While the shift towards digital and data-driven record keeping is an undoubted positive, according to a graduate nurse coordinator in Melbourne Western Suburbs, a historical appreciation of changes in workplace procedure can also help graduates understand the need to continually improve standards of patient care.
Robyn Peel, who is Western Health’s Education Site Manager (Footscray and Williamstown Hospitals) and Transition to Practice Coordinator, first started as a student nurse at Prince Henry’s Hospital in 1983 and admits that the scope of process change can often be difficult to perceive, even when you are highly experienced.
“You don’t really realise it until you sit back and think, ‘Wow, look what we’re doing now compared to what we did when I first started; there’s huge differences and huge improvements,” she says.
When EMR (Electronic Medical Records) were introduced at Robyn’s workplace at Austin Health as a pilot early in her career, it took a bit of getting used to.
“That was a big change to get used to not having patient notes at the end of the bed and having things on a computer… Just that whole workflow change of doing that was different.”
Robyn says the pilot help set in place a system that allows nurses to proactively refer to any documents, policies and procedures that they need while working with a patient. But to ensure the system functioned effectively, educators played a crucial role in ensuring experienced staff were able to transition to a new way of working.
“It was all done face to face. Some of the best training you get is… when educators are on the wards, they’re up there, and showing nurses exactly how to do something when they need to do it,” she explains.
While nurses had to adapt to new ways of working, those weren’t the only shifts that Robyn witnessed.
Policy documents have gone from pages in booklets and files gathering dust on shelves to regularly updated documents on a digital database, and where nurses once “did it all” in Robyn’s words, ward clerks and other administrative staff have become crucial to the record-keeping and patient management.
“Everything was on paper, and then if you wanted to pull a history, you had to go down to Medical Records and physically get it,” she says of the time.
While EMRs have made things easier, the demands on nurses have also shifted.
“We didn’t have as much paper work and as much documentation to do as we do now,” she says, observing that nurses are required to record and review much more complex information in today’s hospital system.
An example Robyn says that epitomises this shift is the handling of nurse care plans.
Whereas once they were a single page with a list of tasks and observations that nurses would tick off, with the plan only altered if the patient’s condition changed.
However, using the EMR, daily care plans and risk assessments can now be re-evaluated and revised more frequently, allowing a more immediate response to the patient’s needs.
“We’re far more individualised in the care we deliver to our patients,” she says in summary.
Robyn says today’s new crop of nurses would benefit greatly by understanding the changing practices in their area of work, so they know how new technologies and processes shift and reinforce the types of knowledge that nurses draw upon.
“As time’s gone on, we’ve gathered much more evidence as to how to practice best, we’ve gathered much more evidence on the records we need to keep [and] the sort of data we want to investigate,” she explains.
“But it’s important to know where we come from. It wasn’t always this way, and it’s been a continual journey of changing and improving patient care.
“As these young nurses start their careers, they’ll be part of a journey that involves constant change as well, because that’s the only way we improve the care we give to our patients.”