Health IT and the nursing shortage
We have a huge and growing shortage of primary care physicians. We are importing physicians to partly fill the need.
While this does not seem apparent on the ground, it becomes obvious once care is guaranteed and demand jumps to what should really be considered normal.
There is a second shortage we don't talk about, one related even more directly to the need for better health IT.
That's a nursing shortage.
While the shortage of doctors can be seen in how many are aging, and how few are coming out of school willing to go into general practice, the shortage of nurses is seen best in first-year burnout.
Most analysts seem to think health reform will help cure this problem, but I think health IT will do more.
The biggest reason cited by nurses for washing out of residency is confusion. They are given a lot of work and not a lot of information. Give them more information and they gain confidence. Tell them what to do -- the goal of evidence-based medicine -- and the confusion disappears.
A second, perhaps more important factor, concerns control, usually an issue for doctors.
Health IT gives nurses a lot more control. They often learn the system faster than doctors. IT is an important element in their on-the-job training.
This can change power relationships in important ways.
- Nurses may be depended upon to deliver complete backgrounds on patients to doctors who lack IT training.
- They have the proper protocols in front of them.
- As checklists become common they may know more about what to do next than the doctors.
- Nurses will be seen as experts, not just helpers.
We have discussed here how many want to make nurse-practitioners the front line troops in health care. The goal is to save money, but the route to that runs through IT, which gives them both data and close contact with doctors in providing care.
The nursing shortage will be as tough to cure as the doctor shortage, but health IT and the changing power dynamic that can emerge from it seems to be a big part of the solution.