Nawojczyk, 47, manages the information services department for a two-hospital system in Houston-Doctors Hospital Parkway and Doctors Hospital Tidwell. The community hospitals combined account for 263 beds, 13,000 admissions a year and 39,000 emergency room cases. "We have two of everything"-ORs, ERs, intensive care units, all supported by one IT department, he said.

"When I got into this field initially, it was just with a nursing documentation system," Nawojczyk said. That was 1992, when computers in hospitals primarily handled billing and other business operations. But as clinical systems evolved, so did Nawojczyk. The RN among computer specialists now is responsible around-the-clock for his hospitals' hardware and software applications in both business and nursing. He traded his stethoscope for a pager.

"I'm noticing more and more that lots of directors of [information] departments are clinical persons now rather than technical persons," Nawojczyk said. He attributes that partly to the rise of informatics specialties in nursing degree programs, something he said he may one day pursue to supplement his on-the-job computer know-how. "It's obviously easier to teach a clinically minded individual the ability to deal with computers than it is a computer person with the clinical stuff," he said. "That doesn't mean there isn't a need for the technical aspect; there certainly is. We work hand in hand."

With virtually unlimited information just a few keystrokes away for business staff and nurses, it's also up to Nawojcyzk to ensure that hospitals' staff follows all confidentiality and privacy laws.

His two favorite IT stories center on what Nawojczyk describes as a battle for nurses' acceptance of computerized documentation, whether it's the Meditech system he employs or one of dozens of other systems that cover order entry, labs, pharmacy, dietary-all the aspects of total patient care.

But as a group and as individuals, he has a way of winning over nurses.

Nawojczyk is an emergency medical technician-turned-RN. He said that while working for an Arkansas ambulance company, he was fascinated by what went on in emergency rooms and had the desire to do more. So he volunteered as an orderly, then as a technician and sort of evolved into a nursing degree.

His move to information services-and then to director of the IT department after about 10 years of emergency and critical care was a similar evolution-starting with a fascination for electronic documentation and a desire to do more.

"I think back to our initial implementation back in '92-93. I love telling this story," Nawojczyk said.

"We were telling nurses that all of a sudden we're taking their pens and papers away from them and they're documenting on these little handheld devices that look like Nintendo games. They were just freaking out," complaining it was too hard, it took too long, etc.

"We brought them into this kicking and screaming," Nawojczyk said, but once they got around the learning curve and saw better communication among all caregivers, and that documentation occurred directly against a plan of care vs. on a generic form, they got excited about it.

"Several years later, the hospital was up for sale and the nurses were absolutely in a tizzy thinking they were going to lose their computer system and have to go back to hand documentation. It actually was kind of heartwarming for me."

Nawojczyk said that if push came to shove, he'd return to a clinical role, but he is regarded among staff as the nurse that he is, and intends to stay in information technology. But it's not a specialty for everyone, especially those with thin skin, Nawojczyk said, telling another story.

"I remember teaching class one day and this particular psych nurse didn't want to be there. I was standing at the door greeting the participants in the class and this nurse came up to me. I could tell she was not happy.

"She said, 'I don't want to be here. I don't like computers and I don't like you.' Those were her exact words, and I thought to myself, 'Oh, boy! I've got my work cut out for me today.'

"Well, at the end of the day, as they were leaving, she was the one who praised the system the most. Once she had the knowledge of what the tools, what the computer system could for her, she was amazed. She did a total turnaround. Once she got in there and realized that she couldn't destroy something, she couldn't harm someone, she couldn't break it, then she embraced it."

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