Nurses need to be a knowledge workforce

Medical technicianHandling information electronically is already essential for clinical care and becomes even more critical as the electronic patient record is introduced. The 2007 survey by the Royal College of Nursing (RCN) showed nursing's position on IT use and training, as Sharon Levy, RCN informatics advisor, explains.

Delivering professional nursing requires not just caring hands or a kind heart but also a sharp and inquisitive mind, one that enables the practitioner to utilise '...clinical judgment in the provision of care...' ( RCN 2003).

Information is at the heart of professional care and nurses, midwives and health visitors are the largest group of clinical information users. Through skilled therapeutic interaction, nursing professionals obtain, record, share, use and store sensitive information, in both paper-based and paperless formats.

They must, however, have the knowledge and skills to manage information within ethical, professional and legal frameworks, placing the needs and preferences of the patient at the centre of their care.

Record keeping, information governance, effective communications, critical thinking and information appraisal are all topics that should be embedded in the pre-registration education of student nurses, in the view of the RCN.

Furthermore, basic IT skill is a core competency that should be taught to those who are entering the profession, as well as to those who are already working in the health service. Enabling clinicians to know how to use and maximise the potential of clinical IT is key to successful implementation of all UK national IT programmes.

The recent Royal Society report on Digital Healthcare 2006 noted '...the single most important factor in realising the potential of healthcare ICTs is the people who use them.'

Over the past four years the RCN, the largest professional body and trade union for the nursing professions, has polled its members to identify attitudes, readiness and concerns regarding IT developments in the NHS. Earlier reports are available on the RCN website.

Members were asked to complete the 2007 survey on Nursix.com during the month of June. 2,635 nurses responded to it, including a few non-RCN members.

We are not claiming the sample is representative of the nursing professions workforce across the UK. Our survey used a convenience sample of self-selected nursing professionals who are more likely to be interested in and aware of NHS IT developments. Also, the participants completed an online survey, which relied on a degree of IT competence.

An overwhelming majority (94 per cent) of respondents had heard of the electronic patient record (EPR) before taking part in this survey and two thirds of them welcome its introduction.

Opinions as to whether respondents feel 'ready' for the introduction of EPR vary considerably, with 46 per cent in agreement, 43 per cent disagreeing and 12 per cent uncertain. 

The study shows that an overwhelming majority (91 per cent) of respondents have access to a computer both at home and at work. Almost all respondents use their computer to get information from the internet. Email access and word processing are also well-used at home by the respondents.

Most respondents use a computer at work, at least daily, but have to share IT access with many colleagues. 68 per cent note that their access to a computer at work was adequate for their needs. The most frequent purpose for using the computer at work appears to be getting information from an intranet, followed closely by email correspondence amongst other health professionals, and getting information from the internet.

Respondents were asked to judge their own level of IT skills on a scale of one to ten. The mean score recorded overall was 6.8 with little difference between nurses qualified in the 1990s/2000s and in the 1960s/70s/80s. Those nurses already familiar with EPR had a slightly higher score than those who had never used EPR (7.1 vs 6.7). Alarmingly, however, 55 per cent of respondents indicate that they have received no IT training within working time in the last six months.

Extra training is widely desired amongst respondents in order to consolidate their existing IT skills before being able to use EPR. Only 20 per cent asserted that they did not need extra training at this point in time. When prompted about their experience of European Computer Driving Licence (ECDL) training, 18 per cent of respondents did not know about ECDL and 23 per cent were aware of it but not planning to do it. Only 11 per cent were full licence holders and 8 per cent are in training.

This year we identified a link between using technology and positive perception. Findings suggest that users of EPRs have generally more favourable attitudes towards clinical IT than those who have not yet experienced using technology as part of the process of delivering care.

As was noted in previous years, clinical engagement through consultation, training and information, about IT developments in the NHS, remained a key risk to successful implementation of UK national programmes.

The vast majority of nurses believe that their IT skill level is quite high but recognise that they need further training once clinical systems are in place. The lack of implementation of nursing systems could explain why the majority of respondents did not received any training in the last six months.

We included some open ended questions in order to capture some qualitative data. Whilst this analysis is still underway, a comment gives an insight to the clinical 'reality' that many nurses face:

'IT training, as well as ECDL, is available through my employer free of charge However, ECDL is e-learning at home via local colleges... I am not very technologically minded and find it hard to learn IT skills and retain aspects that I do not use every day e.g. PowerPoint presentations. To access hospital in-house training requires being able to commit to a half day session and pre-book. I find I end up cancelling because clinical issues take priority... We can't learn, teach or progress unless the staffing levels support releasing staff to attend training etc consistently.'

It is acknowledged that IT often acts as a catalyst to change, and the development and implementation of clinical IT is no different. For nursing, it can be seen as both a driver and an enabler of the changes in nursing practice that are required to meet current and future healthcare challenges.

It is, however, widely recognised that at present nurses are not adequately prepared for the incorporation of care technology into nursing practice, and in particular into nursing documentation, and that the solution to this deficit may lie in nursing education.

We, at the RCN, endorse the recommendation made in the Royal Society report, which suggests that: '...higher education institutions and professional bodies responsible for the different disciplines adapt their curricula to integrate the use and understanding of healthcare ICTs into the basic training and continuing professional development of healthcare professionals'.

We are currently working with the BCS to develop 'products' which should enable students and qualified practitioners to attain a level of competence required to maximise the potential of clinical IT. Such development enables learners to grasp core nursing practice and information management concepts and skills and support the need of the profession to move beyond the role of computer operators and data entry activity into the realm of a knowledge workforce.

For more information contact Sharon Levy, email Sharon.Levy@rcn.org.uk.

September 2007