A New Dimension
Cathryn Domrose

Students and new grads are eager to learn technology that will
make their jobs easier and allow more time for hands-on patient care

Next year, along with their textbooks and stethoscopes, students in the graduate entry program at the University of Illinois at Chicago College of Nursing will carry laptop computers and personal digital assistants, or PDAs, into classrooms equipped with wireless Internet access.

For the first time, the portable computers will be required for students in the university’s advanced practice program for students who have degrees in fields besides nursing. Faculty and graduate students say they expect similar requirements for the college’s undergraduate program within a few years.

“I’ll be surprised if a lot of students actually have to buy them,” says Barbara Simmons, RN, PhD, clinical assistant professor and coordinator of the graduate entry program. “I know quite a few who already have them.”

While the health care industry by most accounts is reluctantly moving into a “shotgun wedding” with information technology, student nurses and new graduates are embracing it as they would an old friend. Students are taking notes on laptops, researching diseases on the Internet, and looking up drugs on handheld PDAs. Some nursing schools require computer courses as a prerequisite, others expect incoming students to know how to use word processing programs, make computer presentations, send e-mail, and surf the Internet.

Nurse educators in hospitals say most new grads seem right at home with computer skills, such as charting and pulling up lab results, although they seem a little more intimidated by bedside technology such as IV pumps, monitors, and ventilators. Students and new grads say they are eager for any benefit they can get from technology that will ultimately make their jobs easier and let them spend more time learning to do hands-on patient care.

“For our current students, I think (information technology) is totally second-nature to them,” says Charles Yingling, RN, BSN, a graduate student in the family and occupational health nurse practitioner program at University of Illinois at Chicago College of Nursing.

“This is the group of students who will bring it to the bedside.”

Lagging Behind

The use of information technology in U.S. health care has long lagged behind other industries. Health care institutions acknowledge the benefits of using information technology, particularly for patient convenience and safety, but cite costs, a mishmash of computer systems, and the reluctance of health care workers to use computers in daily work.

More than 90% of an estimated 30 billion health care transactions happen over the phone, by fax, or on paper, according to eHealth Initiative, a nonprofit organization that aims to increase technology adoption. Less than 20% of U.S. primary care physicians use electronic patient medical records, compared with 90% in some European countries, according to a July report in USA Today. Less than 5% of hospitals had a computerized system to order medications in 2001, according to a report in Health Affairs.

But as computer capabilities evolve and new regulations emerge, the situation is poised to change rapidly. In May, President Bush announced a 10-year goal to have electronic medical records for all American patients. David Brailer, the new national health information technology coordinator, announced that the U.S. Department of Health and Human Services would form a technology leadership panel to advance health information technology, especially in rural and underserved areas. While health care hesitated, most universities and community colleges began weaving information technology into their programs years ago. Yingling recalls the uproar when his undergraduate school required all students to have desktop PCs in 1995. Now, he says, it’s almost inconceivable for any student not to have a desktop, and most have laptops with wireless capability. Many instructors now post their course materials online and students who don’t have high-speed computers must spend a lot of time in the school library, he says.

At San Jose State University in California, nursing students are not required to have a computer because the school does not want to put a financial burden on students who can’t afford one, says Christine Hooper, RN, EdD, associate professor in the school of nursing at San Jose State University. But those who don’t have one usually end up buying one before they graduate because they want to work from home rather than from a computer lab, she says. Most of her students hand in their care plans by e-mail. “It’s become almost a given,” she says.

As a result, few new students have problems with the computers, digital pictures, and bar code scanners they encounter when they go to work, clinical educators say.

“Nursing schools prepare them for an IT age,” says Sharon Markowitz, RNC, MS, BSN, education coordinator at Maimonides Medical Center in Brooklyn, NY, a pioneer in health care technology. “Nursing students by far are pretty technologically oriented and they’re usually not computer illiterate.”

Right at Home

Amy Farver, an undergraduate in her second year of the nursing program at the University of Illinois, grew up in a household that adopted the latest computer technology almost as soon as it came out. She felt right at home with the computer charting and order-entry programs she used in her clinicals at the University of Illinois Medical Center at Chicago.
“I really like technology,” she says. “I find it a lot easier to use computer charting than to use paper charting.” Looking up orders on a computer is also easier, she says. “You don’t have to look at someone’s handwriting.” She also appreciates the safety aspects of using computerized cabinets for dispensing medications and supplies. “It’s more secure and accurate as long as you’re careful,” she says, even though it might mean an extra step for a harried nurse. “You kind of have to look at it both ways.”

Students and new grads say having safeguards and quick, up-to-date reference material to back up their decisions makes them feel more confident as they learn the ropes.

“In nursing school, I really used the Internet to look up meds and to write my care plans,” says Merlyn Dorsainvil, RN, who graduated from Phillips Beth Israel School of Nursing in New York in June and is now doing an orientation at Maimonides. “It’s faster than looking things up in a textbook.”

In hospital classes, she uses her PDA to look up drugs and procedures to refresh her memory and support her answers. She prints out information from the Internet or downloads programs into her PDA.

Fellow new-grad Daniela Jean-Francois, RNP, who graduated in May from the Long Island College Hospital School of Nursing, says she quickly adopted the PDA when she started working at Maimonides.

“It’s just wonderful. I love it,” she says. “It has all the diseases. Everything is in there. You just click on a disease and it will tell you everything. I keep it in my pocket because it’s small and convenient.”

PDAs are becoming the must-have item for new nurses and students, say students, new graduates, and faculty members. The pocket-size computers eliminate the need to carry heavy textbooks and drug reference guides through hospital corridors. Simmons says she decided to require them for graduate entry students after seeing how physicians and nurse practitioners used them regularly in their practices, especially to look up medications.

“They have the information at their fingertips when they are looking at patients,” she says. “It’s not, ‘I have to memorize all these facts.’ Rather than thinking you can remember it all, you have to know how to get it.”

Simmons and other instructors say they would like to see more emphasis in nursing school curriculum on how to use information technology in nursing practice. Most students say they taught themselves how to do Internet research or download helpful programs. Farver says none of her instructors suggested she get a PDA to look up medications. “I learned how great it was from other students.”

Many students have not figured out that the technology they use every day could be used in their clinical work, Hooper says. For instance home-health students could use their cell phone cameras to take a picture of a wound to show instructors. Creative faculty could help them make that step, she says.

Changes in Store

Technology is going to be a big part of nursing school curriculum in coming years, whether anyone wants it or not, says Patricia L. Starck, dean of the nursing school at the University of Texas Health Science Center at Houston. “We’re not going to be able to teach without it.”

The UT School of Nursing’s new practice labs have rooms equipped with computers and computerized patient mannequins that talk and respond to student treatments. The students can put in IV lines, read ECG strips, give injections, and use all their senses just as they would with a real patient, Starck says.

A new nursing skills lab at the University of Illinois has an extensive computer lab with a case simulation program that lets students make diagnoses and write up treatment plans, and then scores them on their decisions. At the UCLA School of Nursing, graduate students use a case simulation plan and a PDA journal program that lets them take notes on their patients during clinical rounds that they can study at home.

Lynn Doering, RN, DNSc, FAAN, associate professor and chair of acute care at UCLA, says the master’s program has started to incorporate intelligence technology bit by bit over the years. “It hasn’t been easy for the students or for us,” she says. “Faculty have a hard time with change, too.”

Many students and new grads are less comfortable with bedside and patient care technology than they are with computer technology, says nurse educators. But part of the reason for this is the diversity of equipment from hospital to hospital, unit to unit, or even room to room.

“They’re not really that prepared in school, but I don’t know how that could ever change,” says Gina Brannies, RN, clinical educator for critical care and neuroscience at Memorial Hermann Hospital in Houston. Many bedside technologies, such as ventilators, are very disease specific, with different settings for each situation, she says.

Farver has worked in a hospital where some rooms have older models of Dynamaps, the diagnostic monitors for vital signs. “They were completely different from each other,” she says. “You’d push the button you thought you were supposed to push and the alarms would go off and you’d look like an idiot in front of the patient.”

Students and new grads have similar complaints about hospital record-keeping and order-entry systems. Some hospitals use a paper system, some have different computer systems, some use a combination of paper and computers.

“There isn’t any worldwide system that people are using that can be taught,” Farver says.

Which is why hospitals need to have internships and extended training programs, says Brannies, especially for areas such as critical care and emergency medicine where complex technology and the fast pace can easily overwhelm a new nurse.

With hospitals still poised at the threshold of the computer age, nursing schools can only do so much with information technology, Simmons says. “As long as we develop their thinking skills and show them new ways of accessing information, that’s the best we can do. The rest of it will come with practice.”

For many new grads, their computer skills may be the one thing they feel confident about in a stressful and unfamiliar world.

“I think other things are intimidating,” says Jean-Francois, the new graduate at Maimonides, “but not the computer.”

What’s intimidating for a new nurse, she says, is being on the floor, caring for patients, seeing things she never saw in nursing school, thinking on her feet, and most of all, “knowing you’ll be able to make that quick decision” that could make the difference between life and death. If a computer can help her get to that point, she’s all for it.

Cathryn Domrose is a staff writer. To comment on this story, send e-mail to editorca@nurseweek.com.