1. Hislop, Joyce RN, OCN


Electronic medical records prove a stubborn technical challenge for a seasoned clinician.


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In our oncology practice I am, at 68, the symbolic "golden girl" of a four-generation RN staff of six. My colleagues range in age from 25 to 50. Our lives and career experiences vary, but we share a passion for the challenges and advances in oncology nursing.

Figure. Illustration... - Click to enlarge in new windowFigure. Illustration by Janice Kun /

Always in my mind, however, is the uneasy, nagging sense that to these younger nurses I'm an old dog learning new tricks.


I joined the practice two years ago. During my initial interview, the office manager and the clinical coordinator were pleased with my oncology experience, but hesitant about my inexperience using an electronic medical record (EMR) system. Would I be able to achieve the proficiency level required? After spending time observing a nurse using the system, I told them I could learn to manage it.


Goodbye paper charts! Now I was the conductor of a desktop computer and a laptop-at first unable to quickly switch between the two EMR programs using a single computer, I needed two computers-plus a pager from the infusion room nurses that went off at annoying times and never carried any good news.


Several required computer orientation classes later, I was still entering and extracting information at turtle speed, the by-now-tattered EMR reference manual always within reach, my peripheral vision furtively searching out any colleague to ambush with yet another question. Soon I began cornering the market on Tums. Despite support and patience from management and colleagues, I felt my confidence and job security going down the tubes.


Staffing issues dictated that my orientation time be accelerated, and before the normal three months were up I was assigned to partner with a physician. Now I couldn't afford to dillydally over the keyboard. So I'd complete the patient care documentation portion of the EMR, but skip the billable service fields, thinking I'd fill them in later. Unfortunately, "later" became haphazard and then hardly ever. The billing department sent me daily agitated reminders to clean up the shocking number of data omissions and errors.


Near defeat, I initiated a conference with the clinical coordinator. She enlisted the help of a young systems operator. Tom (not his real name) came to spend some time with me at my computer. In retrospect, I see that he did the best he could with the raw material he had to work with. He was very good, directing his fingers unerringly over the keyboard as I struggled to observe each pathway he used and to jot it down step-by-step in my little black book. Flushed with embarrassment, I'd ask Tom to verbally walk me through something he'd just demonstrated.


After an hour he began to realize that I was still in EMR limbo. His attitude became a tad condescending, his directions bordering on sarcastic. I told myself he was a nice guy; he was just reacting out of frustration with his pupil. Gathering what little dignity remained, I stayed mute and coolly looked him straight in the eye. "Well, Thomas," I was thinking, "someday you'll be 66.


The electronic charting system became anathema to this paper chart nurse-at some point every day I'd want to either throw up or cry. After months of this struggle and continual dependence on coworkers to bail me out, I wrote a letter of resignation.


The manager and clinical coordinator considered my reasons and spoke to the other nurses, all of whom seemed to value my nursing experience over my EMR difficulties. Their suggestion was that instead of partnering with a physician, I do all the daily nurse visits, until now shared among the six nurses-a change that freed them up to focus on uninterrupted work with their assigned physicians. My role involves vascular access device lab draws and flushes, symptom management, teaching self-injection, and other nursing responsibilities. The EMR system for these duties is quite manageable. My dignity was spared, my confidence renewed.


I see many patients on a regular basis, and have developed their trust. If I'm not in the office on one of their visits, they'll mention it when they see me next. I still have the occasional mental block when completing an EMR entry or remembering an information source. Thankfully, my peers are never too busy to recharge my spirits. But I have to say, if this hospital switches to a different EMR system, it may be time to quit while I'm ahead.