The Nurse as Designer: Breaking Down Barriers with Clinician-Center Innovation

Data from the American Nurses Foundation shows that over half of nurses are experiencing burnout due to insufficient staffing and feeling undervalued by their organization. Staffing shortages and burnout necessitate technological resources that extend care teams to make their jobs easier. For these technological tools to deliver on their promised efficiency, nurses need to be included throughout the design and implementation process. 

It may seem counterintuitive to involve them in technology decisions when resources are thin; however, this can actually help with staffing issues. Involving nurses early on can make them feel heard and help ensure the technology being designed, rolled out and purchased will, in fact, help and not hinder their ability to do their jobs. 

Healthcare is traditionally slow to adopt new technologies, and a lack of user-focused design has hindered technology development and acceptance. IT teams typically hold most of the decision making authority, from purchase to design, configuration, and deployment. Including more nurses from the outset helps mitigate the risk of poor adoption. Nurses possess unique insights into patient care, workflow efficiency, and practical challenges faced in clinical settings. Involving them in new technology purchasing decisions helps ensure new products address the realities of the clinical setting and the health system does not end up with a solution that impedes care. 

Integrating nursing expertise into technology design, development, and implementation fosters early user support, establishes credibility with the technology, and leads to significantly better usage across the organization, avoiding the creation of process workarounds. This translates to increased efficiency, improved accuracy, and enhanced patient care. Moreover, reduced friction with nurses using the technology means a greater impact of these benefits, ultimately leading to improved patient outcomes and increased nurse satisfaction.

An RN’s perspective on design and implementation 

During the design phase, usability and nursing workflows should be considered and verified. Nurses are stretched thin and over-tasked. For every action a solution introduces into a workflow, remove two actions. If an AI scribe is implemented, for example, one click is added to approve notes, while two larger actions are removed – capturing notes and transcribing them. 

During my time as a nurse at the bedside, and then in more technology-focused roles, I witnessed firsthand the significant costs and benefits of involving nurses in the design of health technologies. I was a new nurse when EHRs were mandated in the early 2000s following the passage of legislation like HITECH and changes to HIPAA. Many of these early systems were developed primarily by IT departments, often in isolation from nurses. The result was overly complex systems with cumbersome interfaces that did not align with clinical workflows. This led to a high rate of data entry errors, and significant resistance to using the system. My employer had to re-implement the EHR three times before achieving successful adoption. Ironically, the fourth implementation succeeded due to significant changes made based on extensive feedback from nurses during the previous failed iterations. This experience underscored the critical importance of involving nurses from the very beginning of the design process. Had their expertise been integrated into the development process, the team could have avoided many of these pitfalls and deployed a more user-friendly and effective system.

Understand nursing pain points to know they are being addressed. User-friendliness, including the impact on current workflows, is vital. No matter what benefit there is on efficiency or outcomes, nurses are not seeking more screen time. Identifying gaps within new software gives an honest view of its limitations and an opportunity to address them pre-production.

During implementation, be conscious of all possible interruptions to daily tasks, especially as they relate to patient care. Provide the necessary training and support to gain end-user confidence. 

Creating an inclusive, cross-functional team culture

While IT looks at solutions from a non-clinical perspective, its goals are aligned with the rest of the organization. Including more nurses in the teams with engineers and developers who are core to creating and rolling out innovation may require a culture shift. Creating cross-functional teams that leverage varied expertise helps ensure new technologies integrate seamlessly into care environments and enhance clinical efficiency. They can identify the templates and workflows that meet the needs of most hospital staff. 

Making nurses’ time available for collaboration can be challenging with departments stretched thin, trying to run lean and with limited budgets. The nursing community’s feedback around solutions is crucial so advocacy may be needed to get more clinicians involved in innovation to lighten the ask from just a few willing clinicians. 

Another key to creating widely adopted solutions is bringing more nurses with diverse backgrounds onto the team, starting in the design phase and keeping the conversations going. ER nurse perspectives differ from those of other specialties. Vendors can turn to their customer base or potential customers for input, helping them feel heard while simultaneously obtaining invaluable feedback. 

Decision making success: Tech savvy nurses and diverse teams

As more nurses ascend to senior leadership roles, they actively shape technology decisions in hospitals, identifying tools that will make their lives easier or harder, and should be involved in procurement decisions from the start. 

Education programs that blend nursing with tech knowledge are growing to bridge the different perspectives. As technological advancements continue, nursing expertise is crucial in developing, procuring and implementing innovation to ensure that new technologies integrate seamlessly into care environments and enhance clinical efficiency.

Healthcare organizations also benefit from having someone trained to identify and weed out incomplete technology. Some vendors in their early stages sell more promise than product and sometimes it takes knowing what to look for to spot the inconsistencies.

Much discussion, including in this article, has focused on giving a seat to nurses at the technology design table. The reverse is also true. An element of delight and surprise can be gained when nurses keep an open mind about what IT can offer. Maybe IT has a different approach to a clinical problem that may fit even better than what they initially envisioned. Teams with open, cross-functional communication will experience these moments. 

By encouraging cross-functional collaboration, user-centered design and an iterative process that prioritizes the user’s goals at every stage, technology will be better designed and selected to meet clinical workflow and IT requirements.

Photo: Hiraman, Getty Images

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