The Effects Of Electronic Medical Records On Patient Care And Our Expertise

Hospital administrators and insurance providers promote electronic medical records (EMRs) as a magic bullet for healthcare. EMRs save money and advance quality care, so they say. But the truth is much more complicated than the propaganda.

Just ask a nurse.

Linette Davis, from National Nurses United’s Institute for Health and Socio-Economic Policy, presented a detailed analysis of EMRs at our convention. The fact is: electronic medical records eat away at nursing practice and personalized, quality care.

Attack on nursing skill

Nurses, like all professionals, develop their skills over years of practice. But skill isn’t just about time spent on the job or in class. It’s about judgment and the ability to cope with the unexpected. If there’s one thing nurses learn quickly, it’s to expect the unexpected. No matter how common an illness, every patient is different.

EMRs fundamentally undermine nursing skill. They require nurses mechanically to follow menus as they check boxes to answer questions and move from screen to screen. Important information can easily get lost in long lists of irrelevant information. And a nurses’ insight into a patient’s condition, and the patient’s development over time, can have no place in a system that severely limits narrative charting.

Nursing skill develops in stages. A novice has no clinical knowledge to draw upon and follows procedures as learned in class. The competent nurse has extensive clinical experience and prioritizes based on consciously formulated long-term goals.

The expert’s skill is measured in his or her ability to exercise judgment, to see beyond routine issues and responses and act on the basis of a patient’s particular circumstances. Hospital administrators promote EMRs as a way to standardize work processes under the pretense that standardizing means raising quality standards. That’s not true, though. Standardizing really means making work processes uniform so that all nurses perform them in the same way. Routinizing nursing practice and following prescribed rules, as EMRs require, doesn’t promote skill development beyond competence to the level of expert.

But patients deserve expert nursing, care from those who recognize the particular, individual needs of a patient and meet those needs. Expert nurses aren’t bound by rules, pre-determined routines, and so-called “best practices.” They assess the unique needs of a patient and provide care accordingly. The truth is that the primary purpose behind the notion of best practices is controlling nurses and putting efficiency over care. To hospital administrators, the competent nurse, not the expert, is ideal.

Management control

Routinized care turns nursing into something of an assembly line. It requires nurses to turn off their good judgment, thereby deskilling the profession. In theory, IT systems are tools that help caregivers deliver quality care. In practice, they’re instruments that help hospital administrators put management control over nursing practice and expertise and profit before patient care.

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