Digital Technology Still Failing Community Nursing Teams
6 February 2023
The Queen’s Nursing Institute has published the results of a new survey of digital technology in community nursing. The ‘Nursing in the Digital Age’ report (2023) is based on an online survey completed by almost 1200 practitioners during 2022.
The survey results show that digital technology is being used creatively for a wide range of work and its use is firmly embedded across community nursing practice. Technology influences how, when and where nurses interact with patients and deliver their care.
Despite this, many nurses report that the application of digital technology in practice is poor and many feel that it is not saving them time, when time is at a premium.
The survey responses were compared to the previous survey of digital technology carried out by the QNI in 2018, which enabled some trends to be identified. Examples include:
- In 2018, around 85% of respondents reported issues with mobile connectivity. In 2022 this figure was around 87%.
- In 2018, 32.7% reported problems with lack of compatibility between different computer systems. In 2022 the figure had risen to 43.1%.
- In 2018, 29.5% reported problems with device battery life, but in 2022 the figure was almost 53%.
Overall, the community nursing workforce has a high level of digital literacy – poor user experience appears to be around design and function, rather than a lack of computer literacy or enthusiasm. The workforce has an appetite for new technology and can see the potential of new applications, for example in managing wound care or long-term conditions. Indeed, some have taken an active part in the design of local solutions.
Detailed survey responses show challenges regularly encountered by community nurses include short battery life, unsuitable hardware and software, old and cumbersome laptops, authentication challenges, use of multiple platforms, lack of integration and repetition of data entry. Ergonomic issues featured frequently, with heavy laptops and working while sitting in a car seat as major concerns. Some nurses felt unsafe doing this or were worried about confidentiality, thus taking work home to complete in their own time.
The survey results suggest there has been little improvement in either provision or functionality of community nursing technology in the past four years. Scheduling platforms were not generally seen as enablers of efficiency of work. They were felt to enable ‘tick box care’, leaving insufficient time for nursing work and caused workload intensification. Nursing professionals do not like the loss of autonomy, which is a staff retention factor in a workforce that is already fragile and under increased stress.Professor Alison Leary MBE, lead author of the report
The nursing profession has a proud history of embracing new technology at pace and at scale, and this aptitude and desire is as strong today, or stronger, than it has ever been. During the Covid pandemic, technology played a vital role in enabling professionals and patients to communicate safely and remotely, and existing barriers to data sharing were overcome in order to expedite care.
It is disappointing that many challenges which were reported in 2018 are still very much live issues for nurses working in the community today. There is real potential for the benefits of digital technology to be realised should these and other challenges be addressed. The QNI calls upon all those involved in the design, development and deployment of new technology to work together with the nurses who use it every day, to enable them to deliver truly personalised care to the people they serve.Dr Crystal Oldman CBE, the QNI’s Chief Executive
Scheduling Tools, Remote Monitoring and Virtual Wards
Survey responses show that electronic health records and similar platforms are not viewed positively by many community nurses. Views were very mixed around productivity gains and work capture. Some scheduling tools are reported to cause workload issues including over-allocation of work, unmanageable workloads and loss of personal autonomy. Systems were felt to be impersonal and not well designed, acting as a barrier to interacting with patients. Work was intensified by repetition, often requiring dual entry of data because of poor connectivity or design. Overall, respondents did not feel that electronic scheduling improved time for care or increased productivity.
Of the 1184 responses, 703 did not use remote monitoring. Of those that did (481) the most common was the use in specialist long term conditions management by specialist teams. However there appears to be an increased expectation that community nursing and general practice teams will manage and respond to remote monitoring initiated by hospital services.
The report suggests there is limited interaction with suppliers, vendors or decision makers in the design, purchase or deployment of technology. Nurses often stated that technology, particularly that which schedules their work, is deployed without consultation, user experience trials or impact assessments.
Most respondents did not have access to a lead nurse for technology or did not know if one was available. The absence of nursing leadership might account for some of the problems described.
Recommendations from the report
- Obsolete devices should be replaced with up-to-date models. The cost of using obsolete devices in terms of lost time and efficiency is likely to far outweigh the cost of purchasing new hardware.
- Nurses should be consulted at an early stage in the choice of hardware for use in community settings to ensure that it is appropriate and safe for its designated use.
- Companies that design mobile devices should be called upon to improve future designs of those used by the community nursing workforce, actively seeking nursing feedback.
- Nurses should be involved at an early stage in the design and development of software programmes that they will use as part of their everyday work.
- Healthcare provider organisations, commissioners and policy makers should undertake national, regional and local reviews of Wi-Fi internet connectivity in all areas where their services are delivered and understand how this is directly impacting on the work of nurses delivering care in people’s homes and communities.
- Healthcare services and supporting organisations could usefully campaign for improved internet connectivity and ask for increased investment by mobile phone operators and government.
- Scheduling tools and related apps should always be designed, developed and used in a manner that is consistent with the nursing process, professional judgement and autonomy, personalised care and patient need.
- All healthcare providers should have a nurse who is appropriately experienced and skilled to lead on the use of digital technology within the organisation.
Notes to Editors
The new report was authored by Professor Alison Leary MBE, Director of the QNI’s International Community Nursing Observatory (ICNO), and Dave Bushe, ICNO Data Analyst.
Over the last decade, the QNI has been tracking the use of digital technology by nurses, publishing the report ‘Smart New World’ in 2012 and ‘ Nursing in the Digital Age – Using Technology to Support Patients at Home ‘ in 2018.