What's hard about nursing?

The physical tasks of nursing -- starting an IV, inserting a catheter, administering medications -- demand a high level of skill and nursing schools teach them well. However, the mental side of the job -- also highly skilled -- gets no attention. Each nurse must figure out for him- or herself how to:

• Do time management (prioritizing, optimizing)
• Remember to do everything (task tracking)
• Efficiently record and recall patient data (vital signs, responses to therapies, progress notes, interventions needed, additional requests e.g. "Tell my daughter I'm going to physical therapy this afternoon.")
• Remember special conditions such as drug allergies, diets, care details (e.g. for a patient who can't swallow pills, not forgetting to bring the applesauce to mix with the meds without a separate trip to the fridge).
• Work fast yet well in what never seems to be enough time.

Remembering to do everything is no small feat. For example, It is easy to forget to chart patient input/output (I/O), a routine task on med-surg (acute care) hospital units for patients with metabolic, digestive, and kidney conditions. It is easy to forget -- for patients with fragile skin -- to turn them in their beds every two hours to prevent bedsores.  It is easy to forget to fetch all the supplies needed for several activities in a single trip to the supplies room.  These are all tasks with low urgency yet high importance; a little early or late does not matter but they must not be forgotten.

In nursing school, on reflection after my clinical rotations, I considered how little we were taught about these essential mental nursing skills. In our classes, we were lectured at great length about physical skills but I recall no professor speaking of the mental ones.

Surely every nurse grapples with this issue. I brought it up with my adviser. Lamely, she suggested keeping a list on a piece of paper in my pocket. That's it??? I also asked the teacher who was the supervisor of one of my clinical rotations. She said we just had to learn to keep it all in our heads.

There is a better way.  After much thought, I devised NurseMind and over the subsequent years have been refining it and building a company around it.  Here is one of my early publications on this topic, in one of AMIA's (American Medical Informatics Association) publications.

Certainly, things can be done the hard way. Thousands of nurses do it every day. How much of our mental energy is consumed by remembering details and keeping track of routines? How much better we could be doing our jobs -- relieved of this cognitive load -- if we could instead focus entirely on activities that demand clinical skill and provide patient care! This is not just a job aid, it is a real safety and quality issue.