NUR 514 Discuss one ethical and one legal issue related to the use of EHRs that directly impact advanced registered nursing practice

NUR 514 Discuss one ethical and one legal issue related to the use of EHRs that directly impact advanced registered nursing practice

NUR 514 Discuss one ethical and one legal issue related to the use of EHRs that directly impact advanced registered nursing practice

If I recall correctly, charting my nurse’s notes was faster than my paper charting, and I can write narrative events in my paper charting. Electronic charting is very comprehensive, and real-time charting is also important, but many sections are redundant, and some are unnecessary. Of course, documenting is part of the legality in case something happens, so I understand the importance and benefits of electronic charting. I love the bar code scanning administration of medications, as the safety issues are really important. More medication administration errors happened with paper charting. Resources about the nursing practice from technology have impacted my clinical role as I focus more on the education and safety of patients, workflow efficiency, and better communication between different stakeholders involved in caring for my patients.

I have been a nurse long enough to be part of the transition from paper charting to electronic health records (EHR). It has both a positive and negative impact on health care. The shiny side of the coin is it decreases medical errors, centralizes health records, and allows for less fragmented care. On the down side I would say I spend less time at the bedside and more time doing data entry. This was frustrating when I was working at the bedside. Besides being frustrated during the transition from paper to EHR I noticed the younger nurses were dependent on the technology. This dependency is alarming, technology is a tool and the nurses should have the fundamental skills to accomplish their role without the assistance of technology. Another deficit is security how do you keep all this private medical information protected? Cybersecurity is crucial in safe keeping of EHR. I would say the benefits outweigh the risks however, I would be cautious to limit dependency on technology.

 

I have personally never transitioned from pen and paper. I graduated from nursing school 6 and a half years ago! I have heard through the grapevine some of the struggles of paper charting, electronic charting, and how difficult the transition was for some. I have worked with nurses who preferred the old ways and found the change very difficult. Honestly, I couldn’t imagine only doing paper charting. I like that charting is “real time” with electronic charting and feel it is easier to search for specific information whether that is test results or check how a patient’s vitals are trending. I am pro technology and thankful there was a transition, especially since I currently work remote! It makes reading clinicals and information sent via fax much easier than reading different handwriting and little notes from paper charting.

Sounds like the transition from pen and paper to the computer occurred before entry into nursing, the only thing that you know is computerized charting. I am sure that periodically you may have to complete handwritten paperwork. One of the aspects of computerized documentation is that it is legible. Albeit sometimes some people do not use spell check and some people document that way that they speak. I hear a lot of nurses complaining about the time required to document. The aspect of computerized charting that I do not like is all of the checklists and people do not always free text to provide detailed information. There are advantages and disadvantages, I do not ever see us going back to pen and paper charting.

 

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I’ve only been in healthcare since 2009. At that time, while I was working as a CNA in long-term care, we used paper charting for I’s & O’s, vital sign documentation, and care plans. When I transitioned to the hospital a few years later, they were already onboard with using EHRs. I appreciate the efficiency and time-saving aspects of technology. I like to chart in “real-time,” quickly see diagnostic and lab results, and I LOVE using the EMAR. I don’t appreciate having to do paper charting during downtimes. I find that I type ten-times faster than I can write!

I had a difficult time transitioning from pen and paper to computer charting. Paper charting was so much faster.

NUR 514 Discuss one ethical and one legal issue related to the use of EHRs that directly impact advanced registered nursing practice
NUR 514 Discuss one ethical and one legal issue related to the use of EHRs that directly impact advanced registered nursing practice

Passing medication‘s with a computer and having to scan my badge, scan the patient, scan the medication, and then give the medication is quite a process. Charting overall is easier on the computer. I also like the providers have to input their orders, which is legible compared to the old days when you had to to decipher what they are writing.

 

I can remember at a nursing assistant and a new graduate nurse, we would document different shifts in different colored pens, and nursing notes were written every shift, especially on patients that were Medicare or Medicaid patients. I also reviewed orders for thirteen charts on the first night of charge on a forty-patient unit. The difference between pen and paper to the use of technology is the security of the time-stamped documentation. This technology has improved the ability to provide real-time documentation and capture the patient’s events, safe medication management, and provide up-to-date information to patients regarding their aftercare. As an advanced practice nurse, it allows me to perform chart reviews efficiently and provide teaching to the clinical staff.

 

For me, the transition from paper to digital charting was a challenging one. Time was spent trying to decipher the method and creating the necessary charts. My comprehension of the system expanded as time passed. But there are situations when you must enter a doctor’s orders. That was also unusual for me because usually doctors write out their orders. In general, I like the ease and security of medicine administration in a computerized charting system.

During my first couple of years as a nurse, my facility used paper charting. The nurse’s notes, doctor’s orders and specimen requisitions were all on paper. As an operating room circulating nurse, paper charting was tedious, due to the constant needs from the surgeon and surgical tech. Paper charting eventually became easier to complete once I got into a good routine. The downside would be searching for the patient’s H&P or an updated H&P since it would get separated from the chart if the patient came straight from the emergency room. The switch to electronic charting was hard because I didn’t know where to look for certain things in the beginning. Since starting electronic charting, I find it easier because everything is in the EHR. From a previous surgical history to lab results, all are easy to obtain. We can look at the surgical consent where previously we had to wait until the patient came to the holding room to view the consent or labs. Surgeons can look at CT scans without having to go to the radiology department. I am very thankful for advanced technology. I complete my charting at a much faster rate.

 

I think for those of us that had to transition from paper to Electronic Health Records, probably initially had a hard time with the conversion. Now, whenever we have downtime, I remember why computers are so much safer and more efficient. The whole unit and hospital falls apart with an unplanned downtime, everything slows down exponentially. Labs, diagnostics ordering, and results have to be faxed, tubed or hand walked to the department, with these papers can be easily lost. Relying on reading a physician handwriting in a MAR can be tricky and unsafe. Also, the double safety checks of the written MAR are not in there. I think the one concern is that computer charting is much more comprehensive and involved which makes you spend more time on the EHR then we used to with paper charts.

Health Insurance Portability and Accountability Act (HIPAA), Protected Health Information (PHI), and requirements for privacy and confidentiality in Electronic Health Records (EHRs) have become critical issues and a requirement of deep knowledge from the healthcare professionals using them since 1996 (DeNisco & Barker, 2019). “To protect the privacy and security of health information, two sets of federal regulations were implemented (McGonigle & Mastrian, 2022).” With the HIPAA privacy rule, patients are able to expect that healthcare professionals are maintain strict privacy and limit the use and knowledge of their private health information to only people that are part of the treating team. With the Security Rule, the healthcare provider treating the are required to protect their patients’ private health information from inappropriate use or exposure, preserve the integrity of the knowledge, and guarantee its availability (McGonigle & Mastrian, 2022). Ethical and legal concerns are easy to come by when a healthcare team member unintentionally or intentionally share this PHI when they are not supposed to. In nursing one ethical issues that we are held to is autonomy, which could be compromised if the patients PHI is shared to someone not involved in the care and without their consent or understanding (McGonigle & Mastrian, 2022). Legal concerns could be many with HIPAA and PHI on EHRs, but a breach in either of these could mean fines or even jail time, as they are considered very serious offenses (McGonigle & Mastrian, 2022). Measures that I can take in my own practice to protect patient confidentiality is simple: 1) When walking away from the computer, make sure my screen is logged off, so no one can see information that is not intended for them, 2) Never share my password with another individual, 3) Never share private medical information with a caregiver who is not directly involved in the patients care, 4) When sending secure patient information over email, use least amount of identifying patient information possible, such as MRN, and use the secure email functions and identifiers.

DeNisco, S. M., & Barker, A. M. (2019). Advanced practice nursing: Essential knowledge for the profession (4th ed.). Burlington, MA: Jones & Bartlett Learning. ISBN-13: 9781284072570

McGonigle, D., & Mastrian, K. G. (2022). Nursing Informatics and the foundation of knowledge. Jones & Bartlett Learning.

The health insurance portability and accountability act (HIPAA) public law 104-191, was enacted into federal law to ensure that that patient medical data remains private and secure (Tariq & Hackert, 2022). There are two main sections of the law, the privacy rule which addresses the use and disclosure of individuals’ health information, and the security rule which sets national standards for protecting the confidentiality, integrity, and availability of electronically protected health information (Tariq & Hackert, 2022). As an advanced registered nurse practicing in a leadership position, it is imperative to provide teaching and continual reinforcement of ensuring the security, privacy, and protection of patients’ healthcare data. This is critical for all healthcare personnel and institutions in this age of fast-evolving information technology. The use of the internet based EMR’s is perhaps the biggest threat to data leaks that may occur intentionally by someone deliberately entering the chart of a patient they are not caring for, but have socially interacted with. This is a direct violation of HIPAA. This breach in patient confidentiality can result in employee termination and fines.  An unintentional breach of HIPAA happens when the clinical staff leave their computer screens open in-between caring for patients. This is still a violation of patient confidentiality and could also result in employee discipline. Both of these violations will have to be evaluated by the advanced practicing registered nurse in the role of a Risk Management.  Another area that could possibly cause a breach is transmitting data over the internet, the hospital IT department and the advanced practicing registered nurse working as the organizations Informative Nurse must ensure that data is being transferred thought  encrypt transmission systems  to ensure that it remains private. Today, encryption of healthcare records is standard practice, and uses software programs such as MBMD to send messages to providers and All Scripts to transfer information to home care agency for aftercare. The role of nursing leader, risk management, and informatics nurses assist in implementing and auditing the record transmission process..

References

Tariq, R., & Hackert, P. (2022, September 25). Patient Confidentiality. Retrieved from StatPearls: https://www.ncbi