New technology needs to work for nurses

As chief nursing information officer at a hospital trust, Helen Goodman ensures digital systems and devices make life easier for nurses, not harder 

As chief nursing information officer at a hospital trust, Helen Goodman ensures digital systems and devices make life easier for nurses, not harder

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The roles of chief nursing information officer (CNIO) and chief clinical information officer (CCIO) are appearing in an increasing number of trusts – but some nurses are asking what the post-holders actually do. Is this just another layer of management?

My role as CNIO bridges the worlds of information technology (IT) and nursing. I aim to help nursing colleagues with the challenges that technology brings. I am also here to help them find ways that electronic or digital systems can remove repetitive, manual tasks, releasing time and providing rich sources of data for use in business cases, audits or research. 

Going digital

The Wachter review, a report from the National Advisory Group on Health Information Technology in England in 2016, challenged the health service to ensure it uses technology wisely. But it also argued that the NHS cannot afford to remain largely non-digital.

However, for a ward manager, finding time to research the most appropriate solution, or engage with the integration team to ensure a system upgrade meets your needs, can be time consuming.  This is where having a nursing lead to speak up for clinical staff in technical discussions can prove invaluable.  

NHS England has recognised the need to ensure that clinicians in these posts are trained for the role and has launched the NHS Digital Academy.

The rise in the numbers of CNIO and CCIO roles across the country has also led to the formation of our own summer school organised by DigitalHealth. 

I hope in my role I am able to bring practical knowledge to the technology discussion, liaise between clinical and technical arenas, and help nurses by opening their minds to the potential of health technology.

What does a CNIO do?

There is no generic job description for the CNIO role so different organisations may interpret the specific responsibilities differently, but I sit within the digital technology and information division senior management team, and report to the director of nursing and quality.  

My main responsibilities cover the following areas: 

Strategic planning
If a system such as a new electronic patient record is needed I want to make sure that it works for all nursing teams, whether ward or clinic-based. Or if I receive a specific request from one area wanting new devices for their clinical area, I want to make sure they benefit from the experience of their clinical and IT colleagues who have introduced systems in other areas, so we do not all make the same mistakes. 

A batch of iPads might seem a great idea until the team realises that the system they want to use it with is not compatible or will require a system upgrade. Strategic thinking can help teams think more broadly than solving an immediate local problem. Instead, they can plan for the future and find a solution that can bring benefits across their organisation.

I feel strongly that I should represent the nursing staff in our organisation to ensure they are given:

  • Suitable products, software and hardware. 
  • Sound infrastructure so that devices and applications are supported by good wi-fi/connectivity and a technical support team.
  • Sufficient education so staff feel competent and confident to use the systems.

Acting as adviser/liaison
Another important component of my role is to help nurses and IT colleagues understand each other’s worlds. IT staff tend to be based at a PC for most of their day and, with remote access, do not often need to physically go to a ward to fix computer problems. Nurses by nature are active people. They are on their feet most of the day and need their interactions with technology to be quick and intuitive. If there is a problem, the two groups need a common language and way of working out the issue. To improve understanding I have encouraged floor walking or shadowing by IT helpdesk colleagues in clinical areas. 

Engagement of nursing staff 
To help nurses better understand and be involved in discussions about technology, I have tried to provide resources for nursing teams to improve their understanding. I have set up a CNIO intranet site with links to IT training, quick reference guides and an IT helpdesk portal.

‘Patients have their Fitbits so why do we still have huge devices for monitoring them when they are in hospital?’ 

I also write a regular newsletter for nursing colleagues to answer common queries, update them on the latest technical developments, publicise local e-health conferences and demonstrations, and showcase where IT and nursing are working well together.  

I distribute this via an electronic mailing system but also produce a version for printing out for the coffee room. I keep news items brief and easy to digest, with sections such as ‘You said/ we did’, ‘Did you know…?’ and ‘Tip of the month’. I want to be able to demystify the technology we use, especially the newer systems.

Clinical practice knowledge
I like to maintain a presence in the clinical area by working ward shifts, as well as attending nursing team meetings. I sit on a variety of committees to represent nursing and these can be as varied as information governance, clinical data and analytics, or project boards for new equipment or systems.  

Nursing IT strategy
Often nursing staff can feel they are given technology to get on with rather than being involved in the decisions that led to it being deployed. To represent the nursing workforce it is important to understand what they want their CNIO to aim for. When I started in the role I surveyed all senior nurses for the views of their staff and wrote an IT strategy for nurses. The vision statement produced as a result highlighted the potential of digital technology while keeping nurses at the bedside or supporting patients in their homes.

As well as ensuring nursing staff feel more enabled to use the systems already in place, it is great to be able to inspire them about potential future developments. Some staff have done great work already and it is good to provide a forum to share this with colleagues. Others will have ideas or issues that they think technology could solve but are not sure where to go or what might be ‘out there’.  

A meeting place or ‘innovation hub’ can create space to share ideas. I have set up an informal ‘lunch and learn’ space with time to eat while someone presents work they have undertaken. Others bring ideas they would like help to develop. The rest of the group can then give suggestions and guide them to next steps.   

Cultural issues highlighted by a recent white paper produced by DigitalHealth illustrate the need to promote the benefits while removing the fear and suspicion around technology. I hope the innovation hub can promote fresh thinking, while the newsletter and other ways of engagement can dispel some of the fears.

Business case
The CNIO can also lead or contribute to business cases for new technology with the aim of ensuring the product helps the flow of patient care rather than holding it up. 

However, alongside the business case the organisation needs to address the culture into which it is introducing the technology, and the CNIO is well placed to judge this. CNIOs have a depth of knowledge of clinical systems and can help their colleagues see how work could be done better and how technology can support it. 

Chief nursing information officer
Helen Goodman bridges the worlds 
of IT and nursing

When replacing equipment, we need to have intelligent forward thinking rather than simply replacing devices like-for-like. Mobile phone technology improves all the time so if a wearable device is going to capture observations more comfortably and effectively than a traditional blood pressure machine, perhaps there is an opportunity to invest in the future. 

Patients have their Fitbits so why do we still have huge devices for monitoring them when they are in hospital? I have set up site visits and demonstrations so that colleagues can see beyond what we use now and help staff to think differently.

Developing tech

I have seen technology develop around me rather than having grown up with it. I have seen nurses’ attitudes and abilities change. Once the initial teething problems are resolved and staff receive sufficient training, they begin to see the benefits. 

But I am also aware of frustrations in the clinical area when it takes three times as long as the manual process to use an electronic system to check blood sugar. The result may then be auditable and automatically uploaded to the electronic patient record, but it has taken an age to get there. 

Yet there are huge advantages in e-observation, electronic patient handover systems and the wearable devices coming onto the market, and I have a network of other CNIOs to discuss these with.  

Shaping the future

I expect my successors will have more IT knowledge, health informatics qualifications and more development skills than I do. Nursing is developing roles alongside advances in technology. If we keep up we can be effective in informing future developments so we will have usable, reliable technology that keeps us with the patient, either remotely via a telemonitor or at the bedside.

But to get there we need to engage so that we have systems that work for us rather than us having to fit around the technology. Earlier this year the RCN led a consultation to discover the challenges faced by nurses in adapting to digital technologies and the opportunities to improve patient care. With more initiatives like this, and nurses willing to take part in them, we can shape how technology affects our working lives and unlock the benefits for those in our care. 

Further information

Helen Goodman is chief nursing information officer and service manager at Royal Brompton & Harefield NHS Foundation Trust in London 

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