In the recent BMJ opinion piece, titled, ‘How the nursing profession should adapt for a digital future,’ Booth et al (2021) have made some interesting assertions, and point to a number of strategies, such as education and leadership appropriate interventions to improve digital nursing.

However, as a digital nurse in the UK, I would argue that some of their generalised assumptions are simply not transferrable to the NHS. One such example is their contention that, ‘nurses have generally not kept pace with rapid changes in digital technologies and their impact on society.’ I would suggest that nurses in the UK have had no choice about keeping pace with technological advances. Most would prefer to work for a digitally enabled hospital and will embrace change when they get the opportunity – but they are often held back by the NHS organisation that they work for.

Digital maturity is still wildly variable, depending on where you are in the country. If a nurse is lucky enough to be working for a big teaching hospital, such as Addenbrooke's, then they are much more likely to be digitally progressive. However, if they are in a district general hospital that is struggling for funding, then they might be less digitally enabled.

Early days for digital nursing

The challenges faced by the NHS are different to those encountered overseas. When it comes to nurses progressing digitally, a lot of these are related to ‘coming to the party’ a little late. In 2016, the NHS appointed the first national Chief Information Officer (CIO), and Chief Clinical Information Officer (CCIO). It would be another four years before the first national Chief Nursing Information Officer (CNIO) role would be recruited to.

The role of CCIO within individual organisations quickly became viewed as a doctor role, usually consultants given a few Programmed Activity slots (PAs) per week to carry out their CCIO duties. As NHS organisations moved forward with digital programmes, especially the large teaching trusts, more nurses saw the impact they could have working in the digital space and more roles became available, including local CNIO roles. However, at this juncture, many NHS organisations do not have digital nurses or - if they do - these roles are often at project level rather than CNIO level. Perhaps, the lack of digital nurses gives a false impression that nurses are not engaged in the digital revolution of the NHS.

Nurses are the largest NHS workforce, they have more patient contact and collect more patient data than any other healthcare professional, thus when clinical technology is deployed in an NHS organisation, if nurses were to block this transformation, the NHS would be failing to move forward.

That is not the case. When given the opportunity to use a system that is going to improve patient care and make their working lives easier, the vast majority of nurses welcome technology. They are excited by it and, indeed, many will now look at how technologically advanced an NHS organisation is when applying for posts. There may be some initial nervousness, particularly within the older cohort, but that is soon resolved when they use a well-designed intuitive system.

Getting the right people into digital transformation roles

A critical element to nurses adopting technology is organisations understanding that digitising a clinical process can be complex and requires a transformation leadership approach.

One of the main issues with hospitals is that they’re sailing into unchartered territory. They have never gone through a clinical digital transformation before – so, while they recognise that they will need to get people in place to help roll out the new systems, they don’t know how much knowledge or experience those individuals need to have. I have seen instances of hospitals putting a Band 7, mid-level nurse in place for a year on secondment, a ward manager, or a senior sister, and then expecting them to digitise the organisation’s entire nursing practice. It’s not realistic and leads to disappointment and burnout.

Making the decision to go digital is a crucial step, but it certainly isn’t a magic bullet. Take electronic observations, for example, which removes the need for paper charts, and is often touted for its money and time-saving benefits. Despite its value, there are a lot of ingrained customs and practices that can be hard to shake. If the nurses and healthcare assistants using e-observations tools aren’t educated properly on how to use them – including how and why to escalate an alert for increased observations, if they stick to their traditional four-hourly checks, regardless of what the tool is telling them, then you’re left with nothing more than a fancy calculator and won’t get the full benefit of the system. It takes skill, knowledge, and experience to change an organisation’s culture, custom  and practice, which is why having strong, knowledgeable leaders in post is so important. Putting the right nurses in at the right level can mean the difference between a digital system missing or exceeding expectations.

Creating and nurturing digital specialists

Digital training and education is imperative – both to upskill nurses and to raise awareness of its importance amongst their employers. In ten years’ time, we won’t be talking about digital healthcare. Healthcare that is digitally enabled will be the norm, and AI and machine learning will be making its mark. It will completely change clinical practice for nurses, and the profession needs to be prepared.

Digital nursing should be a speciality, just like infection prevention control, tissue viability, pain, palliative care, and other areas. There needs to be a clear pathway from being a digital nurse at Band 7 through to CNIO, preferably at board level, if that is your ambition. Digital enablement is shaping the future of healthcare in the UK, and we need specialists to help every progression that we make digitally.

Thankfully, this is now on the national agenda with England’s first CNIO, Dr Natasha Phillips, brought in by NHSX, calling for career pathways to be put in place for nurses working in the digital sphere, ‘to ensure they are properly valued for the complex work they do.’

Initiatives like the Early Digital Healthcare Leadership Programme, which is the result of a partnership between System C and the Florence Nightingale Foundation, are also encouraging steps forward. It has been designed for individuals who are embarking on a career in digital leadership, including nurses, with the aim of helping them maintain effective patient care while simultaneously embedding digital solutions into practice and engaging the wider workforce. There has been overwhelmingly positive feedback from the first group of eight, who completed the programme in October. They all agree that it has given them practical, applicable, and transferrable skills to use in their digital role. I’m looking forward to seeing the programme develop over the coming years, and hopefully it will encourage the creation of other digital training opportunities as well.

Nurses as enablers – not blockers

Rather than nurses blocking digital progression, I strongly believe that nurses are going to be healthcare’s key enablers moving forward. We know that eighty percent of digital healthcare functionality users are nurses. They are the ones on the frontline, using technology to care for their patients in increasingly effective and efficient ways.

There are some fantastic stories about nurses spearheading digital change. I once worked with a hospital that had experienced a dip in the way it was using technology. They had changed their CIO and various other people had moved on, and there was no one clinical in the digital space. Compliance had drifted. However, one young sister took on stroke rehabilitation, which was one of the most challenging wards, and turned it around. She used e-observations (System C’s CareFlow Vitals) and a variety of strategies, including reviewing the data and introducing 15-minute pulse checks. Staff members would help each other out if there was an amber clock next to a patient’s name in Vitals (indicating that they needed observations to be taken). E-observations and data were used more and more to inform patient care.

Observations compliance increased to 95-6% and recruitment and retention improved, as word spread about how the ward was performing. Quality improved, the nurses were in the bays with the patients more, as they were using mobile technology, so falls reduced, tissue viability improved, compliments went up from patients. They became the flagship ward and the first to adopt any new clinical system. This young nurse did an amazing job, facilitating a complete shift in culture, and is the kind of person that we should be throwing our support behind.

The appetite for digital transformation is there – I see it in my role every day. But nurses can’t do it on their own, and they shouldn’t be expected to. They need their workplaces to resource digital transformation properly. There needs to be a better understanding of the digital leadership roles that are required – and then they need to be filled with the right people. This, coupled with a clear, structured education and career pathway for nurses that want to be digital specialists, will result in more leaders coming to the fore. 

Are nurses digital blockers? No. Are they waiting for their employers and the industry as a whole to catch-up, and provide them with the environment and tools that they need to excel as digital influencers? Absolutely, but I am confident that we are heading in the right direction.