When Melanie Weigeshoff joined Hackensack in 1998 as a nursing assistant, the hospital was still in the dark ages. Most medication orders, lab test results, and doctors' instructions for patient care were recorded on paper, in giant three-ring binders. Weigeshoff was constantly on the phone clarifying doctors' quickly scribbled notes, and she spent hours chronicling her patients' progress by hand. "We were always flipping, flipping, flipping through pages," she recalls, re-enacting the frustration with frantic waves of her arms.
Today that primitive hospital is just a memory for Weigeshoff, 26, now a staff nurse. Although she still uses paper on occasion, her primary tool since 2003 has been a laptop-on-a-stick, a PC that rolls around on what looks like an IV stand. As she greets patients at the start of each shift, she logs in to their electronic records through a wireless connection. She reviews vital signs -- temperature, heart rate -- which had been tapped into the computer by a nurse's aide earlier. Then she clicks over to the medication orders, making a note of each dose on the computer after she delivers it. "Charting is more accurate now," she says, "because we're right there, doing everything in real time." Best of all, she has shaved an hour of overtime off her day.
As the hospital industry grapples with an unrelenting nursing shortage, technology has taken a leading role in keeping employees like Weigeshoff happy. Many of the demands of managed care have been heaped onto nurses, burdening them with more patients to care for in less time and an endless flood of paperwork. The pressures have driven so many out of the profession that the supply of nurses is expected to fall 20% below the demand by 2010. Surveys reveal that one out of every three nurses under 30 plans to leave the job within a year. Technology that makes nurses' jobs easier won't be a panacea, but "it's an important consideration in making the hospital a better work environment," says Carol J. Bickford, senior policy fellow at the American Nurses Assn.
Technology is lightening Weigeshoff's administrative load in all kinds of ways. As she prepares to visit patient Alvest Williams, she grabs the laptop and wheels it into his room. Earlier that day, a roboticized sorting machine in the pharmacy downstairs had read Alvest's prescriptions on his electronic chart and sent them to Weigeshoff's unit. As she checks each prescription on the screen, Williams calls out the names of the drugs in her basket to make sure Weigeshoff has everything, gesturing toward the laptop as if it were another person there to help him feel better. "Protonix?" asks the 60-year-old, who is recovering from pneumonia. "Yep," says Weigeshoff. In the past, she would have had to collect handwritten prescriptions, enter them into paper charts, and fax them to the pharmacy.
For Weigeshoff, the laptop-on-a-stick frees her to be the nurse she dreamed about being when she was a little girl growing up in northern New Jersey. As a teen, she relished the job of big sister, coddling her toddler brother and sister when they needed a Band-Aid on a scraped knee or a kiss on a bumped head. "I love taking care of people," says the ebullient nurse.
But when she first started in nursing, she often struggled to find time for the caregiving part of her job. She was always on the phone with the pharmacy, pressing them for medication refills, or with doctors, trying to decipher handwriting. Now the system ensures that the pharmacy gets drugs to nurses on schedule and that almost every piece of information she needs is at her fingertips, from what insurance plan her patients are on to what tests they've had in the hospital.
Weaning the nurses off traditional paper charts isn't always easy, though. "On the first day we go live on a unit, everyone wants to kill me," says Teresa C. Moore, the hospital's manager of clinical informatics. She oversees the rollout of the technology to the nursing units, with about 50% equipped with wireless computers so far. "It's a drastic change."
Unlike most of the doctors at Hackensack, the nurses are hospital employees and are required to use technology in their jobs. Moore runs weekly user groups to gather feedback. The first day the system went online, for example, nurses complained that the diabetes-treatment insulin was listed on the computer as a regularly scheduled medication. But nurses have to adjust insulin dosing based on patients' blood-sugar levels -- a process they struggled to record because the hospital deployed the software incorrectly. The nurses protested so loudly that Moore and her team worked five days straight to fix the problem.
Weigeshoff welcomes any technology that will make her job easier. Paper charts won't go away anytime soon -- the hospital still requires printed copies of everything entered in the computer, and some notes can't be made digitally yet. "I would love to never have to write again," she says. A dream? Maybe. But at Hackensack, it's getting closer to reality.