NURSES AND COMPUTER COMPETENCY
With the advent of the Internet and computers, nurses have information literally at their fingertips, but some cohorts are being left behind. In April 2004, President Bush published an executive order that provides for incentives for the implementation and use of an electronic medical record. According to the American Hospital Association, in 2006, 56% of U.S. hospitals have implemented some form of an electronic medical record and are in various levels of implementation completion (Ruzicka, 2006). With electronic documentation, even those nurses who have managed to avoid becoming computer competent must learn basic computer skills just to maintain the basic standards of care demanded by the new information age.
An intermediate-sized community hospital located in the Southwest converted to an electronic medical record last year, which we named EDITH (Electronic Data Information Technology for Healthcare). Staff development educators in the facility assumed that "everyone" knew the basics of computer literacy but found to their dismay and chagrin that some staff did not possess basic computer skills. The staff's level of anxiety rose dramatically as each unit "went live" on computer documentation. Complaints about time taken from the patient and lost to documentation rose from the staff, and the time spent cajoling, encouraging, pleading, and, finally, threatening the staff into effective documentation became daunting and exhausting for all members of the nursing leadership.
PARTICIPANT POOL
Cries for more training on the computer rose from the staff. The nursing research nurse, to assess the staff's level of computer competency and level of computer comfort, developed an assessment tool designed to look at computer comfort levels and computer skills needs (see Table 1). The nursing researcher distributed 277 assessment tools to the nursing staff and nursing students affiliated with the hospital during the nursing's annual education program in October 2006. There were 135 questionnaires returned, either immediately or via interoffice mail. The questionnaires were anonymous, with the only identifiers being gender and length of time in nursing in years. The respondents were nurses and nursing students who spend more than 50% of their work time involved in direct patient care. The length of time in nursing varied from less than 1 year to greater than 30 years (see Table 2). The participants were from all areas of the hospital nursing staff, with no one unit represented more than others. As would be expected, the women-to-men ratio was high.
DATA COLLECTION
The assessment measured levels of comfort with basic computer skills. The goal was to provide computer education for staff to lower their stress and anxiety levels, and to improve electronic documentation along the way. The respondent's personal perception about each question could be answered by the following: 5 = strongly agree, 4 = agree, 3 = neutral, 2 = disagree, and 1 = strongly disagree.
These responses were keyed into the SPSS statistical program for processing. The computer skills included in the assessment tool ranged from use of the mouse to ability to access and use common software (see Table 3).
INTERPRETING THE DATA
There were no computer skills that the staff felt completely comfortable performing. Those skills they felt the most comfortable performing were very simple: what "caps lock" means, moving the mouse, and printing a document. These skills had some of the highest scores with minimal standard deviations. "I can make the computer function as I want" scored only 3.91, with a standard deviation of 1.2-so the average nurse felt "neutral" about this skill with a deviation of more than 1 point to disagree and agree, respectively. The skills using software programs scored even lower than 3.5, barely a neutral answer (see Table 4).
CONFOUNDING FACTORS
This pool of participants was statistically small, and the number of respondents may affect the validity of the results, but for this hospital, it was an excellent response. The questionnaire has not been validated with multiple studies.
CONCLUSIONS
A more thorough assessment of nursing staff's computer competency prior to implementation of an electronic medical record would have allowed for better planning of training and education. According to Turpin (2005), the conversion to an electronic medical record is not an "automatic process." The author found this to be true in our conversion process. As a result, the educators plan to implement computer skills classes for staff that address all levels of competency: basic, intermediate, and advanced. As a responsible employer, the organization needs to look at staff's needs as well as those of the educators-and computer education will help both staff and educators progress into the age of electronics more successfully.
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