Using Your Mobile/Smart Phone on the Job

A Nursing Informatician's Perspective

I am a nurse but in my former career I was a computer programmer. I look with my programmer eyes at nursing and observe: nurses need more technology. But not the type of which we already have too much, e.g. EHRs, staffing, messaging, etc. None of those are "nurse-centric." That is, they encumber -- not ease -- nursing workflow. Here is why.

The technology slows us down. It takes us away from our patients. It may be heresy to say this, but in some ways we miss the good ol' days of the paper chart. Remember charting-by-exception? Remember the Kardex? Those were nursing processes/tools that were honed over decades and took a lot less time than today's endless mousing and typing.

Here's another clue: how many of us still carry that sheet of paper we call our "brain" in our scrubs pocket? Admittedly, we couldn't imagine life without the eMAR and bar codes, but still, computers are not always our friends.

So how can we turn the tide and make tech work for us? Enter BYOD (bring your own device).

Many hospitals' policies forbid the use of personal phones on the job. Some provide hospital-owned devices (often ruggedized iPhones). We pick them up from their charging stands in the nurses' station at start of shift and drop them off at the end. Patient data doesn't leave the hospital. This is a good solution; HIPAA is not violated.

But what about hospitals that both ban personal phone use and don't provide their own? MDs would revolt if their phones were taken away. What about nurses?

Another solution is dedicated computers. Many hospitals now have PCs in the patient rooms, or COWS/WOWS (computers-on-wheels/workstations-on-wheels) in the hall. These help but are not ideal. They are a nuisance to drag around. They need to be charged up (but in our haste we often forget to plug them in). Worse yet, they give rise to the infamous "triad": the patient, the nurse, and the computer. It's hard to mouse and type while conversing and maintaining eye contact.

Here is Dr. Bob Wachter's 7-yr-old's drawing of an MD looking at the computer not the patient.

So when we can, we use our own phones... but people think we're just texting our boyfriends. This is one of several misconceptions we must overcome.

Today, my work is building apps for nurses. When asked what I do, I say, "I build medical software." Then I demo a product. Often the response is, "Oh, it's just an app." This is a challenge. We have some education to do.

That phone in your hand is actually a legitimate computer. It's powerful enough to run professional-grade software. What applications do we nurses run on our phones? The days of the brick-heavy drug book tome are gone. Now we look drugs up with our phones. And that's just the beginning.

The idea that "mobile platforms" (phones and tablets) can run only games and simple apps is another common misconception. This is not lost on technology vendors. They are building tools such as Epic's Rover and Haiku.

Perhaps the biggest challenge of EBP (evidence-based practice, to which everybody is paying lip service) is how to make it practical and part of our daily practice. How does the busy nurse look up a protocol or a guideline quickly and accurately? Who has time to do research when call bells need answering, patients await care, the charge is breathing down our neck, and there is already never enough time? In nursing practice today, such research is rarely done, and when it is, it's usually by looking in a binder in the nurses' station. But with our phones, we can do better!

There are many apps for nurses though few are professional grade... so far. That's changing. The mobile-tools revolution is here. Let's educate our colleagues, management and patients to embrace it!

Dan Keller RN MS © 2019

Updated Tuesday, 15-Oct-2019 16:24:28 MDT

Dan's Health Policy and Healthcare Technology Site