August 15th, 2011
"The changes we've seen as nurses are amazing. It is now a requirement that you have to have computer literacy to be a nurse. That's a struggle in the field. I can't even say it's just the older folks, either. Some are very interested and want to learn. Some of the younger folks just aren't interested. And when it doesn't work they all get frustrated. It's not as easy as paper charting. What you see on paper doesn't always translate exactly to the computer world. "
Meet Emelita Gobel, RN, MSHSA and Clinical Informatics Educator. She is a groundbreaker within her southern Florida health organization. After 25 years of being a bedside nurse in Med/Surg, home health, the cath lab, interventional radiology, ICU, ER and a stint in research utilization, Gobel was looking for a new challenge. She landed in information technology (IT).
How did you end up with a computer job after all those years of hands-on nursing?
I have been a nurse for 30-plus years, in several departments and at several different places. I was looking for a change, a Monday-Friday job, no weekends. I wanted to be active mentally. You know nursing, it's all teaching. Just three of us started the whole IT department about four years ago. The future is where we are headed. Applications for Outpatient, Inpatient, Intensive Care Units, Emergency—they are all different.
And the department has grown, I take it?
Now there are developers, information specialists who are all nurses and there are educators all focused on computer information. Specialists work in developing the programs along with the IT developers. The educators, we teach the end product. The department is now five and a manager. We have six hospitals we travel between. We cater to each specialty. Main core is trying to connect them in some way to share information, but right now, they don't talk to each other.
So how do you decide who teaches what?
We, as the educators, have to learn them all. Once a computer application is developed we take part in the testing, we are experts on all the programs. We then develop a curriculum, figure out how to make it user friendly, develop the didactic. We have a two-day orientation just for the computer system, then four hours of education is dedicated when new applications come out. We tell everyone to expect information overload. I teach the applications to the new employees.
What's the hardest thing to teach about using the computer for electronic medical records?
I think documentation is like an art. You have to make a story about your patient. I know there are regulatory requirements for charting, but all you really need are the facts about the patient. If we don't chart or chart correctly, we don't get paid. With that said, nurses are getting confused. If there is a template, they think they have to fill it. But if it doesn't apply to your patient, don't fill it in. I think they are afraid to leave something blank. There's a free field if you need to add something else. Some RNs get so overwhelmed that they chart and chart and chart — we get a lot of duplication. I keep telling them, "if you put it in once, you don't need to do it again."
What are the challenges from the IT side of the system?
You may not see flow from "A" to "XYZ." It's fragmented. If you want to document in admissions assessment, click there. If you want a blood pressure or labs, look somewhere else. You may need to go to another page for "Nurses Notes" to enter information that doesn't have a tab. As educators, we don't actively participate in development of the programs and applications. The VA (Veterans Administration) has a comprehensive system. It is the only one I have heard of, but I wish everyone could get there. Right now the OR doesn't talk to any other program; the ER doesn't talk to any other program. As far as even getting into each other's applications, you can't. It's just a documentation system.
What's new in IT for you and your department?
I think any system can be of good use if it is friendly and not cumbersome. We are now purchasing a new system and rolling it out. People are already apprehensive. Also, we are implementing a bar code medication administration system. It's only on the inpatient floors right now, not in the ORs or ERs yet. Another of our big challenges is our program for new grads. We have over a hundred new nurses and there are only five of us teaching.
And for you personally?
What I love about the IT field is it keeps my brain active. Being an expert is good. We get to be creative; for example, we use bedside didactic in our education, but it is also a challenge. We are talking and talking and talking: some people follow you, others pass on ahead.
I believe I am going to retire in this field. My next goal is to get certified in the field of informatics. I will continue to teach, learn the new stuff and see how far we can evolve.