D029 Narrative Essay: Innovations in Nursing Informatics

Interview with a Nurse Manager on Informatics and Process Improvement

I recently had the opportunity to interview a nurse manager working in the medical/surgical service line at my hospital. Although informatics is not his primary responsibility, he has demonstrated considerable expertise in developing and implementing new processes to improve workflow efficiency for his nursing staff. During our discussion, I introduced five essential technologies that I was exploring in the initial phase of the Clinical Practice Experience (CPE). These technologies included health databases, electronic health records (EHRs), telehealth, wearable technology, and clinical decision support systems (CDSS).

The nurse manager shared that his exposure to some of these technologies—particularly clinical decision support systems and telehealth—has been somewhat limited. However, he possesses extensive experience in customizing electronic health records to better align with the specific workflows of his team. For instance, he developed navigators within the EHR system to streamline documentation processes related to admissions, transfers, and discharges. This targeted customization helped reduce the documentation workload for nurses by simplifying the process and organizing information more efficiently.

One of the nurse manager’s significant achievements involved leading the creation of a discharge summary report designed to reduce hospital length of stay. This report enables charge nurses to proactively identify patients who are likely to be discharged within the next few days. Charge nurses then collaborate closely with primary nurses to detect and resolve any barriers preventing timely discharge. As a result of these informatics-driven process improvements, the average length of stay on his unit decreased dramatically—from over ten days to less than six days within just one year. This improvement highlights how technology-enabled process changes can directly enhance patient outcomes.

Use of Wearable Technology and Patient Safety Concerns

Our conversation also addressed the critical role that wearable technology plays in inpatient care, particularly for patient monitoring. The nurse manager recounted a serious incident involving cardiac telemetry monitoring. During an MRI, a patient was unable to keep the telemetry leads and monitoring device attached, and unfortunately, the equipment was not reconnected afterward. When the patient returned to the hospital floor, they were found unresponsive. Despite attempts at resuscitation, the patient died. Because continuous cardiac monitoring was interrupted, the exact duration of the patient’s unresponsiveness before discovery remains unknown.

This tragic sentinel event, which occurred on the nurse manager’s unit, prompted him to spearhead a new hospital policy aimed at preventing similar incidents. The policy requires that any patient on cardiac monitoring who leaves the floor must be accompanied by staff certified in Advanced Cardiovascular Life Support (ACLS). He emphasized that while technology offers immense potential to improve patient care and operational efficiency, its safe and correct use is crucial to protecting both patients and healthcare providers.

Summary Table of Interview Insights

References

American Psychological Association. (2020). Publication manual of the American Psychological Association (7th ed.).