How Nursing Informatics Leaders Can Help Make a Digital NHS a Reality

Opinion Article by Debbie Guy, Registered Nurse and Director of Clinical Operations at Nervecentre.
Technology is becoming more important to clinical practice, not just as a management reporting tool, but as an instrument to change the way we deliver care for the better. The government's ambitions are clear - Simon Stevens, NHS England's CEO is calling for technology to help "drive down variations in quality and safety of care" and reduce instances of avoidable patient harm in his Five Year Forward View.

In a subsequent report that focuses purely on modernising technology in the NHS, the National Information Board's (NIB) Personalised Health and Care 2020 says that it is essential that care professionals and carers have access to all the data, information and knowledge they need in order to improve care delivery.

Frontline healthcare professionals also recognise the benefits that technology can offer. This was demonstrated with over 270 applications to NHS England's Nursing Tech Fund 2 - of which 76 were successful in sharing the available £35 million. Interestingly a large proportion was awarded for electronic observations and mobile access projects.

Putting IT into practice
The ambitions above are very admirable, however, the reality is that achieving technology adoption on the wards is not always easy.

As a nurse with over twenty years of experience working on a ward, I have seen IT products introduced across hospitals which have been designed and implemented with little input from the clinical staff who actually use them. This has meant that clinical effectiveness is often lost and the system is not adopted wholeheartedly.

I am not a complete technophobe, but nor am I someone who spends every waking minute connected to their computer or laptop. If you asked me five or six years ago if I could see the benefit of technology for nurses, my answer would be slightly different to now.

The reason? At the time nurses in our trust did not actively use much technology, and if we did, the information would usually be stored in one location on PC-based systems. The idea of returning to the computer repeatedly during your shift was a huge problem when you have two PCs and lots of staff. Unfortunately, I had rarely found technology, as a nurse, particularly helpful to my duty of care. Healthcare technology, however, has come along way since then.

The emergence of the CNIO
As the roll out of clinical information and support systems continues to gather pace, the demand for nursing informatics expertise and leadership grows in tandem. As a result, a relatively new role is emerging here in the UK, which places nursing engagement at the heart of IT deployment, and ultimately supports the delivery of quality patient care and improved nursing practice.

The Chief Nursing Information Officer (CNIO) provides a crucial role in bridging the gap between IT professionals, clinicians and hospital management, ensuring that new technologies meet the needs of nurses in practice on the ward. The CNIO is the voice of calm and reason, with the experience and appetite to lead care transformation by restructuring an organisation's culture and workflows, and having a deep understanding and appreciation of the barriers and pressures involved.

For nurses, technology can present a different way of working, requiring new skills and competencies - which are becoming increasingly important. This sentiment was echoed by Anne Cooper, NHS England's clinical informatics advisor for nursing, who said earlier this year that the nurses' use of mobile devices, online resources and electronic record systems was essential for improving care.

This is where the CNIO can add incredible value as someone with genuine nursing experience, who has a keen interest in technology and understands the problems of the trust. They have seen and experienced the problems on the ground because they have risen up through the nursing ranks and know exactly what difficulties nurses face on a daily basis. Not every trust at this stage has a CNIO but I believe they could be instrumental in our digital health revolution.

Technology at the point-of-care
I believe in giving the right tools to every hospital clinician so they can do their job effectively. For example, a desktop PC, as a device, is often not the right tool for the job. This is a common issue for both doctors and nurses as we do not sit behind the desk; we are on our feet, caring for patients or moving between wards.

Clinicians need the right tools to support their mobility, and that is why mobile technology, and a nursing informatics champion to support the transition to a mobile digitally-enhance environment, is absolutely what nurses need and ultimately what NHS hospitals need.

A recent Deloitte report on connected health confirms that in the UK mobile devices such as personal digital assistants (PDAs) are leading to an evolution in the way clinical data and information moves to and from the bedside to the patient record.

Indeed, the NIB report I mentioned earlier says the NHS needs to look into ways to present faster, more accurate diagnosis, and investigate opportunities to transform how remote channels can be used to deliver care.

For this to happen however, nursing teams need to be able to trust the technology they are going to use. It needs to be suitable for nurses' requirements and easy-to-use. Technology that ticks the IT teams' boxes, but does not comprehensively consider the needs of clinical staff is doomed for failure.

In these scenarios nursing informatics leaders are crucial in liaising with nurses and clinicians, as well as the organisation's IT team, to smooth out any problems, iron out any difficulties and ensure that the IT product or system is intuitive and user-friendly before it is ready to be used on the ward.

Experience is essential
As part of a team in an IT company, I have had some great experiences of working with nursing informatics leaders. Julia Ball, assistant director of nursing at University Hospitals of Leicester NHS Trust passionately believes in clinical engagement and the importance of involving frontline staff in IT projects right from the very beginning, right through to the final sign off.

During the implementation of an e-observations project, the trust appointed staff 'champions' when implementing Nervecentre's electronic observations, handover and Hospital at Night solutions. Nursing and medical teams on some wards 'buddied up' with those champions to pass on knowledge and experience of deploying a new system - producing strong advocacy for the technology and therefore an effective, engaged, and rapid roll out across other parts of the hospital.

Nursing informatics leaders help to translate and articulate the new IT systems' risks and benefits to clinical staff, whilst sharing clinical challenges and issues to the organisation's IT department and effectively managing partnerships at all levels to ensure nursing goals are communicated and met.

This was the case in the deployment of Nervecentre's mobile electronic observation solution at Nottingham University Hospitals NHS Trust which was overseen by the trust's chief nurse information officer, Caron Swinscoe. With a wealth of experience in nursing and IT, Caron's leadership and vision for smarter healthcare delivery helped a successful transition to mobile healthcare across the trust.

Overcoming challenges of resistance and unease
Nursing informatics leaders face many challenges - including cultural ones. Nurses are working longer in their careers and are used to certain ways of working. There can be resistance to new systems and technology, with many staff anxious of change. When I was a full-time practising nurse, I would perform my day-to-day tasks without once using a digital system so I can relate to nurses' concerns when asked to use new technology.

The NHS is undergoing a huge cultural change but it cannot leave any of its staff members behind; NHS managers must be aware of the concerns, especially of the more conservative nurses, and educate and train them accordingly. And that is crucially, where the nursing informatics leaders can support; they can ensure all nursing staff are equipped with the training and expertise to carry out their duties aided with technology.

Championing the voice of the nursing informatics
The varying roles of nursing leaders that advocate informatics are a real asset to the NHS. I would however like to see the role of a CNIO promoted and appointed in as many trusts as possible.

Crucially, the CNIO is not just another bureaucratic figure. They will work in collaboration with the Chief Medical Information Officer (CMIO) guaranteeing that the voices of nursing and clinical staff are infused in the IT decision-making process. After all, nurses are key users of patient data and are responsible for documenting large amounts of patient information.

The benefits of managing real time data effectively are significant for patient safety - from the ability to reduce avoidable harm by identifying deteriorating patients early, to ensuring that there is sufficient staff resource to give each patient the attention they need. It seems logical for nursing staff to have an informatics champion who is responsible for defining and implementing their organisation's strategy for IT adoption and implementation, ensuring patient safety remains at its forefront.

However, the CNIO needs to use other skills above their nursing experience. In order to perform their job effectively, the CNIO ideally should have a general understanding of the workings of hospital IT and a genuine passion and enthusiasm for new technology and change. CNIOs should also have the enthusiasm to learn to speak the language of technology, and articulate and educate nursing and clinical staff, who want to work with digital systems, about how to get the best out of technology for improved patient care. There are many challenges to technology adoption in healthcare, however, the rise of the CNIO is a huge leap in the right direction.

A digital future for nursing
Currently, the CNIO role in the UK is often overlooked, with hospital trusts apathetic to the role’s potential, struggling with financial and budget constraints or failing to clearly define the requirements of the role.

However, in organisations where the role has been implemented, the CNIOs have become well-respected drivers of change and central to operational management. As the digital healthcare revolution continues to take shape, I believe that this approach will become the norm, with CNIOs developing into influential, guiding forces that will help to steer trusts towards becoming effective and safe digitalised providers of healthcare.

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