Enough of being digitally ‘done-to’: 2020 is the year of the nurse, let it also be the year of digital nursing

Recently, Health Innovation Network (HIN) hosted a roundtable discussion with senior nurses involved in digital from across south London. The event was chaired by Breid O’Brien, Director: Digital Transformation at Health Innovation Network with special guest speaker Natasha Phillips, Chief Nursing Informatics Officer: University College London Hospitals NHS Foundation Trust (UCLH) and Digital Health’s CNIO of 2019. Breid and Natasha share some of the discussion highlights and why they are evidence that if 2020 is to be the year of the nurse, then nursing needs to be made a central part of the digital discussion in 2020.

We have a combined 62 years of nursing and healthcare experience and have seen an incredible amount of change in our profession during our careers, but the most significant has probably been the transformation of the time nurses spend with patients. Based on our experience and what we observe happening now, and depending on which studies you read, nurses currently spend approximately 20 – 25 per cent of their time on medication administration. In addition, data from Safer Nursing Care Tool (SNCT) observations shows nurses spend 10 per cent of their time acting as the glue in the system by communicating and raising issues. Seven per cent of time is spent on documenting care away from the patient (i.e. excluding documentation that happens by the bedside). At best, this means 37 per cent of nursing time is not spent on direct care.

This calculation started a lively discussion at our recent roundtable for senior nurses involved in digital across south London, prompting some to suggest that, in their personal experience, it is much closer to just one third of their time that is spent with patients. Additionally, data from “Productive Ward: Releasing time to Care” shows another third is lost to looking for things and duplicating work.

For many nurses, time spent on direct patient care is where the joy of work resides, and this is the time our patients’ value most. The group concluded this imbalance between time spent on tasks and time to care needs to change. We need to release time to care.

How technology could help

It’s undoubtedly true that technology is a huge part of the answer, but, as a profession, nursing is not yet reaping the benefits. We are often digitally ‘done-to’. We often have systems that are designed by others, such as patient flow systems, which, although fulfilling an important need, were designed to meet the needs of the organisation with little understanding of the increased workload for nurses. Attendees gave examples of innovative new systems implemented in their practices, which have led to the need for nurses to duplicate their notes. Under these systems, if nurses see 14 patients, they end up writing 28 sets of notes, as they have to create a physical and a digital copy.

Nurses are not routinely involved in the design of new systems, and other countries like the US are much further ahead in recognising nursing informatics as a profession. The group identified a lack of education for nurses in undergraduate and post-graduate environments when it comes to using digital tools in care delivery, though the group recognised HEE is working to change this.

Nurses are in a prime position to lead transformative change, with a depth of experience and a very rounded view of the system. Sometimes, we underestimate the role that nurses can and should be playing right now in system design. Technology can be overwhelming, the volume of data alone. But let’s remember – nurses have been using data for years, and effectively. If someone cannot explain a new technical system clearly to a nurse, then we argue that they need to get better at explaining it.

Imagine a world where digital is at the heart of our practice, the heart of our education and the heart of our leadership. This is happening in patches and where it does, the results show the great potential. It’s happening where change is clinically-led, where nurses sit on advisory committees and where nurses are embracing the opportunity to change their practice, not just digitise what is already happening.

Year of the nurse

If 2020 is to be the year of the nurse, let’s make 2020 the year that nursing and nurses are put at the heart of digital transformation, and where these examples become the norm. Let’s make 2020 the year that we stop walking back and forth to computers and put the power in our pockets, the year we embrace audio and voice recognition. Let’s create a culture where newly trained nurses come in with bright ideas, and we create the right opportunities for them. Technology will not always save time, but it will make our practice safer, and it does have the power to improve our approach to tasks.

To do this, we need to stop the feast and famine approach to technology spending and projects. Bursts of capital funding won’t do the trick – expensive, capital-funded roll-outs are just the beginning. Successive governments have proclaimed innovation is a panacea and announced new policies, CQINs and mandates, as though they are the answer to a problem rather than the first step in a long journey of change. Privately, most will admit that they understand that change takes time. Let 2020 be the year that this is publicly recognised, and the slow, painstaking work of ongoing training and optimisation of systems is sustainably funded.

Nurses are close to their patients. Let 2020 be the year we use this to drive real change. What could we be asking our patients to do with technology to help us? Entering their own health information, accessing information, monitoring their own health trends? Too often there is still a fear of putting people in charge of their own care – hunger from patients to change the system will help encourage people to take risks, never with patient safety, but with innovative approaches to care delivery.

2020 is the year of the nurse – let it also be the year of change. If that sounds optimistic, that’s because it is. But after spending time in conversation with fellow senior nurses discussing these issues, we were left inspired and hopeful. Rather than battling organisational hierarchy and tradition alone, we vowed to do it together. To share and learn from each other and to create a new community of digital nurses. No more digitally done-to. The opportunity is there for us to work as a community. Let’s let 2020 be the year we take it.

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