Nurses and engineers are remarkably similar. Both are trained problem solvers and both rely on innovation to find solutions. Nurses, who use more devices and deliver more services than other health care professionals, routinely improvise workarounds to address everyday problems in health care delivery. However, unlike engineers, they are rarely empowered to innovate new products and don't always see themselves as having the ability, support, or power to lead. Most engineers, while tasked with innovation, are unfamiliar with health care at the operational level.

But what possibilities exist when engineers partner with nurses in real time to tackle everyday health care challenges-with each discipline bringing forth its own perspective and expertise?

REAL-WORLD EXAMPLE

Some of the most promising solutions to today's pressing health care issues can best be addressed in the clinical environment through a nurse-engineer partnership. Consider, for example, the COVID-19 pandemic. To respond to the complex needs of critically ill patients with SARS-CoV-2 while conserving personal protective equipment (PPE) and reducing their own risk of exposure, clinicians across the United States adopted the practice of moving medical devices-most commonly IV infusion pumps-away from the bedside and into the anterooms or hallways outside of patient rooms.1

However, while the use of extension tubing to allow the placement of IV pumps outside rooms may facilitate patient care, the alteration of the intended mode of operation of a medical device presents safety implications for both patients and clinicians-in this case an increased likelihood of IV medication administration error. This does not necessarily mean that the practice should not be adopted, but it does require that all members of the health care team be aware of the safety risks.1-3

Now contemplate an alternative scenario: if engineers had been present in real time to collaborate with the nursing staff on this workaround, clean room technology would have emerged as another possible solution. Clean room technology involves isolating a pathway within the room with a clear, sterile barrier to create safe access to the patient, the IV pump, and other bedside equipment. The nurse-engineer collaboration, which would have prioritized safety and clinical workflow while optimizing resources, could have resolved the problem in real time, within the existing environmental constraints, and with fewer associated IV medication administration safety risks.

SUPPORTING NURSE-ENGINEER PARTNERSHIPS

Despite their potential benefits, nurse-engineer collaborations face multiple barriers. Below are some examples, along with suggested solutions.

Nurses' self-perception. Many nurses don't perceive themselves as having the ability, support, or power to be innovative in the clinical setting. Although nurses use workarounds every day in their clinical practice, they rarely consider these ideas as raw material for innovation and wider dissemination.

Solution. Altering this self-perception requires changes to both the nursing and engineering professions. Instead of allowing medical products and devices to define nursing interventions, nursing leaders and educators need to ensure that products support nursing practice. These changes will take time, but nurses can begin by educating themselves on the products they use every day and report any issues to the manufacturers and to their nursing supervisors. Engineers, for their part, should stop relying on clinician training as a strategy to prevent errors and instead develop products specifically designed for real-world nursing practice.

Lack of nurse-engineer teams. The power of the nurse-engineer approach stems from integrated, real-time collaboration to identify problems, create solutions, and evaluate outcomes to improve patient care. However, such collaborations are uncommon because current clinical practice settings have not embraced this approach.

Solution. To foster nurse-engineer teams, nurses can invite engineers into the clinical setting to observe the environment and evaluate the possibility of turning workarounds into innovations. This would allow engineers to witness the real-time use of health care products, assess workflows, watch product failures, and brainstorm with nurses on potential improvements. Nurses could also reach out to engineering schools with specific product improvement proposals and bring students or faculty experts into their clinical settings to collaborate and problem solve. Finally, nurse leaders could work with hospital administrators to develop internal innovation opportunities that would bring nurses and engineers together to tackle system-wide issues.

An alternative to nurse-engineer teams is cross-training. Schools of nursing and engineering could develop undergraduate nurse-engineer dual degree programs, as Duquesne University in Pittsburgh, Pennsylvania, has done. In addition, administrators at hospitals and other clinical settings could hire engineers to work alongside the nursing staff to help identify and create real-world solutions to ineffective health care products, processes, and workflows. Engineering teams could likewise hire nurses to be part of their product development and testing teams.

STRATEGIES FOR HEALTH CARE INNOVATION

Empowering nurses to become innovators, forming nurse-engineer partnerships, creating a path for engineers to enter nursing, and encouraging nurses to be trained in engineering are all strategies that can help create the infrastructure needed for meaningful health care innovation. While realizing the full value of this approach may take some time, it's important to remember that the most successful and cost-effective health care innovations can best be achieved through open minds and interdisciplinary perspectives. Our own experiences have helped us appreciate the power of this collaboration. Our wish is to see nurse-engineer partnerships at the front lines of care become the new standard for health care innovation.

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