Nurses know stress. Ever-increasing demands on health care resources combined with the rollout of the Affordable Care Act (ACA), long hours, and staffing challenging have put serious strain on the nursing profession. Although all of these stressors are significant, two new stressors are of growing concern: technical medical errors and questions about the entry level of education for nurses.
Technology-Induced Medical Errors
For years, health care professionals have advocated the importance of technology in the health care industry. Advancements in technology have made it possible for patients to use portable devices to access their medical information and monitor their vital signs. Now, there’s a call for better interoperability, saying a lack of sufficient progress on this front contributes significantly to medical errors.
According to “Missed Connections: A Nurses Survey on Interoperability and Improved Patient Care,” a March 2015 report from the Gary and Mary West Health Institute, meaningful progress in reducing medical errors requires using technology to create an automated, connected, and coordinated health care system. This is only possible when there is a seamless flow of information among all devices involved in caring for a patient.
Callie Ballenger, RN, an online adjunct nursing instructor at Ottawa University, notes that nurses are surrounded by medical devices—from IV pumps to computers used for documentation to devices implanted in patients. She says this technology is nice when it all works but can make for a great deal of stress when it does not work properly.
“Nurses need to be properly trained on the care of patients with these medical devices and contact information for the manufacturer of these devices needs to be readily available to nurses,” Ballenger says. “There is a great deal of stress when you are in a patient emergency and do not have this information readily available.”
The survey of more than 500 nurses (conducted online by Harris Poll on behalf of the institute), revealed that 50% witnessed a medical error resulting from a lack of coordination among medical devices in a hospital setting. Roughly half estimated that as many as 25% of medical errors and adverse events might be prevented if devices could share information seamlessly. According to a 2013 study published in the Journal of Patient Safety, preventable medical errors are estimated to cause more than 400,000 American deaths each year.
The lack of information-sharing between devices can affect how a nurse does his or her job. The survey found that nurses spend a lot of time programming and setting up devices, followed by data transcription. About 41% said they spend three or more hours per shift on these tasks.
Sonya Curtis, MSN, an assistant nurse manager at the North Texas VA Health Care System, notes that medical devices are examined by biomed. Biomed places a sticker on the device to show the last time they have recalibrated or assessed the device to ensure it is working properly. The nurses’ job is to review the sticker before using the medical device.
“A nurse can be held liable for using a medical device on a patient causing an adverse event,” she says. “The nurses’ workload, short staffing, and quick orientation [to unit and equipment] can cause negative patient outcomes. This can be a tremendous stressor.”
“Taking time to read manuals and programming medical devices, can add to their overwhelming emotions (i.e., stress); furthermore, affecting nursing productivity,” Curtis adds. “All this can lead to medical errors.”
The Entry Level Debate
There have been a number of initiatives aimed at addressing the nursing shortage in the U.S., including state and federal grants to nursing schools to increase the number of faculty and students. But as these nurses graduate and enter the workforce, they are faced with stress regarding their level of education.
Determining the entry level of education for nurses has been a controversial topic for at least three decades, according to Constance Dallas, PhD, an associate professor at the University of Illinois at Chicago College of Nursing. But the ACA, with its emphasis on increasing the scope of nursing practice, and the increase in Magnet Hospital status, with the focus on BSN-prepared nurses and evidence-based care, have revitalized the conversations.
“These conversations can be stressful for nurses when they trigger worries about their job security. Financial demands and family demands may influence the ability of some nurses to continue their education,” Dallas says. “Low-income students may be reluctant to consider a nursing career that requires a minimum educational level of a DNP or PhD.”
A more highly educated workforce saves lives and reduces stress in nurses. A study published in the October 2014 issue of Medical Care found that a 10% increase in the proportion of BSN-prepared nurses on hospital units was associated with lowering the odds of patient mortality by 10.9%. The study also found that increasing the amount of care provided by nurses with BSNs to 80% would result in significantly lower readmission rates and shorter lengths of stay.
Curtis personally and professionally believes the entry level of the nursing profession should be a BSN.
“With higher education comes more responsibility and prepares the nurse to obtain a broader knowledge of nursing practice. This in itself is stressful,” she says. “The BSN nurse does have more educational courses, which assist to a better patient experience and patient outcome.”
Ballenger agrees. “There is a great deal of information that nurses need to know, and we are trusted to care for people in some of the most critical times in their life, so I do not think we can sacrifice knowledge and skills by requiring lesser education,” she says. “If all nurses are BSN-prepared it levels the playing field and decreases stress, as the ADNs do not feel that they have lesser education or that BSN nurses are above them.”
Overall, Curtis argues that these new stresses are only the tipping point so nurses need to be prepared to deal with this stress in their nursing education.
“Health care is an evolving field and change is constant so it is important for nurses to be lifelong learners and educate themselves on new equipment and procedures so they can provide the best care to patients,” she says.
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