The Covid-19 pandemic has impacted nurses and the profession of nursing permanently. Lessons have been learned, fatigue has been overwhelming and uncertainty is a constant.
Nurses are on the very front lines of care – the foot soldiers in the battle against a deadly virus we still do not fully understand. The sacrifice and dedication is inspiring in the face of such overwhelming challenges. But still, nurses remain in the trenches, caring for their patients with a humbling dedication.
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Rhonda Collins Rhonda Collins, DNP, RN, FAAN has served as the Chief Nursing Officer of Vocera since January 2014. As CNO, Dr. Collins is responsible for working with nursing leadership groups globally to increase their understanding of Vocera solutions, share clinical best practices and to bring their specific requirements to Vocera's product and solutions teams. […]
‘I stand poised with my colleagues at the pier, reining in a river with a Dixie cup. And I have never been more proud to call myself a nurse.” ?Stacy N., Emergency Room Nurse, from the WikiWisdom Forum
It’s stunning that as late as September, nurses are still reporting inadequate supplies of PPE. Reports of re-using contaminated PPE, unavailable PPE, and using a single mask for weeks on end are still being reported.
“Let the staff wear PPE if they feel they need to. We should never have to justify a situation in which we feel the need to protect ourselves. Ever. Especially with a disease that no one knew and still knows nothing about how to fight or protect against. If we are going to save lives, personally I don’t need to be called a hero or be thanked. I want to feel protected and supported. And that was not the case from Day 1.” —Ashley O. WikiWisdom Forum
According to an American Nurses Association survey published in September 2020, 42% of nurses say they are still experiencing intermittent shortages of personal protective equipment (PPE). Over half of the 21,000+ nurses who responded to the survey report they are re-using single-use PPE, and 68% say reuse is required by their facility’s policy. Not surprisingly, 53% of nurses say the PPE situation makes them feel unsafe.
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Our failure to adequately protect nurses has led many to feel like pawns in a giant chess match – powerless and expendable – and causing some to quit in frustration. In fact, a survey of 1,300 nurses found that 67% of respondents plan to quit their jobs or the profession. Even if they don’t quit, many will suffer from burnout and potentially post-traumatic stress disorder (PTSD).
It isn’t just the lack of PPE that is creating this situation, however. Another significant factor is the rapidly growing cognitive burden being placed on nurses. Fragmented information and notifications seem to come at them non-stop. Some are important, but many quite frankly are unnecessary because they could be handled in other ways that are less distracting.
Adding to this burden is that communication has become more challenging in the Covid-19 era. To make or answer a call on a communication device to get necessary information, nurses often must leave the patient’s room, strip off PPE, take out the device, memorize the information, wipe it down after the call in a labor-intensive process, and then either put on new PPE or put the old PPE back on knowing that the risk factor to themselves and their patients has increased dramatically.
That is why it’s imperative to design a strategy that can build support for nurses caring for patients. This is where cognitive science can help.
By providing technology that consolidates information in the context of the patient and enables everyone to communicate in the same way, we can reduce the cognitive burden that has built up over the years. Following are three areas any strategy should address.
- Close the gap between documentation and communication
The electronic health record (EHR) is the hospital’s core repository of information. Yet that information is often tied to workstations which do not fit the mobile nature of nurses and other clinicians when they are attempting to manage multiple critically ill patients at warp speed. If nurses are required to match up their communication devices to the EHR before they can obtain information, it creates an additional cognitive burden. They must also carry information in memory before they can use or communicate it.
A better approach is for documentation and communication to be closely integrated so current information is available on command and new information can be documented quickly and easily from the bedside. Tying documentation and communication together enables nurses to be efficient while focusing the bulk of their attention on patient care rather than attempting to get two disparate systems to work together.
- Give nurses more control over their communications
When a patient presents in the emergency department (ED) with Covid-19 symptoms, the nurse knows he should be tested for the virus. But knowing how to communicate that information (and to whom) can be a challenge.
Should the nurse notify the infection team who is doing triage, and if so, what is the proper protocol? Should the nurse contact the physician in the ED instead? If yes, should the call go directly to the phone the physician is carrying, to a pager or through her answering service?
Having to memorize so many options again creates an unnecessary cognitive burden that adds to the stress nurses face in times that are already tough enough. A better approach is to put everyone – physicians, nurses, staff – on the same communication platform. By using the same software, they can use the same nomenclature, including abbreviations, email address format, and framed so nurses don’t have to work in and out of different systems. The platform handles everything for them.
- Ensure software enhances rather than distracts from workflow
In a fast-moving situation such as a surge of Covid-19 patients, clinicians cannot waste time searching for information or struggling to communicate. They need clear, just-in-time information in the context of the patient that can be pushed to them as they move through the hospital. That doesn’t mean everything that is generated needs to be sent to them, such as alarm and alert notifications that aren’t actionable. They should only receive the information they absolutely need, which will help reduce the cognitive burden.
This also applies to the over-customization of applications. Sometimes, in their desire to be thorough, hospitals customize software with so many drop-down boxes that it forces nurses to search too long for information they need. In a pressure situation like the one we are currently facing, all that customization gets in the way of care.
Instead, information should be presented in a way that follows and enhances standard workflow. Again, that information should also be actionable. Enabling nurses to focus on what needs to be done, when it needs to be done, without a lot of extraneous information coming at them helps relieve the cognitive burden while also enhancing the level of care they deliver.
Preparing for the future
Most eyes right now are focused on the present. But in light of the surveys mentioned earlier and the toll Covid-19 is taking on nurses, physicians and staff generally, healthcare executives must also begin preparing for the aftermath once the survivor mentality has passed.
Key will be determining how to manage healthcare team members who are trauma survivors and will experience PTSD for some time to come. Counseling and support groups will be important. But so will systemic changes to ensure they don’t have to face these same challenges when the next pandemic or other major event occurs.
Part of that will come with a commitment to ensure they never run out of PPE again. But it also means ensuring that communications, which are the backbone of patient care, is approached with a strategy and as a system of its own rather than as an afterthought tacked onto some other system, such as the EHR.
This includes moving communication away from hand-held devices and toward wearable, hands-free, voice-controlled communication tools that can be worn under PPE (and used without removing PPE). Giving nurses the ability to say, “Call the cardiologist on call” and having the software contact that physician in the appropriate way simplifies and speeds the communication process for all while conserving supplies and keeping everyone safer. It should be considered as part of the standard PPE for all clinicians in the future.
Easing their burden
We have asked much of nurses during the Covid-19 pandemic, and they have more than risen to the call. Even the strongest and most resilient among us have a breaking point, and we are beginning to see those cracks forming.
It is important to ensure we are taking the steps needed to help nurses bounce back from the current trauma and to care for their needs moving forward. They have eased the health burdens of many. It is time to do the same for them.
Photo: gpointstudio, Getty Images
Rhonda Collins, DNP, RN, FAAN has served as the Chief Nursing Officer of Vocera since January 2014. As CNO, Dr. Collins is responsible for working with nursing leadership groups globally to increase their understanding of Vocera solutions, share clinical best practices and to bring their specific requirements to Vocera's product and solutions teams.
Prior to joining Vocera, Dr. Collins was vice president and business manager for Fresenius Kabi, USA, responsible for the launch of the company’s Intravenous Infusion Pump in the U.S. and led the American Nurse Project, elevating the voice of nurses across the country. Through her previous experience at Masimo Corporation as vice president of nursing and Baylor University Medical Center as vice president, woman and children’s services, Dr. Collins has deep experience maximizing market share and profitability while building on best clinical and business practices.
Dr. Collins holds a doctor of nursing practice from Texas Tech University Health Sciences Center and a master’s degree in nursing administration from the University of Texas. A registered nurse for 28 years, Dr. Collins is a frequent speaker on the evolving role of nurses, the importance of communication, and how to use technology to improve clinical workflows and care team collaboration.
