Nurses and electronic communication

Welcome to the world of electronic communication! You may already be deeply immersed in this world or it may be new to you. This chapter invites you to consider ways in which nursing and healthcare delivery is and will be changed by electronic communication. As you read, reflect on how you can continue to grow and stretch as the limits of our imagination are tested in this new world.

The nursing profession has changed. Nurses today are on the move. Keeping in touch requires a strategy different from that used by previous generations of nurses. Some of you may be reading this text through an electronic tool. You may be taking an online class. Nursing course delivery is changing.

If the way information is being received has changed, so has the way information is transmitted. According to a report by the Pew Internet and American Life Project (Rainie, 2009), communication in the United States is changing among people at all income levels and ages, with 73% of the American population now using the Internet or e-mail. Further research by the same organization has shown that 59% of those adults are accessing the Internet wirelessly (Smith, 2010).

With this rapid increase in mobile communication access, it is important for nurses to add an electronic communication skills set to their repertoire. The ability to type and computer literacy are necessary skills for busy nurses today (Cronenwett et al, 2007). Delaney (as cited by J. Karnas; Delaney, 2007) also agrees: “Informatics competencies are required for all nurses, whether generalists or specialists, to function in the 21st century.”

In fact, socialization into nursing has a new context, with the focus today being on “building nursing intellectual capital” (Simpson, 2007). Simpson states that the changing healthcare environment “will demand nurses for whom technology use is as inherent as critical thinking.” The National League of Nurses (NLN) agrees. One of their position statements recommends “preparing . . . nurses to practice in a technology-rich environment” (NLN, 2008).

According to the Quality and Safety Education for Nurses (QSEN) Initiative, informatics skills are vital for future nurses (QSEN, 2010a). As such, QSEN calls nursing informatics one of the six pillars of safe and effective nursing care, recognizing this competency as one of the required Knowledge, Skills, and Attitudes (KSAs) needed to promote patient safety. According to their definition, nurses should be able to “Use information and technology to communicate, manage knowledge, mitigate error, and support decision making” (QSEN, 2010b). It is recommended that these KSAs be part of simulations during nursing school to allow the student to begin to practice these core competencies needed by the nursing profession; as a result, they have found their way into the core curriculums of many universities and colleges. According to QSEN, registered nurses (RNs) are now required to be knowledge workers, system thinkers, and complex adaptive system managers, all of which require excellent communication skills in the midst of such a dynamic, interactive, and ever-changing practice.

Referring to the TIGER initiative recommendations (Technology Informatics Guiding Education Reform, 2007): “All nurses in every role must be prepared to make HIT [healthcare information technology] the stethoscope of the 21st century” (Westra and Delaney, 2008). Westra and Delaney also emphasized computer skills, informatics knowledge, and informatics as a skills triad needed by every nurse, from the bedside nurse to the chief executive nurse. Also recognizing this need, the Agency for Healthcare Research and Quality (AHRQ) has created several toolkits for healthcare IT, to facilitate the process of assisting all healthcare providers to become competent in healthcare IT (AHRQ, 2010).

Because of the challenges within the electronic side of healthcare in the past few decades, a new professional role has arisen: the nurse informatician. According to the American Nurses Association Nursing Informatics: Scope & Standards of Practice, nursing informatics is defined as “a specialty that integrates nursing science, computer science, and information science to manage and communicate data, knowledge, and wisdom in nursing practice” (American Nurses Association, 2008). As a nurse with education and experience on both the clinical side of nursing and IT, the nursing informatician focuses on the nurse workflow from the end-user point of view. Rather than having the nurse adjust his or her workflow to meet the electronic guidelines, this role works to have technology meet the nurse’s current workflow. According to Simpson, a pioneer among nursing informaticians, “information technology can transform nursing tasks into nursing knowledge” (Simpson, 2007). The world of electronic communication within healthcare has changed forever.

Computer technology and learning

According to an Australian study, being computer savvy with social networking and communication, however, does not necessarily translate into a desire to learn electronically (Curran, 2008). Even members of the Net Generation, who have been called Digital Natives by some, were found to prefer less electronic communication when it applied to learning and more hands-on and traditional face-to-face sessions (Gregor et al, 2008). Bennett and colleagues (2008) also reported on the same phenomenon. From the preliminary research, even the most computer literate students appreciate variety in the teaching methods of online classes, a hybrid blend of online and face-time, for learning electronically is not the same as socializing electronically.

Web 2.0-social media

Living in an interconnected world, the fastest mode of communication is often the preferred method. As fast as e-mail is compared with postal mail, the new social networking environment has created even faster ways to communicate. Texting outperforms e-mail as a fast way to send quick, time-sensitive material. With text messages, the participants often type in shortened versions of normal words. In fact, text messages have developed a language all their own called the SMS language, with abbreviations and representations of particular words with certain patterns. (Most often, texting language omits the vowels from most words to shorten them.) However, as efficient as text messages can be in communicating, they are not always the most effective means in a professional or educational setting. (For example, during clinical rotations a student wanting assistance with a procedure may relate this to their faculty via a text. However, because texts normally do not include the sender’s name, the faculty still would not know either the student’s identity or location.)

Another social phenomenon, tweeting (done at the Twitter website), has arisen that is even faster than texting when communicating with multiple people at the same time. When tweeting, the participant can electronically share even the smallest of details of their daily life with their friends in seconds. In fact, one speaker at an informatics conference referred to this new type of experience as living on “Twitter Time” (Novak, 2010). In the professional world, many companies and innovative hospitals have instituted an internal professional social network called Yammer. Similar to tweeting, yamming is an online program that allows participants to share specific details of current work projects, and so on. Yammer, unlike Twitter, is a closed social networking site; participants who work at that particular company with a company work e-mail address can join in the conversations. In-hospital social networking sites such as Yammer have just crossed the million participant marker (Yammer, 2010). Employees post about projects in which they are involved, offer advice and shortcuts, or discuss the latest equipment relevant to their profession. This form of intranet communication is very applicable to the healthcare environment as a place to share lessons learned. Whether texting, tweeting, or yamming, all of these can be delivered and used through a smartphone.

Another effective company-based electronic communication tool is Microsoft SharePoint. In many ways, it is similar to a discussion board for an online college course, only with increased capabilities. At SharePoint sites, employees can post documents, pictures, and so on, for their department. Others in the department can access the documents, make changes, and then repost. It is a wonderful way to communicate and share projects among several people in a department as well as to keep one project calendar for the department. Because nurses often work in a shared-governance type of atmosphere, such sites are very useful for their profession.