside. When there is enthusiasm to drop-by the patient’s side, time eventually follows. Or so we hope.


Fidelindo Lim is a clinical associate professor at the New York University Rory Meyers College of Nursing in New York, New York.

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