The Inclusion of Nurses in the Systems Development Life Cycle
In the media introduction to this module, it was suggested that you as a nurse have an important role in the Systems Development Life Cycle (SDLC). With a focus on patient care and outcomes, nurses may not always see themselves as contributors to the development of new systems. However, as you may have observed in your own experience, exclusion of nurse contributions when implementing systems can have dire consequences.In this Discussion, you will consider the role you might play in systems development and the ramifications of not being an active participant in systems development.To Prepare:Review the steps of the Systems Development Life Cycle (SDLC) as presented in the Resources.Reflect on your own healthcare organization and consider any steps your healthcare organization goes through when purchasing and implementing a new health information technology system.Consider what a nurse might contribute to decisions made at each stage of the SDLC when planning for new health information technology.BELOW IS THE QUESTIONPost a description of what you believe to be the consequences of a healthcare organization not involving nurses in each stage of the SDLC when purchasing and implementing a new health information technology system. Provide specific examples of potential issues at each stage of the SDLC and explain how the inclusion of nurses may help address these issues. Then, explain whether you had any input in the selection and planning of new health information technology systems in your nursing practice or healthcare organization and explain potential impacts of being included or not in the decision-making process. Be specific and provide examples.BELOW IS THE LEARNING READING / RESOURCESLearning ResourcesRequired ReadingsMcGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.Chapter 9, “Systems Development Life Cycle: Nursing Informatics and Organizational Decision Making” (pp. 175-187)Chapter 12, “Electronic Security” (pp. 229-242) CORE SKILL: understanding WHY nurse involvement in system design is a SAFETY issue rather than a courtesy — and being able to name what goes wrong at each phase when nurses are absent.
THE PHASES (versions vary slightly; use a consistent one):
1. PLANNING AND REQUIREMENTS DEFINITION / FEASIBILITY — identify the problem, define needs, assess feasibility and cost. WITHOUT NURSES: the requirements reflect what administrators and vendors THINK nurses do, rather than what nurses actually do. This is the most consequential phase to be excluded from, because every later phase inherits its errors — and requirements errors are the most expensive to fix later (the cost of fixing a defect rises by orders of magnitude at each subsequent phase, which is a well-established finding in software engineering and a powerful argument to cite).
2. ANALYSIS / SYSTEM SELECTION — evaluate options against requirements; workflow analysis; gap analysis. WITHOUT NURSES: the system is chosen on price and feature lists rather than on WORKFLOW FIT, and clicks-per-task (the real currency of clinician time) is never measured.
3. DESIGN OF THE NEW SYSTEM — screens, fields, alerts, order sets, documentation templates. WITHOUT NURSES: alert thresholds get set by people who will never receive the alerts, producing ALERT FATIGUE; documentation fields multiply because every stakeholder wants their data captured, and the burden lands on the nurse.
4. IMPLEMENTATION / TESTING AND TRAINING — build, configure, test (unit, integration, user acceptance testing), train, go live (big-bang vs. phased). WITHOUT NURSES: user acceptance testing is performed by people who don’t do the work, training is scheduled without backfill, and go-live support is under-resourced.
5. POST-IMPLEMENTATION SUPPORT / MAINTENANCE AND EVALUATION — optimization, issue resolution, evaluating whether the system achieved its aims. WITHOUT NURSES: workarounds go undetected and become permanent, and the system is declared a success on the basis of go-live completion rather than outcomes.
THE CONSEQUENCES TO NAME: workarounds (which are ADAPTATIONS to bad design, and should be read as diagnostic information rather than as staff misbehavior — that reframe is an excellent point to make); alert fatigue and override rates; documentation burden and its established link to burnout (“pajama time”); e-iatrogenesis; and outright abandonment of expensive systems.
THE NURSE INFORMATICIST role bridges clinical and technical domains — translating clinical requirements into technical specifications and vice versa. That translation function is the job, and it is the answer to “why not just have IT do it?”
FRAMEWORKS: the SEIPS model (work system → process → outcomes) for human factors; usability testing and heuristic evaluation; interoperability standards (HL7, FHIR); and the ANA scope and standards for nursing informatics.
FOR THE ASSIGNMENT: describe each phase, state what a nurse contributes, and describe the concrete consequences of exclusion. Then, if required, propose a graduate-prepared nurse’s role on the selection/implementation team.
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