Clear your mind. Now, what thoughts pop up when you hear the word technology? Depending on your age, technology might be a smart phone, laptop computer, handheld electronic gaming device, or MP3 player. Or perhaps your vision includes some older gadgets that by today's standards are considered mundane such as the microwave or battery-powered toothbrush, or totally passe such as the walk-about radio, VHS tape player, or phone answering machine. Consider technology in health care. Technology is used for direct care delivery, such as administering intravenous infusion by smart pumps and turning patients on rotation beds, and for communication and coordination of care including electronic medical records and computerized order entry. Technology in our personal and professional lives is omnipresent and ever expanding. Technology is our past, present, and future.
The term technology is derived from the Greek word technologia-techne, meaning "craft," and logia, meaning the "study of something." Merriam-Webster1 (http://www.merriam-webster.com/dictionary/technology) defines technology as "the practical application of knowledge especially in a particular area." Applied technology in health care facilitates communication among health care clinicians with speed and clarity. Gone are the days of waiting for laboratory values to be delivered to a unit and manually posted in a chart; it takes only minutes to send a text message alert about a critical value, which leads to early intervention, fewer complications, and better outcomes. Smart pumps help ensure administration of life-sustaining medications within very narrow windows of safety. Lateral rotation beds provide safety and quality by both decreasing work-related nurse injuries and improving patient outcomes with sophisticated interventions, such as putting the patient in the prone position or continuously moving. In these and many other ways, technology is a tool for optimizing patient outcomes and facilitating organizational expectations for safety and efficiency.
On the other hand, technology is no panacea. Potential problems associated with technology in nursing and health care include inadequate operator competency, poor match between clinical need and technology design, and system downtime. These problems are often precipitated by inadequate evaluation of technological devices in the actual clinical setting where it will be used, limited nursing input before an organization makes a financial investment in a device or system, and failing to address generational differences in the value of or ability to adapt to technology. As a result, technology can become a barrier leading to increased workload, hazardous workarounds, compromised patient safety, and unsatisfactory working conditions. Consider what happens when an electronic medical record system is down. Nurses must continue keeping records of patient data, administering medications, and noting responses to treatments. When the system returns to functional, each nurse must then transcribe information from handwritten notes, resulting in duplicate work and potential for transcription error. Optimizing the use of technology requires careful attention to selection, evaluation, training, maintenance, and ongoing troubleshooting.
In the most optimal situations, technology remains only a tool, a method to an end. Nurses in clinical practice are responsible for assessing patient outcomes, understanding that technology augments care delivery by providing data or functional support, not professional judgment. What happens when a nurse trusts an intravenous delivery pump completely and fails to assess patient status? Loss of vigilance in professional judgment may result in missing a pump malfunction associated with life-threatening overdosing or underdosing of medication. Even the best technology in the most attentive system can fail. The constant professional judgment of a nurse at the bedside cannot be replaced by technology.
Clinical nurse specialists are in a unique position to consider the impact of technology at the patient/client, nurse/nursing practice, and organization/system level. Clinical nurse specialists embrace technological innovations in patient care and advocate for technology as a tool to increase efficiency, decrease waste, optimize outcomes, and work for rather than against clinicians as they provide care for patients. Be cautious and consider problems and barriers inherent in applied technology. Engage in the selection and evaluation of devices and programs, ask thoughtful questions, consider unintended consequences (positive and negative), and ensure that decisions regarding the purchase, use, and implementation of technology are balanced. Work with the nursing staff to ensure competencies. Be mindful of generational differences in willingness and ability to using technology. Clinical nurse specialists must role model incorporating the performance of technology into professional judgment. Technology becomes a hazard when we surrender our judgment to the blinking lights on a gizmo delivering potent medications.
Technology-is it a friend or foe, or somewhere in the middle? We use technology in our everyday lives, personal and professional, to assist with the acquisition and application of knowledge and accomplishment of tasks. Technologies in health care will only continue to expand, let clinical nurse specialists be on the front line of ensuring its safe, competent use.
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