Where ‘automation has not been kind to nursing’

Ashleigh Hollowell (Twitter) – Wednesday, November 1st, 2023

While automation holds the lucrative promise for many fields of removing mundane tasks from workloads, some nurse leaders are hopeful — but questioning — if emerging technology will do the same in their field.

Particularly in the face of a national nurse shortage with more than 275,000 additional nurses required to meet demand by 2030, automation could be a solution to free nurses’ time, allowing them to attend to patients in other, more direct ways.

At the same time, over-automating and leaving nurses out of the conversations that happen during the development and before the deployment of new technologies could hurt a profession that already struggles with too few nurse educators, high turnover rates, and inequitable workforce distribution.

“Technology has not been as kind to nursing as it probably should be, in some cases, has been unforgiving and cumbersome, has added to the workload, and it has impacted nurses’ well-being…” Katie Boston-Leary, PhD, RN, director of nursing programs at the American Nurses Association, told Becker’s. “A lot of technology has been implemented for physicians to help their workflow, help with how they do surgery, etc. So those investments are being made on that end. The key is to make the call a clarion call for them to be made on this other end for nurses as well.”

What nurses don’t want automated

Closing the gaps that currently exist in the nursing workforce will require technology, innovation and dialogue, Dr. Boston-Leary said, but it is possible.

Nurses are most satisfied with the parts of their job that require human and patient interactions, according to a 2023 survey jointly conducted by market research firm McKinsey & Co. and the ANA. So automating parts of the workload that free up time for nurses to do more of that, is key, nurse leaders agree.

“Sitting at the bedside and holding somebody’s hand when they’re having a tough time during their hospital stay…” Danielle Weber, MSN, RN, chief nurse executive at ChristianaCare in Wilmington, Del., told Becker’s. “I think there’s always going to be that aspect of nursing, that you have to lay hands on a patient, and it’s never going to be fully automated. I think it would be a disservice to the profession if we did remove that aspect.”

Ultimately, automation should be developed for the field as “an enhancement to the care, but not a replacement for that connection,” Romoanetia Lofton, DNP, RN, chief nursing officer and chief administrative officer of Alameda Health System’s Wilma Chan Highland Hospital in Oakland, Calif., told Becker’s. “Best practice for nurses is to use technology to reinforce or supplement information provided. Nothing can replace the impact of a healing hand, a soothing voice or a listening ear.”

Where nurses desire automation

Nurses most desire automation of charting, documentation, tracking down equipment, people, medication and information, and administrative tasks, according to the McKinsey & Co. report.

In total, nurses reported spending 15% of their shift on charting and documentation; 6% of their time tracking down what they need to do their job; and 5% of their time on tasks that are supportive or administrative — like toileting, bathing and getting patients’ meals — and do not have them working at the top of their license.

“The biggest one is documentation. Some nurses will say that the biggest broken promise in healthcare was documentation systems that were part of the Affordable Care Act, which were adopted wide and far,” Dr. Boston-Leary said. “It’s selling point was not only that legibility issues would be addressed, but also that we’d be able to see what the other person is doing real time, we’d be able to share notes and to have less burden with it. But that’s gone way to the other end where there’s evidence that nurses feel that this is actually one of the biggest issues that they have with workloads: where the documentation prevents them from spending more time with their patients.”

Looking ahead as more technology, automation and emerging fields like artificial intelligence begin to change the way healthcare is practiced, hospitals and nurses should continue the dialogue to ensure it works for the nurses who are stretched thin already, she said.

“We, as nurses, have to question and advocate for these things to be implemented broadly.” Dr. Boston-Leary said. “And yes, it’s going to cost institutions money, but there’s a lot that can be saved on the back end, with retention and recruitment. These are all things that build towards a healthy work environment, which is what we all want for each other. There’s evidence that shows how the staffing crisis and nurse wellbeing impacts physicians too. So, they should also be advocates for beneficial technology automation for nurses.”