Registered nurses are split on the impact on patient care of newly implemented electronic medical records and charting systems in their hospitals, according to the findings of the first national survey of nurses on computerized records. President Obama has strongly advocated computerized records systems to reduce medical errors and improve patient care.
The AFT Healthcare survey of 604 hospital nurses is the first such survey since President Obama authorized $19 billion in the American Recovery and Reinvestment Act to assist in the development of a robust health information technology system. The bulk of the stimulus funds—$17 billion—will provide physicians and hospitals with incentives (additional Medicare and Medicaid reimbursements) for using electronic systems. Computerized records are intended to reduce medical errors, save time in charting, and improve patient care and safety.
The survey found that half—49 percent—of the surveyed nurses said their electronic systems have had a positive effect on the overall quality of patient care, while a nearly equal number—47 percent—said they have had a negative effect (23 percent) or no real effect (24 percent). When compared with "the old days" of using paper records, 27 percent of nurses said patient care and safety is better since the implementation of computerized records, 25 percent said it is worse, and 39 percent said it is about the same.
Regardless of their views on the impact of the computerized systems, there was widespread agreement on what is needed for an effective system. Nearly all—93 percent—of the nurses surveyed said that it is important to have additional staff during the transition to make sure patients receive safe care, 84 percent said it's important for nurses to be involved in selecting the hardware and software for the new system, and 85 percent said every unit should include someone with clinical and information technology training for a smooth transition.
"There is a right way and a wrong way to bring this kind of important change to the health industry. It needs to be done well, so that it succeeds in achieving better-quality patient care," says AFT president Randi Weingarten. "When technology is introduced with little or no consultation with frontline workers, there's a lot of unnecessary stress and wasted time and money, as many nurses have found," said Weingarten. "To guard against that, nurses' opinions and concerns need to be heard."
AFT Healthcare said it has asked the U.S. Department of Health and Human Services to use the survey results to inform policy, so that computerized systems use "best practices" to ensure the effort actually produces the intended results: improved patient care and safety.
Highlights of the survey:
- 49 percent of nurses said new computerized systems have had a positive effect on patient care.
- 70 percent said the systems have reduced medication errors, 60 percent said they have had a positive effect on patient safety, and 58 percent said they have helped in the coordination of care.
- 23 percent of nurses said new computerized systems have had a negative effect on patient care, and 24 percent said they have not had any effect.
- While they see computerized systems improving some aspects of care, pluralities of nurses also say that these systems have had a negative effect on stress levels (49 percent) and morale (37 percent).
- 50 percent of the nurses said the computerized systems have had a negative effect on the amount of time needed to chart patient information, while 38 percent said they have had a positive effect, and 12 percent said they have had no real effect.
- Nurses were evenly split on whether the systems reduced the amount of time spent on paperwork—38 percent said they have had a positive effect, 38 percent said they have had a negative effect, and 22 percent said they have had no real effect.
- While 73 percent said implementation of the systems went smoothly, many problems were identified, including 52 percent who said physicians are refusing to use the new systems.
- Nurses who reported a higher level of frontline staff involvement in implementation were more likely to report a positive impact on patient care.
Nurses widely agreed that each of the following would be extremely or very important for computerized systems to improve patient care:
- Additional clinical staff should be present during training and when the system "goes live," to help with the patient load and ensure safe patient care.
- Training and support should continue to be available for a considerable period of time after the system has been activated.
- A clear explanation should be provided for how the new system will affect patient care.
- Every unit should include someone with both clinical and information technology training to help nurses understand the new system.
- Representatives from all professions that will use the new system should be involved in selecting the hardware and software, and in planning the training and activation. [AFT press release]
April 16, 2010