Associate feature: Nursing the cognitive overload

Nurses can do it all, but they shouldn’t have to do it all alone. If the COVID-19 pandemic did anything positive for our healthcare professionals, it was to highlight the long-known, often-accepted problem that exists in nursing.

Nurses are a one-stop-shop for information. Whether you are the patient, the family member, or the doctor – everyone calls on nurses for the most up-to-date information.

Being the gatekeeper of information comes with an invisible burden – a hefty cognitive load that all too often can lead to burnout and errors.

The mental load of nursing encompasses remembering a lot of information in different categories: the timing of tasks (when to take vitals, administer medications, draw blood for testing); which numbers to call (such as who is the on-call doctor, who is the nursing supervisor this shift, is the cardiology consultant in the clinic or the administrative office today); and the context of information (for example, is a lower lab result cause for alarm, or is it actually an improvement from previous results).

This mental load can quickly turn into overload because nurses don’t have the ability to control when – or how fast – information comes to them.

Great nurses are the foundation of quality healthcare. To be great, our nurses commit a lot of information to memory.

Some of the memorised information absolutely should live in their heads. While other information, as long as it stays readily accessible, could ‘live’ somewhere else, like a piece of technology.

“Chaotic, unpredictable work environments can take a toll,” said Rhonda Collins, DNP, RN, FAAN, chief nursing officer, Vocera Communications, Inc, at Holyrood Connect Digital Health & Care Scotland Annual Conference and Awards 2021 panel discussion on delivering digital solutions at pace.

“Now more than ever, we must protect the mental and emotional well-being of our clinicians.”

This is where leveraging technology can help reduce the cognitive load nurses carry with them every shift, such as the Vocera Smartbadge – a wearable hands-free device that can even be used while worn under personal protective equipment (PPE).

Using simple voice commands, nurses at the bedside can relay information to other members of the patient’s care team as well as receive alerts by providing the ability to call by role.

Vocera even removes the need to constantly update on-call sheets or remember which team members are on shift. Nurses can simply say, ‘call the on-call radiologist’ to be connected to that consultant.

When COVID-19 came about, nurses often felt trapped by their PPE. Once donned, clinicians didn’t want to doff it prematurely and waste high-demand resources. Nurses, covered in PPE inside patients’ rooms, felt isolated.

“[Vocera] has been a life saver during the pandemic,” said Saroj Patel, PhD, chief digital and innovation officer, Royal National Orthopaedic Hospital at Holyrood Connect’s annual conference and panel discussion.

“Because the badges can be used underneath your PPE, staff can communicate very easily hands free without having to take it off.”

Vocera provides advanced connectivity, which can be life-saving in critical situations, while outdated technology, such as pagers, are no longer fit for purpose, failing miserably in comparison with modern communication solutions.

The Royal National Orthopaedic Hospital (RNOH) started incorporating Vocera two years ago when it moved into a new facility. One of the first tasks of implementation, RNOH replaced all bleeps in the hospital with Vocera. All clinical staff use Vocera to communicate.

With this change, RNOH saw a major improvement in its crash team response. Before Vocera, the crash team was assembled primarily through a process that required a nurse to initiate a call to an operator who could send out the necessary bleeps—which could take nearly two minutes to complete.

Since switching to Vocera, the crash team assembly time has dropped to less than 30 seconds, which can be a life-saving improvement when a patient is having a heart attack.

There is an assumption technology only adds to the mental burden. But in reality, analysing existing processes and workflows to identify potential bottlenecks or obstacles should be done before deployment.

This should then help ensure that technology is properly adopted and utilised and therefore an effective solution that actually delivers improvements and efficiencies, providing a return on investment whilst reducing the burden upon users.

This is the principle behind an all Vocera platform and customer deployments. With Vocera, the user is able to define how the technology works, instead of the technology defining how the user works.

The Vocera Smartbadge, for example, can be customised to learn the user’s voice through PPE; it can learn a command to hold calls; and it can push through only alerts the user deems high priority, letting all other alerts remain accessible from a workstation.

As Dr. Lesley Holdsworth, clinical lead for Digital Health & Care, Scottish Government, summed up during the Holyrood Connect panel discussion, the pandemic has created a new urgency to incorporate more digital solutions.

While the pace and scale of these changes cannot be maintained long term, the momentum to move us forward should most definitely continue.

This article was sponsored by Vocera.