Teaching Tech: The Challenges of Making IT Work Across Generations
Published in Nurse Leader October 2010
By Cathy Geisen, RN
Start a discussion among nurses about adopting
a new technology, and watch the generation
gaps play out across the assembled faces.
Nurses fresh out of school are apt to look bored.
Whatever device and whatever software you’re
putting in their hands, they’ve been there, done
that. They likely did it this morning on their way to
work—listening to iPods, watching “The Daily
Show” on their cell phones, wirelessly accessing
The New York Times on their laptops. Of course you
need to get some more technology onto the floor.
Why wouldn’t you?
Some mid-career nurses, for their part, likely
will roll their eyes and think to themselves, “Here we
go again. Yet another boardroom brainstorm about
how to make us more efficient. More training, train-
ing, training—how long is this going to pull me off
the floor?”
Veteran nurses, well, you might see some fear
reflected in those eyes. “We’ve got this job nailed
down—why go messing around with something
that’s working fine? What’s technology going to do
that I can’t do better myself? Why now, of all times,
near my professional sunset?”
THE NEED FOR POINT-OF-CARE INFORMATION TECHNOLOGY
Continue the discussion with a few stories—the kind of
run-of-the mill stuff that crops up every single day in local
news papers and on Web sites:
A 2-month old who exhibited early signs of congestive heart
failure was prescribed intravenous digoxin.The infant was given a
dose 10 times greater than intended because of a decimal point error.
The child died.
An elderly patient with rheumatoid arthritis died after receiving
an overdose of methotrexate—a 10-milligram daily dose of the drug
rather than the intended 10-milligram weekly dose.
One patient died because 20 units of insulin was abbreviated
as 20 U, but the U was mistaken for a zero.As a result, a dose of
200 units of insulin was accidentally injected.
Pause for a moment, and let that sink in.These and
numerous other stories will cut across the feelings of boredom,
apathy, and fear that discussions of technology can illicit
across generations.Things are not OK. Medical errors are
frequent, mostly avoidable, sometimes fatal, and always
carry consequences.
Then, tick off some startling, sobering statistics to really set
the hook:
- Up to 98,000 patients die each year due to preventable
medical errors at hospitals, according to the Institute of
Medicine’s seminal 2000 report,“To Err is Human:
Building a Safer Health System.”1 - Medication errors are among the most common medical
errors, harming at least 1.5 million people every year, says
a report from the Institute of Medicine.2 - Studies indicate that 400,000 preventable drug-related
injuries occur each year in hospitals. Another
800,000 occur in long-term care settings, and roughly
530,000 occur just among Medicare recipients
in outpatient clinics.2
The evidence points to an urgent need for technology
that provides decision support to nurses at the point of care.
But for nurse educators, there are significant barriers to
speaking across generations to make the case for technology
and ensure that nurses of all ages and experience levels are
using the technology consistently and correctly.
What’s a chief nursing officer (CNO) or other nurse leader
to do? Make sure you understand that as much as nurses are
all the same, they are different as well. Nurses, no matter what
generation they grew up in, share common training and traits:
they are highly skilled, highly efficient caregivers who carry
back-breaking workloads and must make numerous critical
decisions during the course of a typical day. But don’t forget
that each generation of nurses has different perceptions and
feelings about technology.Your job is to tailor conversations
and training to provide the support necessary for each group.
THE YOUNG AND THE RESTLESS
Nurse leaders might assume that the younger generation of
nurses would be the easiest to get on board for new technology.
You might be surprised.
Yes, young nurses intuitively know how to use any device
or application thrown at them, and they likely will embrace the idea of using technology. But the key danger with this group is staying focused on using technology consistently and correctly.
The problem: young nurses often are too skilled with technology—
they think they know it all, and as a result they want
to run before they walk, according to Becky Quammen, chief
executive officer (CEO) and founder of Quammen Group, a
Winter Park, FL-based healthcare information technology
(IT) consulting firm.
“Young nurses know how to use technology, but they
don’t know how to use it in a care environment.They often
go too fast in and out of applications, skipping necessary data
fields, and relying on technology to do their thinking instead
of relying on their nursing skills,” Quammen says.
In addition, young nurses are used to the fast and intuitive
flow of information on consumer electronic devices.They
often get frustrated with the “clunkiness” of clinical software
and, as a result, are constantly looking for shortcuts to make
the technology “move” faster.This can lead to skipping over
important security and safety steps when using technology to
perform their professional duties.
GETTING MID-CAREER NURSES ONBOARD
Mid-career nurses often are open to technology adoption and
fairly comfortable with computerization.This is the group
that was introduced to technology fairly early in their
professional careers.
But therein lies a challenge. Many, if not most, mid-career
nurses, especially in inpatient settings, have seen technology
come and go. Many hospitals are on third- or even fourth-
generation systems, each of which has required new training,
often new computer devices, and new workflow (for example,
hardwired vs wireless environments).
As a result, they have come to expect significant workflow
disruptions and will demand that new technology be customized
for their environment and include the necessary
bells and whistles.
They will stubbornly resist new technologies if they are
not convinced of the benefits and time savings, and they
demand to see the clinical value of technology before they
get behind a project.They understand that for all its advantages,
overlaying technology on existing manual processes
can be painful and more time consuming than old processes.
TAKING VETERAN NURSES ACROSS THE FINISH LINE
Veteran nurses also present unique challenges.They, like mid-
career nurses, probably have some experience with technology.
But technology has not been a constant in their professional
careers, nor in their personal lives.
For these nurses, any new technology represents a steep
and sometimes embarrassing learning curve, and large-scale
change in their environments causes a great deal of anxiety.
As a result, they frequently question the value of new
technology and will resist adopting it in the twilight of their
careers. Fueling their anxiety is the realization that they will
have to discard long-used work processes. For example, conducting
patient assessments in an automated environment
often requires rigid adherence to filling out data fields at the
point of care.
Veteran nurses may be used to having conversations with
patients and writing down notes from memory, focusing on
documenting what they felt were the most important points.
Technology that is perceived as requiring them to focus more
on data fields and less on their professional judgment can be
seen as dehumanizing. For veteran nurses, who have been on
the clinical frontlines for decades, this can be a confidence-
shattering change that makes them feel like they have been
pushed aside by computers.
NEW TECHNOLOGIES, NEW POSSIBILITIES, NEW TACTICS
To teach across generations, Quammen suggests taking a hard
look at traditional training methods. Because different age
groups have widely disparate technology skills, training
overkill can be an obstacle to adoption.
Instead of scheduling countless hours of training, 1 or
2 hours of structured training is all most users need for new
technologies.Additional training can be offered to technology-
timid nurses—most likely mid-career and older nurses—in a
more relaxed, informal setting, such as a technology “lab”
where nurses can drop by when their schedules permit.
This also effectively separates younger nurses from the
other groups, which can be critical because younger nurses
often are an impediment during training.This age group’s
technology skills can unknowingly embarrass older nurses
during training sessions, making those older nurses feel inadequate
and consequently more fearful of new technology.
“A less-regimented training environment can speed adoption
because it doesn’t tie up nurses in classes about what
they already know, and doesn’t put them in an environment
where they feel intimidated,” Quammen says.“Training
doesn’t need to be lengthy and onerous—nurses should have
the opportunity to learn new technology at their own pace.”
ESTABLISHING A WINNING RECORD
There is a sense of urgency to introduce technology proven to
increase patient safety and support the clinical work of nurses.
But many hospitals have learned that one surefire way to create
nurse resistance is to ask them to do too much too soon.
Electronic health records, for example, change the entire
landscape of care delivery and have an impact on virtually
every care process. Introducing an electronic health record
(EHR) without having established a winning technology
track record is a recipe for disaster.
Introducing technology that is easy to use and provides
immediate and significant benefits goes a long way in establishing
that track record and increase technology acceptance.
SAFETY IN HAND
There are a number of technologies that provide the same
benefits of being intuitive and easy to use, minimally disruptive
to workflow, and able to be deployed quickly. But a pharmaceutical
algorithm computerized calculator provides a
good example of the power of technology to automate
processes that are complex and prone to error.
The system automatically performs all unit conversion and
equations, such as pounds to kilograms and milligrams to
micrograms, while calculating the correct dosage volume.The
device also captures common entry errors such as misplaced
decimal points or improper expression factors. In addition, it
provides alerts about seemingly inappropriate drug orders if a
calculated dose falls outside the established limits for the drug
ordered. Because the technology is intuitive and easily fits
into established nursing workflows, it is easy to teach, taking
only about 45 minutes for each nurse to become comfortable
with the system.
The technology is designed to help reduce errors related to
drug-dosing verification and volume calculation at the point
of care. Studies show that 37% of all medication errors occur
at the point of care when nurses are administering medications
to patients.3 The problem is tragically compounded
when administering medications to children.A 1995 to 1999
study by the US Pharmacopoeia (USP) Medication Errors
Reporting Program demonstrated a significantly increased rate
of medication errors resulting in harm or death in pediatric
patients (31%) compared with adults (13%).4
MEDICATION DOSING DOES NOT COMPUTE
The reason for many errors is that nurses are short on time
and lack the necessary math skills to perform accurate calculations
on the spot.A survey by the National Council of State
Boards of Nursing found that 84% are asked to calculate
medication doses at least daily or weekly. Studies also show
that many nurses struggle when trying to accurately calculate
medication doses.
The computerized calculator helps nurses ensure they are
providing the correct dose at the point of care and provides
other functions to increase medication safety.
The Children’s Hospital of Illinois at OSF Saint Francis
Medical Center was an early adopter of the technology and
has introduced it to the entire nursing staff at the 127-bed
facility, which includes a Level I trauma center and a Level III
neonatal intensive care unit.
A study conducted by two Children’s Hospital physicians
found that nurses working with the device computed accurate
doses 92% of the time, whereas nurses using traditional
methods computed accurate dose volumes only 64% of
the time.
In addition, nurses using the computerized calculator
could calculate the volume of drug doses in 1.5 minutes,
whereas those working without the device took 1.9 minutes.
Those 20 to 30 seconds in time savings per calculation can
make a critical difference during a hectic day and help convince
mid-career nurses and others focused on time savings
and workflow.The technology delivers additional time savings
thanks to its ability to recall drug information and
immediately recognize unsafe drug orders.
Nurse leaders will spend an increasing amount of their
time championing technology adoption and training multigenerational
nursing staffs on how to use IT consistently
and correctly. Providing nurses with technology that is easy
to use from the get-go can help get nurses, regardless of generation,
on the computerization bandwagon. Leaders will
find themselves preaching to the choir if they understand
multi generational needs, provide flexible training, and steer
their organizations toward technology that quickly and effectively
enhances patient safety and fits into the workflow of
their nursing staff.
References
1. Institute Of Medicine. To Err Is Human: Building a Safer Health System.
New York: National Academies, 2000.
2. Committee on Identifying and Preventing Medication Errors, Aspden P,
Wolcott J, Bootman JL, Cronenwett LR, eds. Preventing Medical Errors:
Quality Chasm Series. Institute of Medicine. Washington, DC: National
Academies Press; 2006.
3. MEDMARX 2001 Annual Data Report: A Human Factors Approach to
Understanding Medication Errors. Rockville, MD: Center for the
Advancement of Patient Safety, US Pharmacopoeia; 2002.
4. Cowley E, Williams R, Cousins D. Medication errors in children: a descriptive
summary of medication error reports submitted to the United States
Pharmacopeia. Curr Ther Res Clin Exp. 2001;62:627-640.
Cathy Geisen, RN, is a nurse educator at Children’s Hospital of Illinois, a
part of OSF St. Francis Medical Center, Peoria, IL. She can be reached at
Catherine.P.Geisen@osfhealthcare.org.
