Nurses seeking final say - Contracts limit equipment's input

By Nikki Cobb
San Bernardino County Sun
September 11, 2006

It all comes down to this: If a nurse observes clear signs of distress in her patient, but the monitors and gauges all indicate that all is well, whom do you believe?

Nurses say their professional judgment is being undercut in such situations, to the clear detriment of their patients. And they're starting to insist in their contracts that in such a situation they will have the final word on the condition of the patient.

Technology is good, they say, but not a substitute for a nurse's evaluation.

"(Technology) is a tool for us to use and be able to utilize, not a basis for undercutting the expertise that nurses have," said Dorothy Schoonmaker, assistant hospital administrator at Arrowhead Regional Medical Center in Colton.

Nurses, having undergone years of training and practice in their field, believe their professional expertise is being undermined by increasingly sophisticated equipment. And they're taking steps to protect their part in patient care.

Last summer, Northern California Catholic Healthcare West nurses voted into their contract language guaranteeing that their expertise will never be superseded by technology.

Catholic Healthcare West in Southern California, with approximately 2,500 nurses, negotiates independently of its counterpart in the north, and will confront the issue when bargaining for a contract next July.

"It's one of the standards now in negotiating successfully every new contract with RNs," said Liz Jacobs, spokeswoman for Oakland-based California Nurses Association. "Technology is moving very quickly, and should never supersede the professional judgment of a nurse."

Jacobs said another clause nurses are more often insisting on is that all new technological equipment a hospital buys should go before a committee of nurses to be evaluated.

St. Mary Medical Center in Apple Valley isn't a Catholic Healthcare West hospital, but included in a recently signed contract language similar to that of the nurses' association.

Lois Sanders, a registered nurse at St. Mary, said the nurses at her hospital insisted on a clause dealing with longer-term "futurist" technology, especially monitoring systems and other automated devices.

Sanders said many hospitals are starting to use monitors that gather information from a patient and transmit it to a central off-site location where it is read and analyzed - out of view of a nurse.

Sanders said such devices can be to the detriment of the patient, adding an extra step in the chain of reactions should something go awry.

"If something happens, you need to know right away," Sanders said. "You don't want to wait for somebody to call you with information on your patient."

"We support the use of technology in many ways, just so it doesn't override the technical judgment of a clinical nurse," said Diane Hirsch-Garcia of the California Nurses Association. "It's a trend in the hospital industry to have the sort of language Catholic Healthcare West (in Northern California) included in their contract."

Judy McCurdy, associated hospital administrator for patient-care services at Arrowhead Regional, said the most prevalent situation is a case where an alarm may not go off, though the patient is clearly in distress.
 
The nurse should rely on her own observations and instincts, not on the alarm, McCurdy said. The alarm is just one tool in her arsenal and shouldn't override the nurse's judgment.

"Technology is something that has to be taken as an adjunct and not as the end-all," she said. "We do have to be mindful never to become dependent on technology. It's never a substitute."