Each May, I write a CNO Perspective report on a topic that’s top of mind for nurse leaders. Last year, I wrote about reducing cognitive load for nurses and other healthcare professionals.
I’ve spent the past year speaking and publishing on this topic, and the response I’ve continued to receive tells me the theme remains important and timely.
In watching the toll COVID-19 has taken on healthcare workers, I realize that cognitive burden is even more of an issue now than it was before the pandemic. The mental and physical burden nurses must carry in this time of need is life altering for them. For this reason, I decided to devote this year’s CNO Perspective report to outlining a strategy to help strengthen nurses’ resiliency.
The report presents a short review of cognitive capacity theory, with a focus on four of its eight skills or executive functions1: Multiple simultaneous attention, working memory, category formation, and pattern recognition. It examines how these executive functions tie to the cognitive burden nurses have carried in coping with the pressures of patient care in the face of COVID-19. It looks at how clinical leaders can leverage communication technology designed to simplify clinical workflows to help build nurses’ resiliency.
3-Point Strategy to Help Strengthen Nurses’ Resiliency
The report outlines a three-point strategy for how principles of cognitive science can be applied in the patient-care environment. Following is a high-level summary of the three elements.
1. Address the Strategic Delta Between Documentation and Communication
With patient surges from a crisis like COVID-19, caregivers move through the hospital trying to manage critically ill patients at warp speed, and the patients just keep coming. A key lesson here is that care teams are mobile, and information must be, too. Documentation and communication must work together to relieve clinicians’ cognitive burden.
2. Give Clinicians Control Over How They Communicate
The stresses of responding to COVID-19 have made it clear that hospitals need to empower nurses to control the way they communicate. We must remove from nurses the burden of constantly having to adapt to varied preferences. No nurse should have to ask, “Does this doctor want to be paged? Does the other one demand I go through the answering service? How do I call the department I need to reach?” Although nurses and physicians communicate differently, hospitals and health systems should standardize communication using the same software, so nurses don’t have to work in and out of disparate systems.
3. Use Software to Enhance Workflow, Not Distract from It
The intensity of COVID-19 clinical workflow has demonstrated that clinicians need clear, contextual, just-in-time information. There is no time to be searching for information or struggling to communicate. Information must be pushed to the healthcare team on the go. Nurses don’t have time to search through complex fields of information when they are under such pressure. Efficient clinical workflow requires purposeful communication and meaningful information centered around the patient.
Now is the time to make plans for how to support healthcare workers who are trauma survivors and will likely experience PTSD for a while to come. What protocols and resources can be put into place to ensure we don’t run out of supplies? How do we ensure that communication, which is the very backbone of patient care and safety, is considered an essential part of PPE and no longer an afterthought or tacked onto another system?
Some hospitals will continue to manage in crisis mode for some time. Others are seeing a break or slowing in the stream of patients. We don’t know for sure what the future holds. But what we can do is define what is essential, ease the burden when we can, and use the lessons learned to plan for future crises that impact and strain our healthcare system.
1. Cognitive Skills: Why the 8 Core Cognitive Capacities. C8 Sciences, https://www.c8sciences.com/about/8ccc/.
Rhonda Collins, DNP, RN, FAAN, is the Chief Nursing Officer at Vocera, where she works closely with nurses, physicians, IT professionals and other hospital leaders around the world to improve the lives of patients, families and care teams by simplifying workflows and improving clinical communication. A nurse for more than 30 years, Dr. Collins is a co-founder of the American Nurse Project dedicated to elevating the voices of nurses across the country through interviews, an award winning book, and a feature length documentary.