Nursing is a profession within the healthcare sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life.The American Nurses Association (ANA) states nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.
In this paper, I am trying to highlight what nurses actually do in Indian Healthcare Scenario based on my experience from small private hospital to large corporate hospitals. As soon as you reach an in-patient ward, the busiest people can easily be found in white uniform running from pillar to post to get their day-to-day tasks completed.
I have seen nurse playing these roles at various capacities:
- Store Clerk – To indent drugs and consumables, mark the consumption for billing and stock update, drug return on discharge etc.
- Discharge Clerk – Initiate discharge process on physician’s instruction, follow-up with front-office for bill clearance, follow-up with physicians for discharge summary, follow-up with diagnostic departments for pending reports and so on…
- Billing Clerk – Filling the activity sheet on paper and send it to front-office for billing
- Scheduling Clerk – Scheduling Radiology procedures, Follow-up with OT on when to send the patient etc.
- Phlebotomist – Collect the lab sample and send to lab for further processing
- F n B Clerk – Take patient’s meal request and communicate to F n B department
- Bed manager – Intra/Inter ward transfers
- PRO (Patient and Attendants Relation Officer) – Manage their complaints just about anything
- Physician Assistant – accompany the physicians on round, capture their instructions to the closure, remind/alert them on events etc
- Nurse – in whatever time left from other roles
- And many more…
If there is an enterprise HIS/EMR implemented, nurses end up using at least following modules in order to do all above listed activities:
- Scheduling Module
- In patient module
- Inventory Module
- Pharmacy Module
- Medication Administration Module
- Procedures module
- LIS – Phlebotomist
- Linen Control
If these modules are implemented using different products, nurses end up logging in/out from one application to another and all their activities are messed up.
What nurses actually need from HIS/EMR application is:
- Ability for nursing supervisor to allocate a number of beds to a particular nurse for a shift. This nurse will be responsible for entire care of the patients allocated to him/her.
- Nursing Dashboard/Work list – This work list should populated any and every task for those patients who are allocated to logged-in nurse. S/he should be able to clear all pending orders and activities from this work list without having to navigate through menus in the application. This will ensure a single screen operation for nurses and they will not miss any important task especially clinical in nature.
- Shift Handover remarks should be added in case any task is not completed for any reason during a shift so that next shift nurse takes over without having to spend one hour on taking hand over from previous shift nurse. By the way, shift hand-over is noisiest time in any ward.
- Care Plan – Nurses should be able to define the care plan for each patient and follow it rigorously. System should be flexible enough to create disease based nursing care plans which needs to be followed from the moment diagnosis is captured by the physician.
- Nursing Documentation it should be initiated from the work list. System should allow creating disease based as well as generic templates for nursing documentation.
To be honest, I have worked on few products which take care of these requirements in bits and pieces, not holistically. I am looking forward to seeing a complete nursing module and developing it to nurses’ life a lot easier and focus more on patient clinical care.
Dr. Rajesh Gupta
Healthcare IT Executive