1. Biddle, Sunny BSN, RN
  2. Milstead, Jeri A. PhD, RN, NEA-BC, FAAN

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Today's nurse manager must be on top of direct patient care, the needs of families, and the requirements of agency administration. In addition, we must understand federal and state laws and regulations that have application to our role. When it comes to policies regarding electronic health records (EHRs) and telehealth, we must also have a working knowledge of informatics, including an understanding of the interface among computers, technology, finance, and patient data. Knowing how to analyze information and data enables us to provide evidence of the fiscal impact of nursing care.

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One of the tenets of the Affordable Care Act (ACA) is that all healthcare agencies maintain EHRs for quality, safety, and efficiency, and these EHRs must demonstrate meaningful use.1 In the past, agencies simply moved paper records onto electronic storage devices, such as floppy disks and external hard drives. However, that process didn't allow for the sharing of information or data between healthcare providers. Stored data didn't indicate how many patients had diabetes (or other chronic conditions), how many patients fell during hospitalization, the mortality or hospital-acquired infection rates, length of stay, or other important information. As nurse managers, we need to utilize information from the EHR to show meaningful use. Therefore, we're important to the process of determining how information is organized and categorized within the EHR.


We often write monthly reports to address whether our departments are successfully meeting quality indicators. We're also responsible for communicating the results to staff members and the administration. For example, if clinical nurses are reporting post-op infection rates, do you have access to the EHR to determine common patterns, such as staffing, skin preparation, pre-op antibiotic use, and the temperature and humidity of the surgical suites? If not, then your EHR isn't providing meaningful use as designated by the ACA. What can you do about it?


One scenario involves the process of changing policy. Suppose you find that there's inconsistent and/or incomplete documentation within the EHR to address the issue of infection in the OR. Consider convening a small group of colleagues who are invested in resolving the issue, including an IT specialist, selected frontline staff, and the staff educator. This group will study the issue of incomplete documentation in several areas to pinpoint particular items necessary for more complete records. At this point, the group can submit recommendations to administrators and eventually progress through the organizational decision-making hierarchy.



In a related area, policies concerning telehealth are important for us to know. How often do you find yourself collaborating with offsite providers regarding treatment modalities for onsite patients? Do you talk with physicians, pharmacists, psychologists, physical therapists, or others? Do you use phone calls, faxes, text messages, or mobile applications during your consultations?


Many organizations find themselves unprepared for the continual expansion of telecommunication usage. Healthcare providers are becoming available 24/7 for consultation by way of mobile devices, such as cell phones, tablets, and other communication tools. These devices have the ability to store and transmit patient records for quicker evaluation of the patient's condition. Nurses are often the "middle man" in telecommunication or telehealth processes because they have current clinical information on patient histories, conditions, and treatments. Nurses are also responsible for coordinating care by improving communication between and among providers.


Nursing staff members need to have a working knowledge of all devices used to transmit information, as well as being cognizant of security issues related to telecommunication. For example, when transmitting an ECG reading through e-mail or text message, the nurse must be sure to have gathered and entered the recipient's information correctly or the patient's information could be routed to any number of individuals. For this reason, we must ensure that our staff members are mindful of HIPAA regulations and other issues of security and privacy.


Utilizing EHRs, mobile health applications, or e-mail can be a liability for a healthcare organization if there's a breach in patient confidentiality or privacy, which is why organizations must have policies in place that guide the use of telehealth and communication. If you believe that a particular policy within your institution is absent, outdated, or not addressing new practice areas, consider this approach:


1. Put your issue in writing addressed to your supervisor. You'll be taken more seriously if you follow the chain of command rather than first going to senior administration.


2. Examine current policies to determine if they can be amended or adjusted to fit your current concern.


3. Find policies at other organizations or within other sections of your organization that fit the issue. Bring copies of these policies to meetings during which the issue will be discussed.


4. Volunteer to help develop a new policy.



It may take more than one try to get everything that we feel is essential addressed in a policy. Don't give up-persistence pays. Remember to use your informatics skills to provide data that will convince others to support your efforts. In the end, we're accountable for patient safety and quality care. Being a policy advocate is being a patient advocate.


Our changing role

Part of our leadership role is being knowledgeable about existing policies, asking questions about new policies, and making suggestions to improve them. As nurse managers, we're a valuable resource and should be at the table when issues are discussed that directly relate to nursing, especially when they affect patient outcomes.


Is there a mechanism at your organization through which nurse managers can learn and share information about anticipated or new policies? If your organization doesn't have a committee or other means of input, you may have to begin a discussion with your supervisor about the importance of sharing information before it becomes policy. Have you been in a position where your input may have made a difference in how a policy was put into service? How can you make sure that your knowledge is shared during the policy making process?


We must be very aware of how technologic innovations impact nursing practice and embrace our dimension of influence. Policy making without nurse input will be incomplete and may lead to problems with implementation. It's time that nurse managers speak up with the authority of our education, credentials, and experience.




1. U.S. Department of Health and Human Services. Key features of the affordable care act by year. [Context Link]