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Charting Challenges

Facilities support seasoned nurses through shift to electronic record keeping

Friday June 10, 2011
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Jackie Pichette, RNC, was apprehensive when her employer made the change from using paper charts to a computerized charting system. “I’d been a medical-surgical nurse for 25 years. Not being from a generation that grew up using personal computers, I was afraid I couldn’t keep up,” she said. “I knew this would be a daunting challenge for me, but I was determined to learn.”

In addition to attending computer training classes at the University Medical Center Brackenridge, Austin, Texas, Pichette volunteered to work with a team of IT company and in-house nurse experts to set up Cerner Corp.’s compass charting software.

“This experience helped me to get used to program details and system functions, and I found I was becoming more proficient in knowing more about computer technology and computer systems,” Pichette said. “I was barely computer literate five years ago when the system changed. Today, I’m a proctor who assists others to develop their computer skills.”

The average age of RNs is about 47, according to Katie Brewer, RN, MSN, an American Nurses Association senior policy analyst. The Health Resources and Services Administration in the 2004 National Sample of Registered Nurses, reported 41% of RNs were 51 and older.

“To work in nursing today, you must be computer literate,” said Terri Bernaz, RNC, MS, MA, education and training manager at Overlook Medical Center, Summit, N.J. However, experienced nurses who aren’t computer literate are not at a hiring disadvantage, she said. Hospitals value experience, expertise and patient assessment and people skills. “As long as they’re willing to learn, hospitals will train them to use computers,” she said.

Using a computer is like turning pages in a book because you don’t see everything at once, Bernaz said. “When you’re performing computer charting tasks, you access different screens and follow assigned tasks. There’s a screen for pain management, another for vital signs and a third for I&Os.”

Although the majority of nurses know how to perform computerized charting tasks when assigned to the OR, some nurses require basic information and, in a few situations, an educator may have to begin department training by teaching a nurse how to use the mouse to access Windows.

Many older nurses have doubts about working in a nursing environment filled with technology, said Marivic Castillo, RN, an informatics nurse at Overlook. “Providing them with quick reference guides is helpful, and [it’s] reassuring for them to know computer [help] is only an email or phone call away via our computer support help desk,” she said.

When they reach assigned units, newly hired nurses at Monongalia General Hospital, Morgantown, W.Va., have opportunities to use the hospital-based computer program and its applications under supervision of a preceptor, who builds on skills taught in orientation, said Jim Martin, RN, BSN, clinical educator for the critical care unit.

“Most [computer inexperienced] nurses have a fear of clicking in the wrong place as they work with computerized charts and tend to become frustrated when they attempt to enter information in a format the computer won’t accept,” Martin said. “Rather than modifying information to what the computer accepts, they try to find another place to input the same information.”

Understanding the role of computer icons also can be difficult for nurses used to paper charting, said Stacey Goins, RN, computer information systems clinician at Monongalia. “They’re used to paper charting in a time when icons didn’t exist.”

Charting tasks are more comprehensive and more time-consuming than they used to be, said Jan Boone, RN, BSN, staff educator for Monongalia’s department of medicine. “We do a lot of charting, and our nurses must be able to move back and forth when using electronic medical records.”

Helen Sutton, RN, a Monongalia employee, has been a nurse for 30 years and started her career using paper charts. “Computerized charting wasn’t an issue when I started out, and I had to learn the basics of the electronic process one step at a time,” she said. “Of course, younger nurses in their 20s and 30s are good at computer charting because they grew up using computers. It’s important for older nurses to have a good attitude and be willing to learn from our younger peers.”

Some nurses may have an easier time working with computers if they take a keyboarding course, said Sally Millar, RN, MBA, an informatics specialist at Massachusetts General Hospital in Boston. “Instead of hunting and pecking while trying to locate the right alphabet keys, they could become more efficient, and computerized charting tasks would take them less time to do.”

“What’s needed is more balance in our computer systems,” Millar said. Users get frequent “pop-ups” — charting task reminders — and “hard stops,” when memory and software compatibility errors occur, she says.

In addition to a “Delicate Users” class set up for inexperienced computer users, the University Medical Center Brackenridge provides a one-on-one training format and the extension of class time to accommodate nurses’ learning needs, according to Ruth La Monica, RN, BSN, CMS, nurse manager for the med/surg department. “We’ve also developed a supplemental teaching program called Train Domain,” La Monica said. “The program shows our nurses, inexperienced in computer use, how to navigate through the electronic patient record. They can gain access to it from any in-house computer.”

In addition to other educational opportunities, Ellis Hospital in Schenectady, N.Y., provides computer lab sessions for inexperienced computer users, said Emily Camenga, RN, BSN, an informatics nurse specialist. “Nurses can practice computer skills at the lab during the day, after work or on their days off,” she said. “We encourage these [users] because they’re self-directed learners. Healthcare technology’s developing at such a fast pace it’s important to become a self-reliant computer user.”


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Tips for Becoming Computer Savvy

A positive attitude is vital to the learning process. Don’t tell yourself you’ll never learn how to use a computer.

If you don’t have a personal computer, get one. Even playing games, such as solitaire, will show you how to navigate using a mouse and open and close programs.

Practice sending and receiving emails and photographs. Sign up with a social network, such as Facebook, to get used to clicking on icons and using keystrokes.

Take beginner computer courses at your local library, then learn how to use the Microsoft Word word-processing program and Excel spreadsheet program so you’ll know how to type, sort, send and save data.

In job interviews, don’t say you are uncomfortable using computers. Mention any personal computer use and past professional computer use, and stress that you’re willing to put in the extra time it takes to become proficient.

Your anxiety level will decline when you see an electronic chart is similar to a paper chart. The information input method is different, but the content is the same.

Ask questions. Be prepared to venture out of your comfort zone.