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.
As the chief nursing officer at Vocera, I have the opportunity and privilege to speak with nurses all over the world.
While it may sound cliché, the stories I have heard from the frontlines are nothing short of remarkable. Despite fears and fatigue, they are dedicated to supporting their patients and colleagues. Against the odds, with more questions than answers about COVID-19, their commitment to their mission is relentless. As a nurse for more than 30 years, I have never been prouder of my profession or the dedicated people in it.
Collaborating, Not Competing
Several conversations I had during the peak of the virus with healthcare leaders in New York were truly inspiring. Specifically, the conversations I had with chief nursing officers at three different hospitals – one in Manhattan, one on Long Island and one in upstate New York. In the midst of so much tragedy, they were able to see the strength of humanity and cultivate some positive changes because of the situation.
The pandemic, they explained, broke down the walls of competition between hospitals. Healthcare is a business, and like any other business, organizations strive to outdo competitors. But during the crisis, besting each other was no longer important. What was important was doing the right thing for the greater good. In the case of these three hospitals it meant moving the sickest patients to where the greatest resources were and moving other patients where there was more capacity. There also were more willingness to share supplies. The healthcare “system” truly worked as a system.
Together, as colleagues not competitors, they continue working to solve various challenges at each location, including preserving supplies of personal protective equipment (PPE). Even more impressive is how they are sharing ideas on how to generate revenue because so many elective surgeries were canceled. The collective creativity and moral support have been remarkable.
Leveraging Hands-free Communication
In addition to volunteering people and supplies, healthcare leaders have also been sharing best practices to ensure care teams feel supported and are safe. Among these best practices is hands-free, voice-controlled communication. The realities of COVID-19 and PPE make it difficult and unsafe to use hand-held devices. Going hands-free eliminates the need to leave a patient’s isolation room and remove PPE just to ask a simple question, get supplies, or receive an update from care team members.
It also means nurses transferring from other departments or hospitals to help with the surge do not have to learn the names of their new colleagues. During the coronavirus crisis, nurses and doctors from different departments were being transferred to COVID-19 floors, and clinicians from other parts of the state and country were being deployed to help in hospitals where they did not routinely work. Having a familiar communication system in these unfamiliar settings can provide some peace of mind and confidence during difficult situations. With an intelligent voice-controlled communication system, a volunteer or displaced clinician does not need to worry about remembering names or extensions. They can simply say the role of the person or group they need to contact, like “call respiratory therapist” or “call COVID team.” Anything we can do to make the lives of care teams easier we must do. Standardizing communication across hospitals and health systems would go a long way to simplifying clinical workflows and speeding time to treatment, especially during patient surges.
Protecting the Well-being of the Frontlines
Safeguarding the mental, emotional and physical well-being of healthcare workers is critical. Before the coronavirus pandemic, healthcare workers faced several challenges that caused cognitive overload, exhaustion, stress, and safety risks. Fear of getting COVID-19 or passing it along to family members has added even more anxiety.
As long as COVID-19 remains a public health risk, PPE is a must-have for healthcare workers. By making hands-free communication devices worn under PPE a standard, hospitals can better safeguard their frontlines from infection. Communication technology can also protect the psychological well-being of staff.
Nothing has brought the challenges of multitasking in a patient-care environment into focus like COVID-19. The constant need to respond in the moment, inability to plan and strategize, impedes many clinicians’ ability to sustain attention. As multiple demands occur or change and discreet data points are exchanged in this high-stress, fast-paced environment, a person’s working memory reaches its limits. It is in this space of burdened memory that tasks are forgotten, and mistakes are made. Vocera technology can carry the burden of memory for clinicians by providing contextual, just-in-time information.
We must recognize and celebrate nurses, doctors, and other healthcare workers for their tireless work. We must also give them the tools and resources they need and deserve to do their jobs safely. Now more than ever, we must also find and implement ways to reduce their cognitive burden and support their capacity to care.
In light of recent events, and the toll that COVID-19 has taken on healthcare workers, we have never had more reason to honor nurses and other frontline heroes.
As part of the worldwide 2020 "Year of the Nurse and Midwife" celebration, the American Nurses Association extended National Nurses Week to National Nurses Month to expand recognition opportunities and elevate the extraordinary work of nurses.
Regardless of the week, month, or year, I am always proud to be a nurse. I also am proud to work with more than 50 nurses at Vocera who help me support thousands of our peers in hospitals and health systems around the world. Our team of clinical experts works tirelessly to help make the lives of nurses, doctors, and other care team members easier and safer. Helping others is what inspires most nurses to join the profession, and this innate purpose to do good for others drives nurses to stay with the profession even when times are tough.
“It is the greatest honor to be there and to take care of someone in their darkest moment,” said Carolyn Lopez MSN, RN, CAHIMS, a nurse for 24 years.
“Nurses epitomize everything that is good in healthcare,” explained Jamie Duffy, BSc, RSCN, who has been a nurse for more than 20 years and worked for the NHS in England for a decade. “We are medical detectives, caregivers, counselors, and usually the central link between all the other professions allied to medicine. I am immensely proud of everything I have achieved as a nurse and am incredibly proud to have chosen this as a lifelong profession.”
As the chief nursing officer at Vocera, I have the privilege of working with Jamie and Carolyn. During our Year of the Nurse activities, they, along with several other Vocera nurses, shared personal stories from their professional journeys. These stories shine the spotlight on the importance of nurses and the healing, human connections they foster.
The need to help others is often a driving force in many nurses’ stories. Another one of my colleagues at Vocera, Jenilyn Turner, MHA, RN, was inspired by her game-changing grandmother to become a nurse. Jenilyn lived in Charlotte, North Carolina, and spent every childhood summer with her grandmother in Brooklyn, New York. Her grandmother, who is a nurse and relentless advocate for patients, took Jenilyn to the frontlines of healthcare every day to witness this meaningful work. Jenilyn’s grandmother advocated for the rights of people with disabilities and fought for their access to healthcare. She drove sustainable change through activism and her constant questioning of the status quo.
Consider an MRI machine in a hospital. Can someone with a disability access that machine? Her grandmother made sure that question was always asked, and she worked to make sure an accessible machine was made available. She also made sure that women with certain disabilities who could not access traditional mammography machines could get the mammograms they needed and deserved.
So, when Jenilyn turned 18 and was planning to go to college, she chose nursing over all other career options. “I liked the idea of engaging with people, advocating for them, and seeing them get better. I told myself that whether I was at the bedside or not, I wanted to be an advocate for the patient,” Jenilyn said.
Julia Mason, MBA, BSN, RN, CENP, who has been a nurse for 30 years agreed with this sentiment. “It is our job as nurses to facilitate things that people can’t do for themselves, we must be the patient advocate,” she said.
Advocating for and serving others is also what drove me to be a nurse. The thought of being a nurse started early in my childhood because of my family and the people I met in church. I was the daughter of a Southern Baptist preacher. My family’s entire philosophy and reason for being was to be of service to others.
Because of our church and the community outreach work we did, I encountered several medical missionaries who talked about faraway places, providing healthcare to many different people in adverse circumstances. I thought to myself, that is what I want to do—I want to be a nurse. And for more than 30 years, I have had the privilege of being able to call myself a nurse. Being a nurse is not simply a job. It is a lifetime commitment and purpose that makes a powerful impact on patients, families, communities, and countries in every corner of the globe every minute of every day within every year.
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.
Every year around Nurses Week, May 6 to May 12, I write a CNO Perspective Report in which I examine a topic I think is important to nurse leaders.
Last year, the report explored cognitive overload and its impact on nurse well-being and patient safety. Because of the COVID-19 pandemic these critical topics have garnered more attention and generated much needed awareness.
How cognitive overload can lead to medical errors
As humans we parse and make sense of what is going on around us through the act of segmenting. Nurses in a hospital environment constantly segment what is urgent as they manage multiple patients and shifting priorities. When a nurse receives too much information at once from multiple people and systems, it becomes difficult to segment and to focus on the most critical patient care tasks. It is here where mistakes can happen.
How hospitals can minimize cognitive overload
Nurses cannot control the amount of information coming at them, nor how it is delivered. Hospitals need to find ways to offload the need for clinicians to retrieve, retain, and record information, and make it easier for them to collaborate. When a single clinical communication and collaboration (CC&C) platform is used, hospitals can simplify workflows by taking five measures to reduce cognitive load.
1. Contextualize information
Nurses must often solve complex problems without full context. They might have a small piece of standalone information, like a lab value, but it doesn’t tell the whole story. A strategy for countering this problem is to provide patient identifiers with notifications, along with an information chain of relevant context. Vocera technology helps relieve the burden of segmenting information by attaching contextual information to the patient’s record so it’s easy to access. Lab values, vital signs, and other data such as sepsis risk indicators are attached to the profile of a patient who is the focus of a notification or request.
2. Deflect distractions to allow focus on critical tasks
It’s common for a nurse’s attention to be split among multiple information sources. Interruptions and distractions can lead to cognitive overload. With Vocera technology, a nurse can put his mobile device on Do Not Disturb and divert extraneous information to voicemail. He can listen to messages when his brain has working capacity available to segment the information. When a matter is truly urgent, a caller can break through Do Not Disturb. He also can set reminders and forward incoming calls to other people in a group.
3. Provide a single source of information and standard communication protocols
Clinicians often struggle to communicate with each other. They are hindered by barriers such as multiple standards, conflicting protocols, and disparate communication tools. The difficulty of communicating is a drain on working memory. With Vocera technology, a nurse doesn’t have to use short-term memory to sort out what system to use to contact the doctor. The software platform allows a hospital to create a standard protocol and unify communication for clinicians and ancillary staff, using the same nomenclature.
4. Offload the need to retrieve, retain, and record information
Redundancy of documentation is a problem in medical care. When a nurse must write the same information four times in several different places while juggling information about six different patients, she is more likely to make a mistake. Vocera technology lets nurses offload the need to retrieve, retain, and record certain information so they don’t need to carry it in short-term memory. The platform provides a single source of aggregated information that is accessible to the entire care team and doesn’t need to be replicated again and again.
5. Weed out extraneous information
Weeding refers to removing extraneous information from the conversation. With weeding, what is removed is just as important as what is allowed through. Perhaps a nurse doesn’t need to receive a patient’s vital signs every 15-30 minutes if a patient is stable or be notified when a patient’s SpO2 has dropped down to 88% if the patient normally sats at 88%. When it comes to management of secondary alert and alarm notifications, Vocera technology accomplishes extraordinary weeding by allowing nuisance notifications to be filtered out. Clinicians receive only the information on which they need to act.
Before COVID-19, nurses had to manage cognitive overload. During both routine days and stressful times, healthcare workers experience cognitive burden. Identifying ways to lessen that burden by simplifying workflows with assistive technologies can reduce the mental and emotional stress on those who dedicate their lives to caring for patients.