Country Selector: United Kingdom
Recent reports have revealed that record numbers of NHS frontline staff are leaving, with absenteeism also at an all-time high. Burnout, mental health struggles and a lack of work-life balance have been given as the main reasons, leaving the NHS understaffed and under extreme pressure.
Sophie Evans, a former critical care nurse and now a clinical consultant for health communications specialist Ascom, discusses why it has never been more important for the NHS to bring back the joy to nursing, and how technology can play a major role.
Often, when we talk about the benefits of technology within healthcare, we focus on the patient. From how it can be used to improve patient outcomes, its ability to transform how and where care can be accessed, and its potential to deliver near real-time health insights. But very rarely do we discuss the ways in which technology can change how healthcare professionals not only work more efficiently, but also how they feel about their jobs.
Especially since the Covid-19 pandemic, the use of technology has become pivotal for companies across most sectors. Not just in creating new ways of working, but also in helping to enrich employee experience. Technology is increasingly being used by companies to attract and retain talent. By improving workflow and efficiencies, it enables workers to focus on the elements of their job that they are highly skilled for and where it can deliver the greatest job satisfaction.
However, despite being one of the UK’s largest employers, the NHS’ view of technology remains largely unchanged. Perhaps now is the time that it is revisited?
I left the NHS in 2018. I was, and I still am, incredibly proud of the seven years I spent as a nurse.
I didn’t leave because I fell out of love of nursing. I left because I could feel that increasingly the parts of my job that I found most rewarding, that made the lack of sleep and the long hours all worthwhile, were being eroded to make way for more admin tasks.
This took me away from delivering care to my patients to spend longer periods at a computer or filling in forms.
The NHS at breaking point
Record numbers of highly trained healthcare professionals are leaving the NHS. During the third quarter of 2020, more than 27,000 medics left the NHS – that’s around 2 per cent of the entire NHS England workforce. It’s also the highest figure since records began in 2011. (1)
Aside from leaving due to contracts coming to an end, concern over work-life balance is one of the most common reasons given by those leaving the health service. However, that just scratches the surface of the problem the NHS faces.
A study by the University of Roehampton showed that the number of NHS workers struggling with mental health issues quadrupled during the early part of the pandemic. Those operating in frontline care roles were identified as being most at risk.
Thirty-one per cent of frontline workers reported symptoms of depression, compared with 25 per cent of non-frontline staff. They were also found to be more than twice as likely to have severe post-traumatic stress disorder symptoms. (2)
While patients are being driven to access ‘digital first’ healthcare, staff within hospitals use a predominantly paper-based system riddled with arduous, repetitive administration. It’s all very well having an impressive outward facing system, but it’s no use, if the nuts and bolts aren’t as effective and efficient as they should be.
Taking back the time paperwork took from nurses
By December 2023 the Health and Social Care Secretary wants 90 per cent of NHS trusts to have electronic patient records in place. Converting bulky paper records into secure digital form aims to save clinician time, freeing-up a believed 23,000 hours of nursing time each year. (3)
The Government wants technology such as the NHS app to become the digital front door for patients to access care.
Of course, this is great news for both patients and healthcare professionals, but digitisation needs to be felt at ward level too.
While patients are being driven to access ‘digital first’ healthcare, staff within hospitals use a predominantly paper-based system riddled with arduous, repetitive administration. It’s all very well having an impressive outward facing system, but it’s no use, if the nuts and bolts aren’t as effective and efficient as they should be.
Before I qualified as a nurse, I never imagined that 50 per cent of my day, sometimes even more, would be taken away from being with patients to instead complete paperwork. But, that’s the reality.
Take for example the admissions process. On a general ward, a nurse would manage the admissions of four to six new patients each day on average. I worked in Wales and the admission booklet we worked to was 32 pages. That’s 192 pages of paperwork before I’ve even tended to a patient.
The lack of on-hand technology also means that patients are required to share information repeatedly to different NHS contacts, because they don’t always have the paperwork to hand. That’s frustrating for both patients and clinicians.
Being able to record patient data on a mobile device while at a patient’s bedside saves time, prevents records from being misplaced and makes it easier for information to be shared across a clinical team. We call this point-of-care data access.
Bedside patient record keeping can help to give nurses back some of the time paperwork has taken away. In my role as a critical care nurse, of course the main priority was to keep the patient alive, but beyond that, it’s also important that the patient feels cared for in other ways.
Most nurses want to treat every patient as if they were their own family member. Spending time to wash or brush a patient’s hair isn’t a clinical necessity, but it’s in those moments that nurses can find joy and job satisfaction. This is when I, and my colleagues, would feel able to truly provide the standard of care we went into nursing to deliver.
Carrying out tasks that take you away from care can make you feel like you haven’t done your best for patients and lead to compassion fatigue and burnout.
Lightening the (cognitive) load
The physicality of a role as a nurse is one thing, but mentally it’s perhaps even more challenging. The cognitive load of having to always be mentally one step ahead of the next task – while dealing with the unpredictability of patients and their conditions – can become a real trigger for feelings of stress and anxiety.
Most days I would be running on adrenaline and after work I would feel myself crash.
Something as simple as being able to use technology to provide a prompt for an action could lighten that load. This technology would take away some of the mental burden and help stop nurses feeling quite so overwhelmed.
The good news is evolved nurse call technology can provide that. It’s smart, with the ability to interact with other medical devices and software. It provides the nurse with a vital tool to help closely monitor a patient and can support workflow management.
Prompts to remind nurses of routine tasks can be automated. For example, the clinician can create an alert for tasks such as dispensing medication or when a patient needs to be turned to prevent pressure sores. This takes the burden away from nurses and ensures patient care is mapped.
Even something as seemingly simple as arranging for a porter to take a patient into surgery can be time consuming, but this could also be automated. An alert can be set and sent directly to the porter. The same form of alert can be created to remind a nurse when a patient’s medication is ready so they can be discharged.
Reconnecting nurses to invisible patients
The move from ward to single-occupant rooms in a smart hospital provides patients with greater levels of privacy, but it also creates care challenges.
Where a nurse could once look over a ward and see all their patients at a glance, private rooms provide an additional physical barrier to overcome.
Patients can also feel disconnected as they can go for longer periods of time without seeing a member of staff. Staff themselves can feel disconnected too. But through technology, they can both be reconnected.
By integrating the nurse call system with the medical devices connected to the patient, such as an infusion pump or monitor, technology can become a clinician’s ‘eyes and ears’. For example, if a patient’s blood pressure suddenly spikes, an alarm can be raised to alert the medical team via a handheld device, or through a smartphone iOS or Android App.
The status of a patient can be recorded in near real time and viewed from a dashboard. This means, still, at a glance nurses can check up on the whole ward, despite each patient now being housed behind walled partitions.
The technology is changing how nurses work and how patients receive care. Creating a support system not just for patients, but also nurses.
Reducing sensory stress overload
Hospital wards are noisy. Much has been said about the impact of nuisance alarms on clinicians. Now technology is being adapted to be more discreet and less intrusive to patients and healthcare workers.
Previously, a patient would press a button which would trigger an alarm that could be heard by all patients and all staff. It was disruptive. Now, with new systems in place, a patient can request help from their own smartphone device or a handset, which raises an alarm, not throughout the wards, but directly to the devices of people responsible for their care.
This creates a more calming environment for patients and helps eliminate alarm fatigue among staff.
Being a nurse is a physical job. I never recorded the number of steps I would travel up and down the ward each day, but it was always enough that at the end of a shift my feet hurt. Chasing down misplaced paperwork, finding a porter and responding to patient calls would all require physical exertion.
Having smartphone technology on a ward makes a nurse more efficient. What’s more, the alarm system can be prioritised. If two patients both call at the same time, for example, one asking for a drink via the chat functionality and the other has pressed for emergency care. The latter is prioritised, with the former delayed or reallocated to another member of the team to help manage workflow.
More connected care
The pandemic has accelerated the use of technology across the whole health system, but for years nursing was considered a nervous and somewhat reluctant adopter of it.
A recent global healthcare report by Elsevier Health, ‘Clinician of the Future’, claimed 69 per cent of healthcare professionals feel overwhelmed with the current volume of healthcare data available to them. As a result, 83 per cent believe training needs to be overhauled so it can keep pace with technological advancements.
The reason I left the NHS was also the reason I joined Ascom. As a nurse, I believe technology, when done right and integrated properly, could make a massive impact on me and my colleagues.
Technology isn’t the cure all for easing the mental and wellbeing burden of NHS workers. It will never replace a nurse or a clinician. But it can provide huge support by taking away some of the stresses and strains that distracts them from their patients.
Let’s embrace new ways of working so we can empower those on the frontline to do what they do best – to have the time to provide real care for patients.
This article has been published in the Clinical Services Journal, February 2023 issue. Click here to view.
References:
(1) https://inews.co.uk/news/health/nhs-staff-quit-record-numbers-ptsd-covid-pandemic-trauma-1387115
(2) https://www.roehampton.ac.uk/news/2021/april/mental-health-symptoms-quadruple-across-nhs-healthcare-workers-during-covid-19/
(3) https://www.gov.uk/government/news/health-secretary-sets-out-ambitious-tech-agenda