Behind the frontlines – the business of healthcare

Several years ago, I was hired into an exciting position as the director of a system nursing support department.  During orientation, the CNO told me, "Terry, always remember that every penny allocated to your department has been taken from a patient care area, so use those dollars to advance nursing practice or to enhance the patient experience." 

Wow! Powerful words. 

The same advice should be applied to allocations for technology or communication in hospitals. Healthcare leaders need to carefully evaluate their needs and collaborate with frontline staff to wisely choose technology  -  mobile or LAN  -  that meets the needs of bedside caregivers. 

It's a simple concept. What isn't simple is our position as IT vendor companies. As a veteran nursing leader, I'll admit that I have a strong bias against for-profit healthcare  -  wondering if it's ethical for any corporation to siphon off profits for shareholders when the dollars should go to the provision of care, health promotion and disease prevention. As a nurse, I acknowledge my ethical, social and legal contract with the public, as defined in the ANA Social Policy Statement. 

However, as the CNO of an IT company, I understand first-hand the cost of research and development, the need to satisfy investors and to make payroll on Friday. As a taxpayer, I wonder how long we can sustain the escalating competition that makes the financial decisions more difficult for hospital administration and places the needs of the patients and direct caregivers far from the top of the priority list.  

Recently, medical-surgical nurses in a for-profit health system literally cried while relating to me the stress of not being effectively staffed to provide safe patient care "more than 50 percent of the time." During one night shift, a busy charge nurse cared for five patients, coordinated activities on her unit, provided guidance to two new graduates, put together seven patient admission charts (since the HUC position was cut) and still found time to check the crash cart and record catheter-days! I fully understand that nurse staffing is not just about the numbers, it is also about clinician competence and skill mix, patient acuity, teamwork, resources, support departments and physical layout. There is a safe minimum, and a lot of gray area of interpretation above that. 

The recent movie remake of the classic Dr. Seuss tale "The Lorax" has introduced a new generation to the little man who "speaks for the trees  -  let them grow!" If the Lorax "spoke for the trees," then I "speak for the nurses." 

If we are developing technology for sale and use within hospitals, we must remember that the money used to purchase our products is being taken away from direct nursing care staff and as such should improve the environment, the patient outcomes, or the user experience for those same nurses.  

We need to assure that the nursing professionals accountable for 24/7 care of acutely ill patients are included in the development, implementation and subsequent evaluation of these products and in the decisions to purchase them. A multi-million dollar investment in the wrong technology should not happen, but if it does, decision-makers need to investigate and make it right.

Every device or application should include mechanisms to collect direct feedback from users and a means to reintroduce that data back into the development pipeline.  

Every day I look in the mirror and remember that out of the hands of nurses come the resources for our products. This should guide every decision we make. It breaks my heart to hear IT leaders tell me, "We don't want to show this to the nurses; they might like it." I speak for the nurses: "let them know!"

Do you think there may be more to the situation? Is it about the manpower to genuinely support those direct care givers? Is it about sharing control of the IT environment? As a nurse, I would really like to know.

Teresa Anderson, EdD, MSN, RNC-OB, NE-BC, is the chief nursing officer at Voalte. She has 30 years of nursing experience, including academic faculty, staff development, advanced practice, nursing leadership and quality performance improvement activities.