Nurses Make Care Happen

As the slow incremental reforms in the American healthcare system amble forward, within the change lies great opportunity. In seeking to avert the collision course of an aging chronically ill population with a financial burden to maintain the current system, policy makers have had to reflect and discover a hitherto unrealized fact: nurses are the backbone of the health care system. This is both by virtue of their numbers and diversified involvement in caring for patients. With informatics being mandated into the health care system the nursing profession is in an ideal position to create a synergy between their work and technology. The Alliance for Nursing Informatics(ANI) is a collaboration of many nursing informatics groups whose goal is to represent with one voice nurse informaticists nationwide. ANI has stated that if health information technology is used in a ‘meaningful way’ along with best practice and evidence based care that health care will improve throughout the nation. In their statement to the Robert Woods Johnson Foundation’s Forum on the Future of Nursing 2009 they asserted that support of nursing knowledge will produce the following: Leaders in effective design and use of the electronic health record. Health information technology must support and enhance clinical processes to improve patient outcomes. . Nursing informaticists can incorporate their experience with life cycle change and evidence based practice into information systems. The electronic health record must support clinical decision making for nurses that integrates data entry into nurse workflow. Unhampered access is needed at point of care, to be able to share best practices. Funding should be focused on partnerships between nurses and informaticists Nurses are integrators of information. Again technology must support workflow of nurses. Nurses are involved with all communications of patient care from admission to discharge, and are key in maintaining continuity of care. Therefore they must participate in or lead interdisciplinary teams that improve workflow by creating a user centered system design. Specifically health information technology should be able to provide enhanced information at point of care plus create more ways to incorporate evidence based practice Partners in decision making. It is nurses who will be the health care professionals that will use the electronic health record the most. They need to be involved in design implementation and evaluation, and be part of committees on all levels of decision making for initiatives such as patient safety, change management, quality improvement, and usability of systems. Care coordinators across disciplines. Nurses are the professionals that coordinate care in different locations, specialties, and stages of care. The electronic health record should be a patient centered, efficient information flow that would encourage interprofessional communication and create a true health care community. Continuity of care would be ensured between disciplines and health care settings. Technology should integrate all relevant information from the patient and health care professionals that can be consistently transmitted with the patient from location to location. Measures of continuity of care quality must show that necessary information is available in the electronic health record so that both patient and care team can utilize the data to ensure the best health outcome. Nurses are experts to improve quality, safety, efficiency, and to reduce health disparities. Because nurses contribute the majority of information in an electronic health record they will have a great impact on health care quality. In addition, adaptation and further development of measures are needed to address the unique factors of complex care locations. ANI recommends that an adapted version of National Quality Forum indicators be utilized in health care organizations to enhance decision support and clinical measure reporting. Nurses are advocates for engaging patient and family. In an appropriate environment and format the patient needs to see his information to increase the probability of a better health outcome. Nurses’ knowledge of patient education should be utilized and incorporated in the electronic health record. Health information literacy needs to defined and needs a set of objectives. The electronic health record should provide access to the relevant credible educational material to the patient and family based on their language, learning needs and culture. Nurses can be contributors to standardized infrastructure within health informatics. All health care professionals, especially nurses must be able to access health information that is universally understood and provides value in any clinical setting. Standard terminology would enable decision support, discovery of disparities, outcome reporting, improving performance, sharing of best practices, and increasing safety, as well as use of new information from research. Nurses are researchers for safe patient care. New emerging technologies can be opportunities for better patient care. Information fragmentation through use of various systems and devices is the antithesis of workflow and can be eliminated through nurse knowledge and coordination of patient care technologies. Patient information must be available and consistent across each technological device or program and must complement nurse workflow. Nurses need to evaluate any new technology’s positive impact on patient care through consultation and collaboration. Nurses are educators for preparing the future workforce. Informatics must support clinical decision making in complex care. New competencies will arise from new curricula. Nurses must be prepared to use informatics and help develop national health information infrastructure. The profession must ensure that standards based, interoperable, patient centered, technology will make health care safer, efficient, timely, and accessible through informatics competency. Technology must further health care by enabling its delivery to homes and communities as well as clinical settings. Technology adoption will happen faster and become more widespread if nurses are involved in all informatics stages from policy initiatives to design, development, implementation and evaluation. By enabling nurses to become more efficient to deliver safer care the potential of technology to transform health care will be realized when it truly supports the knowledge of nurses. (

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