The pandemic has rearranged several priorities for nurses and created numerous challenges when it comes to operating in a safe environment. A recent report published by Vocera, the 2021 CNO Report: Protect the Nurse, Protect the Practice, highlights gaps in systems and processes impacting the daily lives of nurses. These gaps include an absence of essential resources, infrastructure, and policies, lack of PPE, staffing, support for mental health, and infection control practices.
Omnia Health Insights spoke to the author of the report, Dr Rhonda Collins, Chief Nursing Officer, Vocera, to understand what can be done to protect nurses and combat these challenges to protect the practice.
Dr Collins shared a recent story she experienced while administering COVD-19 vaccines in her community. She was working with a new nurse who said she was leaving the nursing profession and would never go back to it because of her experience during the COVID-19 crisis. When Dr. Collins asked her why she was leaving the profession so soon, the young nurse explained it was because she felt like she was always on an island and felt alone.
“My conversation with this nurse and so many others in the profession is exactly why this year’s CNO Report focuses on protecting nurses. When nurses are protected, the clinical practice is protected.”
Collins has been a nurse for over 31 years and understands these challenges well. She started her career at the bedside, working for several years in high-risk labour and delivery, primarily taking care of mothers who had pregnancy-related complications. She then moved into hospital leadership and managerial roles as smart technologies piqued her interest.
“I became very interested in technology because I realised that nurses didn’t easily adopt technologies that were put in their hands, and I wanted to help bridge that gap. I became interested in trying to understand why some technologies work well in the clinical environment and others do not. My curiosity and need to keep learning led me to nursing informatics.”
Subsequently, Dr Collins started working with technology companies. She focused on starting at the patient bedside and then working towards designing and implementing new technology. “That's one of the reasons I am at Vocera because I truly believe that we make a difference for the patient and the people who care for them. Our solutions make nurses’ work more logical and easier,” she added.
Dr Rhonda Collins
Flawless communication is the foundation of a hospital system, especially when it comes to segregating a patient population from another population for the safety of everyone.
Dr Collins highlighted: “The pandemic has shown us that the foundation of everything that nurses do relies on good communication. Therefore, we have tried to create a safe environment for them to communicate. Through standardised and strong communication tools, nurses can talk to the people that they need to get supplies from or consult without taking off their PPE. Voice-controlled solutions make sure that they don't even have to hold a phone to their face or touch anything, they can just talk. We have focused on trying to get nurses the tools that they need to be able to do what they do and make a difference in keeping them safe and connected.”
Moreover, nurse leaders have had to face the same challenges as bedside nurses. They are fatigued, worn out and frustrated. The world is also facing a nursing shortage of over 11 million nurses in the next decade. “In conversations with health systems, this topic has often been brought up. They say that while there have always been nursing shortages, they haven’t witnessed something like this before. There have been nurses who went through one round of COVID and then the second and said, “I'm going to retire in a year or two anyway, I'm not doing another round, I'm done.” So, nurses are retiring earlier at an unprecedented rate. We have to look at how do we not only recruit new nurses into the profession but also how do we retain the ones that we have,” she emphasised.
Today, nurse leaders are looking for ways in which they can smooth the workflow and provide the necessary tools and protocols that support and make their work easier. “While investing in technology is essential, nurses need to sit at that table and have conversations to understand how the technology would work in a clinical setting,” she added.
Reducing cognitive burden
Another challenge emphasized by the pandemic has been situations where expert nurses working in a particular theatre have been redeployed to another station in the hospital, which can be quite stressful. They don’t know the names of their colleagues, the numbers of certain disciplines, who is on call or staff assignments. By empowering them with the technology that carries this information for them, they can make this transition and their jobs easier.
For the past two years, Dr Collins has been discussing the topic of cognitive burden – the amount of information that can be stored in short-term memory.
She explained that when people are under a great deal of stress, or when they have to learn new things in their job, their cognitive load or their cognitive burden can get very high. And it's in that space that mistakes are made. Due to the pandemic, additional stress has been added to nurses’ already full plates. Nurses are worried about the safety of their patients, as well as their families and their own safety. Cognitive overload is not a personal failing, it is a systemic one. The blame should not be on an individual for being burnt out or not being able to cope. Instead, the focus and solution should be on improving the work environment that is causing the problem.
“We are helping reduce cognitive load by providing technology to carry information and the burden of memory for nurses and other care team members. It is how we use technology in our daily lives. For example, today, when you drive, you don't have to memorise a new address, you just type into your phone, and the software takes you to your destination. That is the same philosophy we use with our technology. Nurses wouldn’t have to remember when to take vital signs, or when treatments or medications are due, the technology is there to remind them. This enables them to work more fluidly and relieves the mental stress,” she explained.
Tech to the rescue
Collins highlighted, there can be resistance to introduce certain technologies into the patient care environment. But technology is a big part of everyone’s personal lives today and it is proven that it can smooth the workflow and enable hospital systems to manage a larger volume of patients.
“We have been able to reduce turnaround time in the theatre and reduce white noise phone calls between nurses and physicians so that they can speak to one another when it matters and makes a real difference in outcomes for both the people who care for the patients and the patients,” she added.
In conclusion, Dr Collins shared that she is continuing with her research and one of the things she is looking at is getting feedback from nurses on communications, task load and the effect it has on cognitive load.
“Our space programme in the U.S., NASA, has created a Task Load Index to measure the cognitive load of high-intensity tasks. The tool has been used with air traffic controllers and pilots as those are all intense roles, but so is nursing,’ Dr Collins said “I am studying the task workload of nurses and using the tool to measure the cognitive load of communication for nurses in patient care environments.”
Dr Collins is inviting nurses around the globe to participate in the study. The data will remain anonymous. “We can then aggregate this data to understand exactly how communication complicated workflows or burdens nurses during work. I would love to invite anyone reading this article to be a part of this important study in our continued efforts to protect the nurse and protect the profession.”