NBNA SPECIAL ISSUE ON THE FUTURE OF NURSING

40 — NBNA.org nBnA nurse LeAdershIp
eLectronIc heALth records: A Mandate for Change in Health Care and Academic
Institutions – A Critical Interface with an Associate Degree Nursing Program
THe fUtUre of NUrsiNG lies in the hands of innovators who
design and implement projects that positively effect change
and assure quality care for the communities they serve. the
federal mandate to implement electronic Health records (eHr)
nationwide led to the 2006 technology informatics Guiding
education reform (tiGer) summit to transform nursing based on
evidence and informatics. most hospitals have purchased or are
in the process of deciding on an eHr system to meet the 2014
federal mandate expecting hospitals to use eHr documentation.
since nursing comprises of fifty-five percent of the health care
force, the plan was to prepare the next generation of nurses to
practice in automated health care systems (Dulong, 2008). eHr
is a workplace reality for nurses and nursing students who are
expected to improve the quality of patient care (kelly, Brandon &
Docherty, 2011). Advantages include: a single consolidated record
per patient, capacity for data interfaces and alerts, improved interdisciplinary
communication, and evidence-based decision
support. However, eHr can add to work complexity by forcing
better documentation of previous unrecorded data (robles, 2009).
Health information technology (Hit) and eHr are vital requirements
for nurses to provide holistic and competent nursing care.
the future of safe, effective health care necessitates incorporating
clinical informatics in nursing education programs while serving to
bridge a gap between academic and clinical institutions.
Although eHr can improve the quality of care, the extent is
unknown due to the dearth of studies (kelly, Brandon & Docherty,
2011). there is a chasm between what nurses currently learn in
nursing programs and what is needed in workplaces with new
graduates expected to function competently (messmer, Braggs &
Williams, 2011). Nurses play a key role in eHr implementation and
adoption and are in a unique position to champion eHr. Among
137 physician practices, the adoption rate for the practice was
83% higher when a nurse was the primary user of the eHr, than
when no nurse was involved (mihalko, 2012). Nursing education
is challenged preparing graduates with 21st century knowledge
and skills for practice in a complex, emerging technologically
sophisticated, consumer-centric, global environment (Warren &
connors, 2007). the institute of medicine (iom) recommended
nurses-in-training should experience, reflect upon, and develop
the knowledge, skills, and attitude creating competence in patient
centered care, evidence-based practice, quality improvement,
safety, and informatics (http://www.iom.edu).
Health care delivery is promising a future of constant change
in health care technology; thus, it is imperative that nursing
Marie O. Etienne, DNP, ARNP, PLNC
Yamina Alvarez, DNP, ARNP
Patricia Messmer, Ph.D. RN-C, FAAN
promotes Hit competency to assure that we are capable of
meeting the health care needs of our growing communities
(simpson, 2010). As 2011 Health information technology scholars
(Hits), our goals included developing innovative, evidencebased
strategies incorporating technology (eHr and HPs) to
enhance the miami Dade college (mDc) nursing curriculum, an
urban college in miami, florida. our project increased nursing
student’s knowledge of patient safety and their skill competencies
using new technologies and teaching strategies.
the project incorporated Hit and eHr into all components of
an Associate Degree Nursing program (ADN) while encompassing
cultural sensitivity for our diverse students. the project addressed
the National league for Nursing (NlN) and Quality and
safety education for Nurses (QseN) competencies to ensure
that nursing students and faculty utilize them in their practice,
providing safe and high quality patient care. the project was
based on miami Dade college’s Vision—an exceptional learning
environment in which students are challenged and empowered
through innovation, state-of-art technologies, teaching excellence,
and student support program. the program prepares
each student with the knowledge, skills, and values to succeed
in a dynamic world (mDc Planning and effectiveness, 2010).
the nursing dean and faculty embraced our project because
of its value and the timing of the iom report: the future of
Nursing: leading change, Advancing Health (iom, 2010). We
capitalized on the strengths of the faculty champions and maximized
the use of the Human Patient simulation (HPs) laboratory
and eHr to develop case scenarios tailored for nursing
students. selected courses included Adult Health Assessment,
fundamentals of Nursing specialties, and medical-surgical
Nursing with plans for Pharmacology while addressing cultural
diversity and gerontological needs of the patients.
components of the nursing curriculum demonstrated a
seamless interface with the integration of Hit and eHr into
the ADN program. Proposed projects include advancing this
technology into all components of the ADN and integrating
simulation into the rN-BsN program curriculum. skiba (2006)
articulated a call to action: preparing the next generation of
nurses to use emerging technology and the need for higher
education to ensure literacy in information technology. With the
limited number of available nursing positions in the area, these
ADN graduates should be more marketable and motivated to
coNtiNUeD oN PAGe 42