A nurse educator in the late 1980’s, I had the opportunity to become part of a new standard in patient documentation.
Everything nurses do and observe in regard to patients - condition, pain level, vital sign readings, interventions like medications and treatments - must be documented.
Our hospital was the first in the Milwaukee area to develop electronic documentation that would be accomplished on touch screens at the patient’s bedside. Rather than a generic product, information technology (IT) chose software and, together with nursing, built screens with information personalized to our hospital protocols.
My colleagues and I developed education for nurses, nursing assistants and unit secretaries based on the information they would be accessing and entering. Training classes were presented day and night in the computer lab to accommodate the needs of every staff member.
The new technology represented a huge change. Excitement was running high, along with anxiety.
That anxiety came along to the classroom with the staff, of course, because, really, who enjoys being pushed out of their comfort zone into the free fall blackness of the unknown abyss? At least, that's how some staff members seemed to feel at first.
While many were positive and happy to learn, others came to class angry and threatening to resign if they had to incorporate this change into their daily work. Some did actually resign, only to move to hospitals that eventually used similar systems.
Others felt care would be fragmented if they had to talk to patients and document patient responses at the same time.
Nursing assistants began to realize they were going to log on to a computer, read screens and type words. Some could not read well, and most had never used a typewriter, much less a touchscreen keyboard.
Some feared they couldn’t learn the new technology and would lose their jobs.
I remember a nurse in class one night who had difficulty using the tip of her finger to make selections on the touch screen. She instead stabbed at the screen with the tip of a nail file, and, in her anger and fear, punctured the thin, delicate screen.
As educators, we conveyed technical information, but also tried to injected humor, compassion and lots of reassurance into the classes.
IT was surprised when we asked for computer solitaire to be installed on the training computers, but solitaire was invaluable in teaching mouse skills. A computer scavenger hunt helped staff find information on various screens. We engaged in role play to encourage nurses to find ways to talk to patients and make eye contact while accessing the documentation screens smoothly and without distress or interruption.
The refrain I heard most at the start of a class was “I’ve never touched a computer in my life” a statement I enjoyed pointing out was no longer true by the end of class.
When training was complete and the system went “live”, we supported staff on the units around the clock, helping to solve problems and ease the transition, and, mostly, all went well.
I found that I loved every moment of teaching those classes and supporting staff on the units, even in the middle of the night, even when anger and fear bubbled over. I loved conveying information in a way that allowed staff members to gain confidence, let go of fear and move forward with new and better processes.
What we did then seems primitive and naive now, but that’s ok. We were, after all, pioneers, and we did our best with what was available. And, except for that punctured screen, we all survived.