Nurses' effective use of hospital information systems has the potential to produce positive changes in patient safety and quality of care. The trick is getting them fully engaged in the transformation to a robust health IT environment.

Nurses who already are overworked and sometimes computer novices may wonder when they'll have time to learn new skills. They may feel that their jobs are in jeopardy.

A number of Most Wired hospitals have confronted these issues.

To ensure complete acceptance, nursing staffs should be included in all aspects of the transformation project. Karen Carroll, R.N., manager of clinical informatics, Children's Memorial Hospital, Chicago, says this involvement should include system selection, implementation, training, post-implementation management and maintenance. "We utilized both a nurse champion and nursing representatives on the IT team from the start," Carroll says.

Nurse champions are the key, according to Chief Medical Information Officer Brian Yeaman, M.D., Norman (Okla.) Regional Health System. "Having nurses help design clinical workflow and process changes is critical," he says.

There's a price to pay for waiting too long to get nurses involved in the process, says Karen Hughart, R.N., director of systems support services, Vanderbilt University Medical Center in Nashville, Tenn. "We learned the hard way that you engage the target user early in the design phase, testing and pilots, or you pay for it," she says.

Critical care nurse Karen Fuller, a principal at CSC's Health Delivery Group, says management's job is to provide a clear picture of organizational vision. Training should focus on equipping nurses not only with new skills, but also with a new way of thinking. "Make it clear this is not about technology but about changing health care delivery," Fuller says.

Training is handled by Most Wired hospitals in a variety of ways. Beaufort (S.C.) Memorial Hospital has core teams design training materials and run the one- to two-hour training sessions. "We also have superusers working each shift to help nurses the first weeks after go-live," says Chief Information Officer Edward Ricks.

At Vanderbilt, RNs participate in two four-hour classes that cover electronic medical records, computerized provider order entry, nursing documentation and bar-coded medication administration. "We also use the superuser model, where we bring in one person for every 10 staff and train them so they can train their peers," Hughart says.

Children's Memorial utilizes a combination of computer-based training, classroom instruction and practice. Nursing staff are used as trainers and superusers for major implementations. "Superusers provide elbow support for the first weeks post-implementation," Carroll says.

Trickle Up

While improved care delivery and patient safety may be the principal drivers of nurse engagement, there's often an ancillary benefit. When nurses are fully versed in HIT, there is also a strong tendency for physicians to get on board.

Physicians who have not acquired computer skills sometimes feel more comfortable learning from a trusted nurse. "When your nurses are experts in HIT, it gives you a trainer in every corner to help your physicians utilize the system," Yeaman says.

Ricks says nurse involvement in HIT absolutely affects physicians' attitudes and adoption. "Nurses are the first line of defense for physicians on the floor, so the more nurses understand and embrace the technology, the better position they are in to help recruit physicians," he says.

Yeaman advises careful planning. Everyone, from nurses and doctors to those in pharmacy, labs, radiology and respiration therapy, has to be on the same page to be successful. "Be aware of making too many changes at once," he says.

Communication is essential. Keep a line of communication open with nurses, clinicians and others. "The more transparent you are, the more engaged people will become," Ricks says.

Many organizations fail to define success. Some mistakenly believe that getting a system implemented and running is the end point. Fuller says, "Without baseline measurement and ongoing review of defined success metrics that are communicated to the organization, how will nurses know their hard work made a difference?"

Douglas Page is a freelance writer in Pine Mountain, Calif.