Hi, I am needing to reply to both question 1 and 2. 

1. When implementing a new information technology system in an agency, who are the most resistant, why and what would you do to decrease that resistance.

I think many people would inherently say that older staff members and senior/long-term staff memebrs would be the most resistant to implementing a new IT system, but I think there’s more to it. I did find studies showing that to be true (Califf, Sarker & Sarker, 2020) but also found other factors at play. Nurses reported feeling overly burdened by new technologies, feeling torn between their roles as patient caregivers and equipment technicians (Smith & Palesy, 2018). Many staff members reported not receiving sufficient, if any, notification of using a new IT system nor training on the new system and attributed this to their dislike of its implementation (Ko, Wagner & Spetz, 2018). Without being provided any explanation as to why changes were being made, staff assumed changes were based on favorable financial conditions for the company while not receiving any incentive or explanation for themselves (Ko, Wagner & Spetz, 2018). Frustrations with HIT have exponentially increased since the onset of COVID, where nurses have less time and resources to implement workarounds to inefficient or malfunctioning technology (Dykes & Chu, 2021).

I would decrease that resistance by ensuring that any changes are done with the intent of resolving a known or suspected issue, or to improve functionality for users. I would consult with those who would be affected by the change on how best to design and implement it. I would ensure adequate training for users, as well as 24/7 on-site support to assist with any issues.

2. Use your current clinical setting (practice or clinical experience) for responding to below.

a) Has adequate formalized training on the electronic health record (EHR) (or technology if no EHR) been conducted?  Have all health care providers been given basic computer instruction? Have the point of care (staff) nurses been involved in the selection, planning, implementation, and evaluation of the system?

No, not at all. I just started working as a PCT at the end of December after not working in a hospital the last ~2 years. I was given one 1-hour “class” on how to use the hospital’s EHR. It wasn’t even a class, it was a self-led module in a computer lab with a few videos. I took a 10-question quiz to pass the class and be cleared to start working the floor. I was told the nurses get one 4-hour class, but I still think that’s not enough time to go over everything. If we need help with anything we have to call IT, where it’s not uncommon to sit on hold for 20+ minutes. This is almost impossible to do during a busy shift and results in a workaround of people using other staff member’s badges and logins to complete their own tasks.

b) Based upon your above responses. What top 2 recommendations would you make and why? (You must include support.)

One area of previous experience for me is in public health, where we follow a public health ethics framework for policy decision-making. One of the considerations is to collaborate with the target population to identify problems and design solutions, vs. imposing upon them (Childress et al., 2002) and I think that approach is highly effective in many other situations, here included. People are more likely to be receptive to change if they feel they have a stakehold in the changes and that their opinions and perspectives are wanted and considered.

Another recommendation I’d make is to invest in quality technology. One study found major dissatisfaction among nurses after the implementation of a Barcode Medication Administration (BCMA) system to scan medications to ensure the “5 Rights of medication administration.” Despite nurses’ understanding that this change was done to improve patient safety, nurses reported frequent instances where scanners or barcodes were malfunctioning, requiring them to have to leave the patient’s room, find another computer workstation, return to the patient’s room, log back in, and start all over, costing tons of valuable time (Dykes & Chu, 2021). I’ve personally dealt with the oldest, most beat up, cheap and awful pieces of equipment at work. It doesn’t help us complete our jobs, it doesn’t help the patients receive better care, but it does cause us to get dinged by administration for “low compliance rates” with using various tech, which in turn affects our performance evaluations and raises.

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