When it comes to computerized documentation, change is inevitable. Even if your organization has converted to electronic health records (EHRs), you’ll still have frequent updates and occasionally the system can break down.
Of course, any change is stressful and often met with resistance. What’s the key to surviving “Go Live”? A positive attitude and involvement in the project. In this article, I share my experience with the implementation of an EHR system as a way to illustrate these two points.
Keep a positive attitude
When change occurs, the attitude and environment in which it is initiated makes a big difference in determining whether it will be accepted. An attitude is something we choose. Viewing change with an open mind reduces stress for the employee.
It’s useful to remember that every team is only as strong as its weakest link. When examining the behaviors of individuals involved in change, note the early adaptors, late adaptors, and laggards. It’s best to be recognized within your workplace as an early adaptor. Early adaptors often function as a resource to other nurses. By demonstrating ideal behaviors and asking questions as they arise, you foster a positive attitude and make the transition easier.
One tip to keeping a positive attitude is to understand the purpose for the change (see below). This will make it easier to accept new policies and practices/
Purpose of EHRs
Electronic health records were developed as a response to Joint Commissions safety goals. The objective for EHR use is to correctly identify patients, accurately reconcile medications, improve the safety of medication administration, and improve communication among caregivers. This improved communication helps prevent mistakes during surgery and prevent infection. The goal of the American Nurses Association is to develop a standardized nursing language. Electronic health records help to achieve this goal by providing a template of information nurses have to pick from. This way one nurse does not describe a patient’s condition differently than another, unless there is actually a change in condition.
By taking that positive attitude to a committee, you can further ease the stress of change and serve as an advocate for your peers.
Whenever possible, nurses should join committees. Committee work provides a sense of fulfillment, gives you a voice in the change, and helps improve employee satisfaction. Employees who serve on committees learn to communicate effectively. This ability, the positive attitude members usually exhibit, and the satisfaction with seeing results, produces a healthy environment that ultimately benefits patients.
Committees should include not just managers, but those at the bedside, who can bring a unique perspective. Consider, for example, that the equation for nursing informatics, essential for developing an effective EHR is, simply put: nursing + computers + information = informatics. Frontline nurses at the bedside are the best source for information about their patients. Participating in group projects helps bedside nurses understand how the EHR system is designed and how it can be used to improve care.
I represent a 30-bed surgical unit on the hospital-wide OpTime committee. We meet regularly to discuss new changes in the computerized documentation flow sheets that bedside nurses will use. As the only bedside nurse from my unit on the committee, I serve as the resource person to my fellow staff nurses.
I share suggestions and concerns, gathered through interviews conducted with my peers, with the committee members. For example, a common complaint of bedside nurses was duplication of information on the nursing flow sheet. This repetitive charting was viewed as frustrating and a waste of time. I presented this concern to the members of the OpTime committee, which mostly consists of managers and members of the IT department. Those members explained the reasons for the setup of the flow sheet, and made suggestions to make the workflow easier. I then presented these suggestions to my fellow staff nurses at the next meeting. The nurses accepted the suggestions and made a change to the way they were documenting. The members of the IT department took the nurses’ suggestions too. Over the course of a few months, most of the duplicated charting was removed, and nurses were documenting information in the recommended sections.
As part of my committee work, I make suggestions and provide solutions to problems that occur in the live use of the application. Many of these problems are not noticed in the test environment, so the IT department is not aware of them.
Catalyst for success
A positive attitude is a catalyst for success. Nurses on committees who display a positive attitude lead to improved employee satisfaction. Effective committee members provide ongoing communication to staff by answering questions. They enable staff to feel involved in the change. I have learned that the key steps of committee work are: identify the objective, suggest changes, and reflect on and communicate what has occurred to those affected by the committee’s work.
I am excited to be involved and passionate about facilitating a change that will work. I still love taking care of patients, but committee work allows me to take care of other nurses.
I urge all my fellow bedside nurses to get involved. You can better serve yourself, your patients, and your profession through active involvement in committee work.
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Murphy J. Nursing informatics: the intersection of nursing, computer, and information sciences. Nurs Econ. 2010;28(3):204-7.
Sara K. Lyons is a staff nurse at Cleveland Clinic in Cleveland, Ohio.