Editor's Note: The is the seventh installment in our year-long 30th anniversary “Pioneers in Healthcare IT” celebration, featuring articles from past issues of Health Management Technology, formerly called Computers in Healthcare. This article appeared in the November 1983 issue.
Will nurses serve the computer or will the computer serve nursing? This may well be the question for nurses and the industry to answer in this decade.
Acceptance of computers in hospitals will be greatly influenced by whether nurses, the largest population in the healthcare field, accept them on friendly terms. That may depend on how well the industry helps nurses identify, define and meet the needs of nurses through computers.
Healthcare has used computers extensively for several decades, but primarily in financial matters, particularly revenue. Nursing has been used to provide input data, but has not generally benefited as a user.
In recent years, some major phenomena have combined within the healthcare arena to create an exciting climate, within which nurses may have a unique opportunity to harness the power of computers to serve them. Ironically, one of the areas that may be most impacted is budgetary control at the ward or unit level within healthcare institutions.
An acute national nursing shortage over the last several years prompted a close look at the dissatisfying factors within hospital nursing from the nurse practitioner's viewpoint. National studies showed that among their major concerns were a lack of input into and impact on hospital decision-making processes, feelings of powerlessness and organization structures which did not lend themselves to their participation.
These findings encouraged many hospitals to choose to undergo a reorganizational process through which traditional hierarchical nursing department structures have changed dramatically. The “decentralized” structures that emerged established the head nurse as ward manager, with responsibility and authority for maximum decision making at that level.
During the era of acute nursing shortage — an era which many have labeled “the golden years of healthcare” — we also were trying to provide access to optimum healthcare for all people. New legislation concerning Medicare and Medicaid supported that philosophy; treatment modalities proliferated and healthcare costs increased apace. As a result, the healthcare industry faces a situation today wherein legislative bodies, the health insurance industry and employers are now taking vigorous measures to contain healthcare costs.
The nursing administrator who has put in place a decentralized structure is in a unique position to use computers within that structure to provide management-information support for the head nurse, which can enhance fiscal accountability and control at the ward level.
Timely, accurate information, such as that concerning nursing hour ration and personnel utilization, is vital to the head nurse charged with effectively managing precious resources within budgetary constraints. Efficient management-information systems and computerized data processing can provide such information.
Nurses need not be mathematical wizards to work with computers. They must, however, be knowledgeable as to the state of the art so that they may be among those defining and deciding how computers will be used in their institutions. Nurses need and must demand further information about the ever-increasing potential applications of computers to nursing education, patient care and management, especially in settings where their roles have expanded to encompass participatory management.
Within that expanded role, computers can help nurses not only to streamline routine paperwork, which will free more time for ever-important direct interaction with patients, but also can enable them to have a profound effect on their institutions' ability to survive and function cost effectively in tough fiscal times.
In 1983, Fotine D. O'Connor, RN, M.N., was director of nursing services and education for the 2,100-bed Los Angeles County/University of Southern California Medical Center. She also was an assistant clinical professor of community medicine and public health for the USC School of Medicine, and served as director of the medical center nursing department.
