MASSACHUSETTS NURSE NEWSLETTER :: September 2006

2025: A nursing odyssey

By Deb Rigiero

Your mission, should you choose to accept it after reading this work of fiction, is to determine which technologies are current, which are futuristic, and which are total fantasy. While you read this article, think about the new technologies that are being introduced in your facility.

Boldly going where no nurse
has gone before

The year is 2025. The average life expectancy is 90 for men, 93 for women. The age for mandatory retirement is 75. Most cancers are curable. Heart disease is still the number one killer for both men and women. Cardiac surgery is performed via laparoscope on beating hearts. Obesity is a disease of the past thanks to medication that prevents overeating and the country’s obsession with fitness and appearance has become all encompassing. Each citizen has a computer chip implanted in the left inner forearm that has his or her complete electronic medical record (EMR) encoded on it. America has finally caught up with the rest of the world and has universal health care.

There is a moneyless system in place that uses your electronic financial record chip (also implanted) as your bank card and credit card. Homeland security monitors all purchases via a quantum computer that is designed to flag any unusual activity in bank accounts or purchasing habits. Cars run on hydrogen, not gas, and the air quality is greatly improved.

But today we will be looking at a day in the life of ICU nurse Betty. She is 65 and would have been golfing in Florida if the government hadn’t increased the retirement age. Nurse Betty has bid online for the overtime shift that she is currently working and she must have been the lowest bidder, because she got the shift.

It is 6:15 a.m. and Nurse Betty is on her way to work. She has programmed the route she wants to take and set the car on autopilot, and she was also certain to program in a stop at Dunkin’ Donuts. She sends her order via Blackberry so she can speed through the drive-through line. She puts her arm in the scanner to charge her EFR, she gets her coffee, and she is on her way. Nurse Betty spends the rest of her drive to work browsing the daily newspaper on her in-car computer.

Beam me up, Betty!
Betty gets into work at 6:40 a.m. She scans her badge in order to get into the garage, and then uses her thumb print to open the employee entrance doors and access the employee elevator. The doors to the ICU are locked and Nurse Betty opens them with her thumb print.

Once on the unit, she picks up the hand-held computer assigned to her and receives her assignment and patient reports for the shift. Nurse Betty activates her hand-held and, as a result, her patients’ call lights signal her computer and the hospital tracks her location—all the while, her computer access is monitored. By this point in her day, Nurse Betty has had no contact with any other co-workers.
Any phone calls that Betty receives are processed through the main operator and transferred to the appropriate departments, and all orders/calls concerning her patients are linked to her computer—including lab values, physician calls and family calls.

Both of Betty’s patients are in their own rooms and, as she meets with each of them, she scans their EMRs in order to ensure proper identification and to determine the patient’s needs, medication schedules and medical histories. She then examines each patient and dictates her findings into a headset that automatically transfers all of the information to her computer.

Nurse Betty’s first patient requests pain medication and she accesses the room’s pharmacy system via retinal scan and calls up the appropriate drug. The system delivers the med via a series of tubes and within seconds it is available. She then administers the medication and sets the computer to record the patient’s vital signs every five minutes for one hour.

Betty repeats the routine with her second patient but, while doing so, her handheld device vibrates to indicate that there is an important message waiting for her from a physician.

The doctor explains that she is scheduling video rounds for the second patient in five minutes and adds that she wants Nurse Betty to participate in order to provide feedback to the physician. This is essential because, in 2025, Nurse Betty is the only health care professional who actually has physical contact with the patient.

We control the vertical, we control the horizontal

She sets the TV to video conferencing, alerts the patient that the physician will be speaking to him in a few minutes and removes his dressings so the doctor can view the incision from a recent surgery.

The video round goes smoothly. The patient is improving and, as a result, the doctor changes the orders for the dressing while the nutritionist changes the patient’s diet in order to improve wound healing. In all likelihood, the patient will be discharged the following day.

Nurse Betty pages the personal care attendant to help her reposition and perform morning care on her patients. She has to wait because the attendant is assigned to two other nurses as well, so Betty starts the a.m. care on her own. She then completes her notes verbally and the computer converts voice to written words.

Lunch time comes and Betty calls down to the cafeteria to order her meal. She scans her EFR on the phone and the meal is credited to her account. Her food arrives the same way the patient’s meals arrive, via ANT (automated nutrition transport). She sits in the employees lounge near her patients’ rooms and tries to enjoy her quiet lunch. She is quickly interrupted by her patient’s call bell, responds to it and then continues with lunch. There are multiple small lounges near the patient rooms so the nurses can be available when the patients need them.

Nurse Betty continues her shift, answering to her patients’ needs and rarely interacting face-to-face with her co-workers or management. The only time she actually has contact with the other RNs scheduled that day is when there is an emergency and more than one nurse is needed. Patients are transported robotically; reports are given via computers; and physicians remotely monitor their patients. Her movements are monitored continuously and her patients have access to her for the entire shift.

Open the pod bay doors, Betty

Betty finishes her shift, records her patient reports via the computer and waits for the signal that her replacement is there. Her replacement’s handheld computer signals Betty that she is available and on duty, and Betty is then able to turn in her computer and leave the hospital.

She sets the automatic pilot on her car and electronically orders her groceries via her on-board computer. She also checks out the balance of her EFR and determines that she needs to bid on line for another shift. But otherwise, her day is finished.

Resistance is futile, so may the union be with you

The above story is a work of fiction. However, some of the technology described in the article is current, some is close to being available and some is just the imagination of the author. The purpose of the article is to point out that not all technology is bad. In fact, much of it is needed and will improve our lives. But, unfortunately, technology can also be used to isolate the worker, monitor the worker’s activity/productivity, invade individual privacy, and discipline the worker.
We need contract language that prevents the inappropriate use of technology. We need to educate our members to be aware of changes and report them immediately to the appropriate union representatives. And we need to insist on negotiating any changes in technology. In essence, we need to “get smart.”
This article will self destruct in 30 seconds.