1. Doucette, Jeffrey N. DNP, RN, LNHA, CENP, NEA-BC, FACHE

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Q I continue to struggle with nursing staff and physicians using text messaging on their personal devices to communicate information about patients and their families. I feel like I'm the only leader who enforces the no texting policy. What advice do you have to help?

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As texting, e-mail, and other forms of electronic communication from portable devices have become the accepted standard of communication, the challenge for leaders continues to grow. Advocates argue that the use of portable electronic devices is more efficient, which improves patient care. Opponents are concerned about the unique challenges in the healthcare setting, such as patient confidentiality and professional liability. What's clear is that the use of portable electronic devices is only increasing and the key issues related to this form of communication must be addressed.


One area to consider is how your staff members are using portable devices: for work purposes, such as references, drug calculations, and processing orders, or for personal and social reasons. This is difficult because the last thing a busy nurse manager needs to be doing is monitoring everyone's mobile device utilization.


In November 2011, The Joint Commission issued a declarative statement specifically banning the use of text messaging for physician orders, citing the inability to verify the person sending the text and being unable to transfer the original message to the medical record as a means of order validation. However, it updated this position in May 2016 stating, "licensed independent practitioners...may text orders as long as a secure text messaging platform is used and the required components of an order are included." Shortly thereafter, in partnership with the Centers for Medicare and Medicaid Services, The Joint Commission reversed the May 2016 decision once again, banning the use of text messaging for orders.1 The major issue is how to monitor this activity when staff members use nonorganizational mobile devices.


Unfortunately, this is yet another item that's landed on the list of the nurse manager's duties. Often, these activities can be limited by having language in your policy that requires standards for portable electronic device communication, such as encrypted data transmission, sender and recipient verification, and documentation in the medical record. This isn't feasible unless every person carries a device issued and managed by the organization.


The most important issue that needs to be immediately addressed is the inconsistent application of your organization's policy. I recommend talking with your peers about how they hold staff accountable and then assess the level of enforcement. If you find that you're indeed one of the few enforcing the policy, this warrants a discussion with your nurse executive and human resources representatives. Either the organization needs to hold all leaders to the same expectations related to how the policy is operationalized or the policy needs to be changed to allow the activity that's occurring.


The other issue to consider is the amount of distractions and interruptions created by these devices during the provision of patient care. Distractions from portable electronic devices have been demonstrated to adversely affect everything from basic concentration to critical activities such as medication administration. In addition, recent articles have identified that the increased use of electronic devices has actually reduced the amount of time clinicians spend with their "eyes on the patient." I frequently find that staff members believe they're immune to the effects of interruptions. Raising awareness among your staff and physicians is also a good strategy for ensuring that staff members maintain more focus on the patient rather than the device. Processes around the use of portable electronic devices should limit distractions and minimize interruptions, especially during critical phases of care.


Although this issue is never an easy one to manage, it must be managed nonetheless. Taking time to educate healthcare providers on the perils and pitfalls of electronic communication in the clinical setting, particularly regarding HIPAA, risk management, malpractice, and liability, is always a great place to start.




1. The Joint Commission. Clarification: use of secure text messaging for patient care orders is not acceptable. [Context Link]