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Nursing input into all technology decisions at Hackensack “has changed dramatically” in recent years, Ahearn says. As in most hospitals, she says, physicians once drove most technology purchasing decisions. “Now, I think it’s equally driven, if not a little more on the side of the nursing staff.”

Hit and miss

Nurses played a large part in selecting technology at Parker (Colo.) Adventist Hospital near Denver, says Terry Ritchey, RN, MBA, BSN, chief nursing officer of the facility. Some successes have included the Vocera communication device, the interactive patient stations and the smart pumps. Less popular were tablet PCs — which physicians loved, but nurses found awkward to carry — and a bar coding system that requires nurses to scan patient bracelets and medications to ensure they have the right match.

“The bar coding was probably the most difficult one to implement,” Ritchey says. Nurses had difficulty getting the devices to scan and became frustrated. A combination of intense education and improvements to the system has helped win its acceptance, she says.

“Now nurses are telling us they don’t feel safe without their bar code device,” she says.

Cheryl Reinking, RN, MS, director of critical care and med/surg at El Camino Hospital in Mountain View, Calif., plans to introduce bar coding to nurses at her hospital soon, along with a host of other new nursing technologies. “There’s a lot of work behind the scenes that has to happen first,” she says.

To persuade nurses to accept the bar code system, she says she is emphasizing its importance in preventing medication errors and asking nurses to see it as a device that creates an extra step for them, but in the long run will protect both the patient and the nurse.

Such education is crucial to implementing any new way of doing things, say nurses who work with new nursing technologies. “If you don’t spend enough time on education, nothing will succeed,” Reinking says.

Pamela Parker, RN, MBA, BSN, director of nursing informatics at Harrison Hospital in Bremerton, Wash., outside of Seattle, says her hospital learned the hard way what happens when clinicians don’t like a new system. A few years back, the hospital tried out a documentation system with limited text that was difficult for both physicians and nurses to read and use.

Many meetings later, she says, the informatics team decided that neither the technology nor the staff were ready for electronic charting. “So we turned it off and said we’ll wait a few years and then go back,” she says.

Growing gearheads

Perhaps the most important aspect in persuading nurses to use new equipment or systems involves winning their trust, say those who work with nurses and technology.

Nurses at Memorial Hermann Healthcare System’s eICU Advantage Program spend a lot of time visiting nurses in the ICUs they monitor, assuring them that they are not going to replace the bedside nurse. The team of nurses and a physician watch patients from a remote location and alert bedside clinicians if anything seems amiss.

“People get defensive at first because they think, ‘They’re going to be watching me,’” says Janine Mazabob, RN, BSN, CCRN, clinical director of Memorial Hermann Healthcare System’s eICU Advantage program. “But once people see how we blend in with their daily work, they are quick to embrace it.” Workflow support, management support, response time, integration of the system, and ease of use all play an important part in whether nurses will welcome and use new technology, says Ann Farrell, RN, BSN, principal and senior consultant of Farrell Associates, a strategic health care consulting firm based in San Francisco that works with vendors and health care organizations.

Some of the problems nurses have in using new devices or systems “have nothing to do with technology,” she says. “There is often a culture issue with nurses, who are not willing to change their practices without demonstrable benefits to patient care.”

Despite numerous attempts to get nurses to document at the bedside using tablet PCs or other devices, many nurses say they prefer to sit at the nurses station or lounge to document at the end of the day, Ritchey says.

To get nurses to change their habits, nurse leaders and educators must show them some benefit and reassure them of their value, say those who work with nurses and technology. Parker recalls that when hospitals brought in Dynamaps to automatically take blood pressures and pulses, many nurses were skeptical. They thought they could take vital signs better than a machine could, she says, and feared losing human contact.

“There was a sense of loss of their autonomy, of their assessment skills,” she says. Nurses need to understand, she says, that if they delegate certain tasks to technology, they will increase their time to do the assessment, critical thinking, and patient education that no machine can replace.

Despite the obvious benefits of involving nurses in developing and choosing technology, many hospitals still lag, says Gregg Malkary, managing director of Spyglass Consulting Group, a Silicon Valley market intelligence firm and consultancy that is researching the potential for mobile computing and wireless technology in health care. Those that do involve nurses are often hospitals on the cutting edge of technological innovation throughout their systems, he says.

But in many hospitals around the country, nurses do not feel part of the process, he says. “Technology is being forced upon them without taking into consideration what their needs and requirements are.”

Getting nurses involved in choosing and buying technology requires as much of an investment as the technology itself, says Carol Bickford, RN, PhD, senior policy fellow in the department of nursing practice and policy at the American Nurses Association. It requires preparation time, education time, evaluation time, as well as strength in nursing leadership to say, “It’s important to have our people involved,” she says.