"Were there none who were discontented with what they have, the world would never reach anything better." Florence Nightingale (1820-1910)
We see technology as a positive advancement in our professional and personal lives. Even in Florence Nightingale's time she recognized that it was important not to be satisfied with the status quo, and she searched for better ways to care for patients. However, the flip side of the coin is progress or change without a clear purpose. It seems that every day there's a technology that promises a better, faster way to perform patient care. The astute critical care nurse should not take this at face value. The important questions that we as critical care nurses must answer are: Does this technology improve patient outcomes? Does it make us safer? Does it make us more productive?
Technology is merely a tool. I am reminded of a new staff RN who paged our attending cardiac surgeon, concerned because her patient's cardiac index was less than 1.5 L/min/m2 and the mixed venous saturation was low. As I responded to the bedside with the surgeon, he gently reminded the nurse of the value of observation. The patient had bounding pedal pulses and was warm, awake, and alert; the lab value number was not consistent with the observations of physical examination. The nurse learned that day that she must perform the additional role of an interpreter for hundreds of data elements. Each data point must be evaluated by the critical care nurse for consistency and accuracy.
Technology can provide additional information about our patients to enable us to make better clinical decisions. However, there will never be a replacement for the skilled observations of a highly trained critical care nurse. Therefore, I believe it's important to maintain that slightly jaded eye when it comes to new technological advances in critical care. We need a balance between those who are early adopters and those who are perceived as being afraid of progress.
This can be a challenge for bedside nurses. But since you are the end users of all new technology that comes into your units, your involvement in the decision-making process to implement new technology is extremely important. Your voice is essential. Perform a self-assessment on how new technology enters your unit. Ask yourself and your colleagues the following questions:
Who evaluates the potential benefits of new technology?
Is there a multidisciplinary approach?
Have you evaluated the research by investigators not associated with the manufacturer?
How is the trial process set up?
Is there a systematic method of product evaluation?
At the end of the trial is the team brought back together to evaluate the data?
This process is time consuming but should be systematic, and the staff RN is a core member. On occasions, decisions on technology are made based on cost. If there's a systematic method of review, cost can be one element, but safety and improvement of patient outcomes and nurse productivity can hold equal weight.
Go back to your units and examine your process-volunteer to do so. Your patients will thank you.
Kate J. Morse, RN, CCRN, CRNP, MSN
Editor-in-Chief, Assistant Clinical Professor, Acute Care Nurse Practitioner Tract Coordinator Critical Care Nurse Practitioner, Chester County Hospital West Chester, Pa.