Wednesday, October 17, 2012

EMR Is Destroying The Nursing Profession

We've all seen this before. You're walking through the wards of the hospital. All around are the beeps of IV pump alarms blaring from the rooms. The call light has been activated from a room where a patient wants some medical attention. Yet all you see are the nurses sitting at their stations, noses pressed up close to the computer screen or down at their keyboards, busily charting their patients for the electronic medical record system.

It has become all too common to see this as nurses are so busy documenting their patients on the computer that they have little time for actual patient care, or even recognition. When we implemented our new EMR a few months ago, it brought a dramatic slowdown in admission of patients into our outpatient surgery center. The electronic implementation of the preop admitting note is so onerous that the nursing manager told the nurses to cut corners, not all of it beneficial to the patient.

The EMR was forcing the nurses to ask their patients many nonessential questions that delayed admissions but had no practical implications for the patient' hospital stay. Questions that had to be answered on the computerized records include: Do you always wear your seatbelt when riding in a car? What religion are you? Do you use contraception when you have sex?

Because all these mundane questions were delaying the start of cases, the nursing manager decreed that some questions don't need to be asked. You know, such trivial stuff like what kind of meds the patient is taking. Some patients were taking fistfuls of medicines every day. All these drugs had to be entered into the EMR individually, along with the dose, the frequency of intake, and the last time the drug was taken. This could easily eat up fifteen to twenty minutes of preop time. Therefore the manager said that was not important for nurses to know. That information was for doctors to get from the patient and should not take up any nursing time.

Another time saver that was cooked up was the disregard for a patient's lab work. The preop nurse was not to waste any effort looking up a patient's labs. That information too was not worthy of a nurse's time. Laboratory work was the responsibility of the surgeon and anesthesiologist to look up and analyze before surgery, not the nurse.

As you can imagine, many of the nurses were appalled by the new rules. They had just been demoted to being computer entry clerks. The job of the preop nurses was no longer to evaluate the patient for appropriateness for surgery. Instead they're supposed to find out if the patient had gone to the bathroom that morning and enter it into the computer. Everything else squandered too much time to be bothered with.

How sad for our nurses and the nursing profession.


  1. All of these questions are being asked when the patient is already in the ward. These questions were already asked long before the computer age, and they were asked in order to evaluate the patient's voiding pattern. These questions however should not be asked in an emergency situation. I believe nurses have enough critical thinking skills to know when to ask such questions. Computer usage is supposed to amplify the documentation process.

  2. And here I thought it would already be a big help. Well, it is in its early phase as of yet, and developing it to be more of a one-stop thing will be a steep addition to the prices, so maybe there could be a compromise there.