By: Matthew Byrne, PhD, RN, CNE
The rise of the electronic health record (EHR) in nursing education has been accompanied by academic standards intended to prepare tech-ready and tech-savvy students. This is the second in a three-part series on EHR engagement. Part 1 focused on consumer versus technology management. Part 3 will focus on health care providers.
The Problem of Practice-Readiness
To meet standards for the use of EHRs, nursing programs need the right mix of faculty expertise and technology teaching tools to ensure students are meeting the readiness expectations of clinical agencies. New graduate nurses are entering a health care environment that is technology dependent. They are exposed to a wide range of patient care technologies and increasingly sophisticated iterations of the EHR. The skill set required by this generation of nurse knowledge workers is clinical judgment, coupled with insights drawn from the technology tools themselves.
Most nurse graduates entering the workforce today do not feel ready to use sophisticated EHRs as faculty are often ill-prepared to best leverage them in nursing programs (Sorenson & Campbell, 2016). However, the ability to quickly interpret data from multiple places to find a salient set of nursing priorities cannot be something nurses first learn when entering the workforce.
Practice-readiness has expanded beyond the basics of assessments and interventions and now requires a core understanding of how to use EHRs, as well as a variety of other information resources (Cummings et al., 2016). No nurse can know every new medication, procedure, or type of technology. Rather, nurses need to understand primary types and the nursing implications that follow. Being able to access resources within the clinical agency for just-in-time education and informational documents may actually be safer and more effective than relying on memorization alone (Elmezzi & Deering, 2019).
New Challenges and Opportunities
Faculty in classroom, online learning, and laboratory settings will need to adapt their lessons to ensure that practice-readiness factors are addressed. Technology-related competency building could be a part of simulation experiences and critical thinking exercises. Having some type of mock EHR can promote use of these tools and encourage an understanding of informatics principles. Simulating EHRs or using vended products, like any instructional technology, can be a great teaching tool, but must be balanced with the expense and the needed faculty expertise.
Clinical faculty must also be adept at utilizing the EHR at clinical sites, particularly those where they may not be actively practicing. They will need to not only be able to navigate EHR systems to validate student work, but to be able to effectively assign patients and monitor patients alongside their students.
Student readiness for practice will quickly need to evolve toward understanding patient care technologies such as telehealth interventions, remote patient monitoring, and patient mobile health care applications. These are areas of expanding employment for nurses. Despite credentialing and reimbursement challenges, they will continue to be growth areas for the profession (Malek & Mowad, 2019). The legal and ethical challenges brought about by a more engaged and tech-savvy patient population will require new staff development and educational opportunities. Both new and practicing nurses must be aware of how the e-patient experience is different, with new expectations for professional practice.
The history of nursing has seen a growth in professional identity and advocacy. The explosion of technology that impacts practice requires an educated and empowered nursing workforce. Nurses need to be able to properly articulate the impact that poor system design has on workflow, outcomes, and interprofessional communication. Nurses can no longer be passive consumers of existing and emerging technologies. Instead, we must be ready to shape technology with an informed voice to best meet our needs, the needs of patients, and the needs of our interprofessional colleagues. Agency, and a voice of professional advocacy, begins in the entry-to practice academic environment and must be reinforced in graduate studies. The result will be knowledgeable nurses at the forefront of shaping health care technology.
Cummings, E., Shin, E. H., Mather, C., & Hovenga, E. (2016). Embedding nursing informatics education into an Australian undergraduate nursing degree. Studies in Health Technology and Informatics, 225, 329-333.
Elmezzi, K., & Deering, S. (2019). Checklists in emergencies. Seminars in Perinatology, 43(1), 18-21. https://doi-org.pearl.stkate.edu/10.1053/j.semperi.2018.11.004
Malek, L.A., & Mowad, K. (2019, October 21). Rapid expansion of telehealth comes with new challenges. https://www.statnews.com/2019/10/21/telehealth-rapid-expansion-offers-challenges/.
Sorensen, J., & Campbell, L. (2016). Curricular path to value: Integrating an academic electronic health record. Journal of Nursing Education, 55(12), 716-719. doi:http://dx.doi.org.pearl.stkate.edu/10.3928/01484834-20161114-10