Where are all the nurses gone?

One of my friends, quite a successful cardiologist once told me: “I can perform very complex operations successfully, but the good result is likely to be killed by the poor care.” Professional care is absolutely critical for patient recovery process. But it is not unique when patients have to wait for quite a while till the nurse comes to their bed side. The reason is simple: there is not enough nurses in hospitals nowadays even in the developed countries.

The National Healthcare System UK (NHS) is likely to have 47,500 fewer nurses than needed by 2016 [1]. The World Health Organization estimates globally a shortage of almost 4.3 million nurses, physicians and other health human resources worldwide as the result of unsatisfied working environment.


Lack of professional nursing care often leads to medical errors. According to the Joint Commission on Accreditation of Healthcare Organizations, the nursing shortages are responsible for 19% of medical errors resulting in death or serious injury, and that more than 90% of nursing homes lack a sufficient number of health care workers to provide even the most basic care [2]

The reasons that nurses are abandoning their jobs together with patients who need them mostly are mainly not financial. Fatigue, overload and related constant stress as well as often poor communication with physicians leading to conflicting situations are often named as one of the main reasons why nurses are abandoning their profession.

This raises the question of efficiency of the whole care process. For example: how much time a nurse spends on patient care vs. routine administrative functions? I remember the scene in one of the well-known hospitals in Munich, Germany at about 23 -24 pm. The corridor resembled a classroom with about a dozen tables, each occupied by a nurse diligently copying patient data into the medical journal. Medical tests, medications prescribed, what was eaten and what was not, glasses of liquid stuff drank and urinated, etc. If a patient at that busy time would call a nurse, the response would be slow, unless the call comes from the patient bathroom, which often indicates an accident.

Lack of appreciation and often conflicting communication with doctors is another source for nurses’ dissatisfaction. Once I heard a nurse noticing sarcastically: “They (doctors) don’t even talk to us, but we are the ones who stay with patients day and night, and know them much better.”  Nurses do not feel that they are part of the team.  It is not a secret that some hospitals in order to cut costs are replacing a professional registered nurse with a less skilled students.

Could new technologies reduce the burden of routine daily work that nurse have to perform? Could IT help to create a better collaborative environment among all professional healthcare personal , make them understand that they all depend on each other, could learn (not only be punished) from mistakes? If so, it may finally result in a spiral of trust and, as a consequence, a better patient care.

The applications are coming out. Med eTraX, the UK company came up with patient/nursing observations recording system, which allows clinical staff to record a patients physiological signs rapidly and with ease at the patient’s bedside. Designed with Windows 8 technology, the software records and alerts changes of a patient’s condition, ensuring that the appropriate staff are immediately notified. Any deterioration in a patient’s well-being does not go unnoticed or fails actions. Furthermore, the solution is adaptable for using patients’ own homes, providing an enhanced and proactive element of “healthcare at a distance”, which by default dramatically impacts and reduces not only the current cost of care, but time and fatigue related to travels.


With Belgium Electronic Nursing Record (ENR) solution Phebus designed by a company Calidos with Windows 8 Metro style interface, Nurses can easily input information on patient’s vital signs or prescribed medications. The collected data go into the patient’s medical record available to the doctor in charge. All changes in the therapy plan are visible to the nurse immediately. Physician and nurse can working as one team now.

Moving patients from hospitals to homecare not only saves hospitals a lot of money, but offers a comfortable environment which stimulates the recovery. But for a nurse to check up patient’ conditions manually during home visits, than travel back to the hospital to input data into Electronic Medical Record, could be a cumbersome process.  Quite often home health workers have to make repeated trips to/from the central hospital to retrieve and update patient data. To avoid such a hassle Hospitalisation à Domicile (HAD), part of the APHP (Assistance Publique – Hôpitaux de Paris), the public authority responsible for hospitals within the Paris region in France introduced a home care system for nurses. Using the application developed by Avanade, nurses can upload patient data from the hospital DB to a mobile tablet device with Windows 8 OS and update the medical records during patients’ home visits. For example, if a patient is prescribed a new medication by his or her general practitioner or is getting some negative side effects during the treatment this information could be captured at the home bedside and synchronized with the hospital medical record. In urgent cases, a nurse can exchange messages with the hospital medical stuff.


Can IT change a culture of mistrust and lack of confidence in Healthcare as well as optimize care processes? If so nurses could be catalyzers of this cultural change. They are nearly the most advanced and experienced people in IT among the professional Healthcare staff. A total of 77% nurses indicated they work on “clinical documentation,” including Electronic Health Record, 60% dealing with computerized physician order entry system [3]. IT vendors should support nurses with applications as well as training programs to enhance their status in professional healthcare teams. That will help creating a better multi care environment.  Let us hope that the current patients will be able to witness the progress.

  1. http://www.nursingtimes.net/nursing-practice/clinical-zones/management/nhs-to-face-chronic-nurse-shortage-by-2016/5059871.article]
  2. http://womensenews.org/story/health/041123/nursing-shortage-threatens-health-care#.Uq8JBo13vgo
  3. http://searchhealthit.techtarget.com/healthitexchange/healthitpulse/himss-survey-give-it-up-for-the-cnio


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