Multitasking in Nursing and Health IT Systems

Nurses are known to be adept at multitasking. Well-designed Health IT systems can help nurses fulfill their tasks with better efficiency.  Common, fundamental responsibilities of a registered nurse in an outpatient or inpatient facility include managing medication administration through various routes such as intravenous and oral methods, while carefully observing and monitoring patient conditions. They maintain detailed notes about patients’ health using medical coding systems like SNOMED, ICD-10, NANDA, and MEDCIN (Chute, 1997) to document medical conditions accurately. Effective communication with physicians and patients is essential, alongside managing pharmacy and inventory logistics, including the administration, return, or disposal of medications as required. Additionally, they provide immunizations, make minor decisions regarding laboratory tests and place orders in the absence of a clinician, counsel patients during prenatal consultations, educate them about general health matters, and assist clinicians during surgeries, labour, and delivery.

There are many more that can be added to the list, but the primary function remains patient safety and improving quality of life. Moreover, nurses often spend most of their time in clinical documentation on Health IT systems, which includes recording vital signs, adverse reactions to medications, and many more clinical notes. Ultimately, there is comparatively less time spent on actual patient care. One may want to question whether such multitasking is safe during a busy shift. After all, even minor negligence may put a patient’s life in jeopardy.

The answer to this may be that the nurse should organize and manage tasks based on priority. Proper management of tasks in turn leads to improved quality of treatment. A significant amount of time is also saved so nurses can focus on other administrative tasks. Can this be achieved by a nurse? Certainly, user-friendly Health IT systems can help smoothly deliver quality care whilst going paperless – having enough time to concentrate on patient treatment.

The impact of Health IT systems in nursing is further evidence of the need for digitization in healthcare. Nurses leverage technology in various ways, including recording medication history at the bedside and documenting patient demographics and clinical history. They also utilize technology for remote patient monitoring as part of telenursing (Aspas Sebastià and Navarro Martínez, 2024), enhancing care accessibility and efficiency. Additionally, nurses handle administrative tasks such as quality assurance and scheduling appointments for diagnostic tests, while also performing literature searches and reviews to support research initiatives and evidence-based practice.

Well-designed health-technology products also assist the nurse in monitoring errors during patient treatment. Hence, nurses can play an active role in the implementation of health information technologies like EHRs, EMRs, EPRs, smartphones, medical apps, etc., and contribute effectively to clinical practice.

When nurses are expected to take advantage of such solutions, it becomes pivotal for those systems to be usable by them. To prove the usability of Health IT systems, nurses must develop the necessary skills to handle, analyse, interpret, and disseminate health information using such systems. To encourage the usage of digital healthcare solutions, it is important to involve this major user group (nurses) during the analysis, design, development, and implementation phases of the product. This will help in designing a system that contains features any nurse would expect to have to perform daily tasks with ease and provide quality care.

Core Responsibilities of Nurses in Clinical Settings

 If we were to categorize the responsibilities of a nurse into three possible segments (care coordination, digital documentation, and organizational responsibilities), the characteristics of a Health IT solution that nurses will expect to have for performing their duties with ease can be listed accordingly – as shown below:

Care coordination

Everyday activities are mostly focused in the medication administration module of a system. The features of this module should be such that a nurse can:

• Viewing and Managing Physician Orders: These can be normal medication orders such as tablets, syrups, sliding-scale regimens, etc.; intravenous fluids, e.g., those about orders for chemotherapy; any items like syringes or gloves for the patient; and any TPN (total parenteral nutrition) orders. Most CPOE systems (Raban et al., 2024) have the provision to prescribe normal Rx. However, features to prescribe complicated orders like sliding-scale regimens and IV fluids in fractions are important too.

• Medication Administration and Inventory Tracking: When patients bring their own medicine, there should be a provision to enter information regarding the same. For example, consider a patient with a history of hypertension being treated in the emergency room due to symptoms diagnosed as cardiac arrest. The physician treats the patient immediately. Knowing the patient has a history of hypertension, the nurse requests for details of the medication that the patient usually takes. The patient hands over a strip of medication that they are supposed to take; the nurse administers the same at the scheduled time and enters the details in the EHR for that patient. In this case the Medication Administration Record (MAR) systems should provide the ability to capture information regarding the medications that the patient brings from home. Every MAR should have the provision to capture inventory details like batch number, expiration date, and so on.

Return the medication to the pharmacy via a medication-administration module, with a reason that can be entered and witnessed by the assistant nurse in case of damaged or expired medications. Almost every Health IT system should have the provision to capture details of the returned medication. The ensuing workflow, like updating the inventory or capturing the reason or signature of the witness, is also crucial to be implemented.

• Allergy details and drug-drug interactions the nurse should be able to enter the allergy or any significant drug-to-drug interactions for the patients based on their medication history and be able to place an order, and amend any prescription upon the consent or authorization (with the help of an authorization screen) from the physician. This holds for discontinuing and cancelling an order as well and is well-implemented in most systems.

Know if the patient needs to be administered a scheduled drug, with a provision for a witness screen that signifies that this controlled or scheduled drug was administered in the presence of witnesses. Most Health IT systems, even if designed efficiently, may not be able to evaluate whether it’s properly and ethically used. For example, despite having to provide a unique username and password to capture the signature of the witness/nurse, there may be scenarios wherein the nurse may ask a colleague to sign on his or her behalf by providing his or her password. The colleague may not even be aware of the reason for signing and may just blindly sign.

Be aware of drug interactions while placing orders via drug-interaction apps integrated into the system. This is the most crucial feature required in Health IT solutions.

Know that the right dose is being administrated to the right patient at the right time through the right route. This kind of barcode system should be designed well.

Have a view of all the patient details (i.e., diagnosis, vital signs, and allergy information) is important and should be well-designed in Health IT systems.

Have relevant alerts (in the case of any drug to be administered or ordered from the pharmacy) as an integral part of the module. This includes alerts when the nurse is directly placing an inventory order and the medicine is out of stock. The feature to display alerts is implemented. However, if it is poorly designed the user may not be able to understand the purpose of the alert, or miss significant alerts.

Besides orders, alerts in MAR systems may be used in the following situations:

• When the nurse forgets/or has yet to administer a given dose of medication within the scheduled time. The system in this case can display an alert or message a few minutes prior – indicating that the medication (along with dose and preconditions like before food or after food) is yet to be administered.
• The system can throw an alert to indicate that the patient has to be moved or discharged prior to a specified time. For example, assume that the patient has to be moved from a deluxe room to a standard room at 6 p.m. An alert at 5:45 p.m. can be displayed informing the nurse.

Consider the following scenarios:

Scenario (1): An alert when the nurse administers a medication that the patient is allergic to.

Here, the nurse first administers the medicine and then enters it in the system. The system then displays an alert to the nurse and the clinician in-charge to indicate an emergency situation if the allergy condition is not alleviated.

Scenario (2): An alert before the nurse administers a medication that the patient is allergic to.

Here, the nurse first enters the details of the medicine in the system before administering that medicine. The health IT system in this case displays an alert to the nurse, indicating that the patient is allergic to the medicine, and the nurse is informed that this drug is not to be administered. Thus, the nurse refrains from giving the medication to the patient.

In scenario (1), the nurse first administers and then enters it in the system. In scenario (2), the nurse logs in the details of the medicine and, upon cross-verifying, might safely administer the medicine anyway. Here, the appropriate manual intervention at the appropriate time will decide whether the alert is useful or not.

The point to be argued is that one may not have control over what the nurse decides to do. Would the nurse first administer the medicine or enter the details in the system? Is an alert in any way beneficial to the nurse here? Or will proper training help the nurse make informed decisions that make the alert beneficial?

 Digital documentation

• Vital Signs and Daily Notes – Templates for recording vital signs can be made available in a module that could save time and energy. The ability to enter notes and a to-do list each day can be provided. A provision to have templates for various consent forms that nurses can keep records of is a good feature to consider.

• Secure Logins and Data Protection – Health IT systems should be designed such that they are password-protected, and nurses can safely log in at any time without fear of data breach. For example, consider a scenario where a nurse logs in with their username and password and enters the medical records of a patient. They log off the system to take a break. When they log in again, the system should ideally display the recently accessed page. However, if the system displays the homepage or does not provide the option to save the data before logging off, it will result in loss of data and reduced productivity due to poor design.
• Image accessibility: A provision to view and attach radiology images is important, and so is the resolution of the image displayed to allow the user to view the images clearly on any device be it a smartphone, tablet, or desktop.

• Standardized Medical Coding Systems – A provision for the system to support standardized medical coding languages or terminologies (De Groot et al., 2020) such as SNOMED, NANDA, and so on will help the nurse to enter records in the system based on standardized language systems that are used in practice settings and can be communicated uniformly across health facilities. Even though the feature is well-implemented with good the users should be properly trained to understand the features. Many times, due to a lack of training in understanding the usage of standardized medical nomenclatures, nurses are not able to associate the codes with the diagnosis, which leads to medical error. Hence, though this feature is implemented well with a sophisticated design, the design may not be easy to understand.

Digital solutions should be such that the nurses can safely share confidential patient information with clinicians and other senior nurse practitioners.

Organizational responsibilities

• Access Privilege – A proper admin panel within the system where role-based (nurse practitioner, assistant nurse, and so on) access privileges can be assigned will ensure accessibility of sensitive information strictly to the relevant personnel with the valid access rights to either write, edit, view, or delete. Designing highly intuitive and diligent access privilege modules is quite essential in care.

• Task Outline – The home page of a portal for nurses could have the details of the ward and the number of patients they are to attend daily, let’s assume on that list there are 10 patients, and out of the 10 there are two emergency cases. The homepage display could then help the nurse give priority to the emergency cases and deal with the rest later.  Likewise, the task outlier on the homepage could display the number of OPD (Out-Patient-Department) doctors that they have to assist (in case of prenatal consultations for OPD). Other than the routine tasks, there can be links to other informational sites for study purposes. Such features in systems used by nurses should be considered task-friendly features to ease the burden and prioritise tasks.

The Importance of Training and System Usability for Nurses

A well-designed prescribing tool can benefit nursing practices, to promote the Five Rights of Medication Administration (Mula, 2019) – right medicine, right dose, right route, right patient, and the right time. The nurses can focus on the administration part by monitoring adverse reactions and continuing to assess patients.

An online forum where nurses can discuss the impact of technology on their duties and raise issues about nursing practices and technology safety can encourage them to use health IT solutions more effectively. Imparting proper hands-on training and discussing the potential benefits that can be derived from a digital healthcare setting may help nurses come out of their shells and explore the technology. Many nurses already take the challenge and explore ways to benefit from such systems. There are yet many who fear technology, perhaps due to the lack of knowledge of such systems or the poor design.

In conclusion, nurses play a critical role when it comes to the implementation of any healthcare IT software. It is thus pivotal to actively involve nurses in the implementation of technology, from requirements and design through to the implementation phases. This will help identify any loopholes in the systems.

To actively involve nurses, the leadership team of a healthcare facility must identify the needs of nurses concerning digital technologies and make them actively participate during the design and implementation phases. Systems designed, developed, and implemented with nurses as key active users can help in developing efficient technologies that can deliver quality care to patients. Understanding WHY nurses embrace or resist technologies is an important consideration when implementing such systems.

Positive Psychology in Nursing and Health IT Systems

The principles of positive psychology can positively impact nursing multitasking and effective use of Health IT systems by building resilience, focus, and a sense of purpose. Positive psychology focuses on strengths, well-being, and meaning to help nurses manoeuvre through the complexities of their role.   Approaches like mindfulness and gratitude mitigate stress during intense shifts, enhancing decision-making and attention. Recognizing the meaningful impact of their care can create greater engagement and job satisfaction that will encourage nurses to proactively make use of Health IT systems. The integration of these principles would mean that technology teams design intuitive, human-centered solutions focused on minimizing cognitive load and stress. In turn, features like automated workflows and distraction-free interfaces can allow nurses to focus on meaningful patient care. Through the use of the PERMA model, systems can include gratitude notifications to celebrate milestones; flow-supportive designs to enable interrupted less often; and tools within the system that emphasize the purpose of nurses’ contributions through dashboards about patient progress. Real-time collaboration features can strengthen relationships among teams, while gamified acknowledgments of achievements raise morale. This approach to design and testing in collaboration with nurses ensures that such systems also meet their needs, making technology a catalysing agent for well-being, engagement, and improvement in clinical outcomes.

References

1. Aspas Sebastià, N., Navarro Martínez, O., 2024. Telenursing as a tool in emergencies and disasters: A systematic review. Int. Emerg. Nurs. 75, 101478. https://doi.org/10.1016/j.ienj.2024.101478
2. Chute, C.G., 1997. Medcin: A New Nomenclature for Clinical Medicine. Springer New York, New York, NY.
3. De Groot, K., De Veer, A.J.E., Paans, W., Francke, A.L., 2020. Use of electronic health records and standardized terminologies: A nationwide survey of nursing staff experiences. Int. J. Nurs. Stud. 104, 103523. https://doi.org/10.1016/j.ijnurstu.2020.103523
4. Mula, C., 2019. The examination of nurses’ adherence to the ‘five rights’ of antibiotic administration and factors influencing their practices: a mixed methods case study at a tertiary hospital, Malawi. Malawi Med. J. 31, 126. https://doi.org/10.4314/mmj.v31i2.4
5. Raban, M.Z., Merchant, A., Fitzpatrick, E., Baysari, M.T., Li, L., Gates, P., Westbrook, J.I., 2024. Understanding prescribing errors for system optimisation: the technology-related error mechanism classification. BMJ Health Care Inform. 31, e100974. https://doi.org/10.1136/bmjhci-2023-100974