The Nurse Leader as Knowledge Worker

· A knowledge worker is a person who utilizes and processes previously learned, as well as newly presenting, information to care for their client (p.21) or patient. Peter Drucker contrived this term in his 1959 book, Landmarks of Tomorrow (p.117).

· Define and explain nursing informatics and highlight the role of a nurse leader as a knowledge worker.

· “Nursing informatics (NI), a product of the scientific synthesis of information in nursing, encompasses concepts from computer science, cognitive science, information science, and nursing science” (p.2).

· NI provides nurses the ability to continue their education, mitigate errors, support clinical decisions, protect confidentiality, save time, increase the safety of care, implement evidence-based practice, provide timely interventions to alerts, prevent deterioration of the patient condition, succinctly access health records, and communicate with other specialties (p.16).

· A nurse is a knowledge worker because he or she takes data and previous formal education into account when caring for a patient. The role of the nurse as a knowledge worker is twofold in that he or she processes information to take care of the patient in the present but also charts the data for future comparison (p.117). The following are “four roles that nursing takes on as a knowledge worker: data gatherer, information user, knowledge user, and knowledge builder, respectively” (p.119).

· Develop a simple infographic to help explain these concepts.

· A smaller version of the infographic has been pasted on the following page; however, I attached the PowerPoint document as well, since the spacing is more aesthetically pleasing on that copy.

Knowledge User

Nurse

Leader

Continued Education

Mitigate Errors

Support Clinical Decisions

Protect Confidentiality

Time-Saving

Increase Safety of Care

Implement Evidence-Based Practice

Provide Timely Interventions to Alerts

Prevent Deterioration of Patient Condition

Succinctly Access Medical Records

Communicate With Other Departments

Data

Gatherer

Info

User

Knowledge Builder

Present the hypothetical scenario you originally shared in the Discussion Forum. Include your examination of the data that you could use, how the data might be accessed/collected, and what knowledge might be derived from that data. Be sure to incorporate feedback received from your colleagues’ replies.

When admitting a patient into the Cath Lab (usually outpatient procedure) there are several steps that I take to collect their medication data; their preferred pharmacy, medicine bottles if the patient is compliant enough to bring them in, and lists of medications from previous H&Ps are all part of getting the entire picture about their prescriptions and over-the-counter supplements. Once I have their preferred pharmacy, the computer system collects their prescription information, which is shown on my screen. It has occurred to me, however, that if they use more than one pharmacy, their prescription information would be based on their word, and may not be entirely accurate. Most people do not know enough about cardiac medications to lie and are too scared to take cardiac medications without the direction of a qualified provider; however, since I am studying to be a Psychiatric Mental Health Nurse Practitioner (PMHNP) and will, therefore, be prescribing medications that alter one's mental status, I am worried about trusting my patients as proper historians. What if my patient has prescribed Valium from their primary care provider and I prescribe Xanax? The two should not be taken together, and I am responsible for the well-being of the patients in my care. What I would like is for there to be a universal prescription database that all pharmacies must utilize and that prescribers could access for safety. That way all prescriptions that a patient has access to are taken into account by all of his or her providers, providing a continuity of care and decreased polypharmacy.  “Information continuity consists on one hand in the exchange and transfer of information among health care providers and to patients and on the other hand how the knowledge of the patient is accumulated” (Nagle, 2018).  This would eliminate double-dosing, increase safety, decrease the likelihood of addiction, and aid in the opioid crisis. 

A study by Fricton and Davies (2008) revealed that patients, caregivers, and providers approved of and benefited from a Personal Healthcare Record (PHR) easily accessed by approved providers.  Although this study evaluated the benefits of a community PHR in Wilmer, Minnesota versus the national prescription database that I am proposing, I think that the small-scale benefits and approval rating would be comparable.  “The Institute of Medicine’s report, Preventing Medication Errors 2007, states that poor communication and exchange of medical information at transition points for patients from one provider to another are responsible for many medical errors and adverse drug events” (Aspden, Wolcott, Bootman, & Cronenwett, 2007).  Howard, Avery, Slavenburg, Royal, Pipe, and Lucassen, discovered that three to four percent of all unplanned hospital admissions were due to pharmacological adverse events (2006). Even more shockingly, a review by Thomsen (2007) predicted that close to seven percent of outpatients experience preventable adverse drug events. If all pharmacies were required to upload all prescription medications (not only controlled substances) to a database that all prescribers were able to access, I believe that the benefit to this country would be immediate and widely recognized by providers, patients, and communities.

As of 2011, 37 states have been involved in the State Prescription Drug Monitoring Programs (PDMP) with ten other states working on legislation to participate (U.S. Department of Justice, 2016). Although this is a step in the right direction, the fallbacks to the current PDMP are that the information is confined to each state, the information shared only concerns controlled substances, and the funding for all 47 states has topped out at $7.6 million. Considering that I have been a nurse in three states at four different jobs and have never heard anything about a PDMP, I do not condone further investment in the state-regulated PDMP and think that the lessons learned since 2011 should be applied to a federal database, utilizing federal laws. I believe that pharmacological companies have had too much financial leeway and should be held fiscally responsible for the national medication database. To sell pharmaceuticals in this country, the manufacturing companies should have to contribute to the database. The more medications you sell, the more significant your contribution. Although I do not believe in an overbearing government, I do not see how this database could be managed without federal influence. Ideally, a non-profit organization would regulate the database for compliance, revisions, safety, and funding; however, the participation of the pharmacies and pharmaceutical companies would have to be a law in place.

Of course, anything involving health information technology will have to consider the patients’ rights to privacy. This subject can be complicated, so I have thought about keeping the rules as simple as possible. Before a prescriber would be able to view or write a new prescription, the patient would have to approve said prescriber as an appropriate person.  I have added in the consent to receive a new prescription since it is human nature to serve oneself. If a patient cannot obtain the medication he or she needs, the incentive to approve the consents will be more impacting. The consent to access medication information could be emailed, texted or given to the patient in person.  A Personal Identification Number (PIN) could be issued to the patient for increased security.  The database would need to be secured and kept up-to-date with the latest technology to prevent inappropriate access.

References:

Aspden, P., Wolcott, J., Bootman, J., & Cronenwett, L. (2007). Preventing Medication Errors. The National Academies Press. doi:10.17226/11623