Adapting to New Technology with Kristie Copeland

Kristie Copeland: When a surveyor comes in and sits down and says, "I need you to go into your record and show me where I can find" whatever it is that they're asking for, we need to be able to show them right then the information that they're looking for.

Host: That's Kristie Copeland, the chief nursing officer at Claiborne Memorial Medical Center. She was tasked with leading her nurses when Claiborne decided to change from a paper system to an electronic medical record. In this episode, Kristie discusses what the transition process was like and how MEDHOST's assistance was a vital piece of this process.

Kristie: We're learning something new and putting it together and working as a team who can provide that care for our patients, for our community, the best way they possibly can in a quality cost effective manner.

Host: This is Health IT on the Record presented by MEDHOST, a show that explores how innovations in health information technology impact every aspect of a health system from multi-hospital networks down to individual patients. In a moment, Kristie will share the importance, in her experience, of adapting to technology as a rural medical center. Enjoy the conversation.

Kristie: Hello, my name is Kristie Copeland. I'm the chief nursing officer at Claiborne Memorial Medical Center.

Host: Thank you so much, Kristie, for taking some time to share your story and share insight. As I understand it, you've been there, Claiborne Memorial, for a little over 25 years.

Kristie: Yes. When I graduated, this was the first position that I took after becoming an RN. Back then we were in the labor and delivery business and had babies. That's where I started. And then at the time I was able to also orient to med surge – surgery – ICU, ER. So, I've done a little bit of everything.

Host: Wow. When you rewind it back and you just think back to how things worked back then, what comes to mind? How do you remember the early days in your career?

Kristie: Early days, we had paper charts. We had physician's orders. We had three different colors of charting for the nursing staff. Black was for days, green was for evenings and red was for nights and back then we didn't work 12 hour shifts. Most of the time we worked eight hour shifts.

Host: So when you talk about those different colors, you're talking about the ink colors that you are writing down.

Kristie: That's correct. Whenever the nurses did documentation, that's how you could tell which shift was working: by the color of the ink.

Host: Now when you kind of start to skip ahead in the timeline, closer to present day, not quite there yet, how did you feel when you were having to go away from paper and you're shifting away from that? What was the team dynamic like? You were CNO, did you have hesitations? Walk me through that.

Kristie: Change is always difficult. And going from paper charting to everything – literally you pick up one binder and everything to deal with that patient is right there at your fingertips – to something electronic, that at the time was new to a lot of the nursing staff. I mean, they went to school to become professionals, to take care of patients. They did not go to school to learn how to use a computer. So, that was a scary thing for staff. I think that was the biggest concern at the time. How are our staff going to adapt to having everything in electronic form instead right at their fingertips?

Host: Could you walk me through the implementation process? Take me back. What kind of response did you get from your team and what were some tips you used to get them on board?

Kristie: When we first started talking about the electronic medical record and how we were going to implement this system, we did have some pushback, but once the staff, and not just the nurses, the physicians, the ancillary departments understood the way they could each log in and look at the same information, whether you're in the lab or in radiology or in the unit, and they could all see the same information without literally walking back to the unit where that one chart is kept, I think it made a difference in, "Hey, this may be beneficial to our hospital. It may be beneficial to the patients and those of us that work with the patients."

So, we had to show them, "This is where we are right now, this is where we want to be," and gradually, it took some time, but if you don't change you're just going to wither away and die. It was difficult. We put the process in place, we created our flow sheets and our assessments and just jumped in and did it.

Host: That image you talked about just now, the withering away, it definitely makes sense. That narrative that you're telling your team at that time is, "Hey, this is different, but we've got to make some changes." And really once they started to see, "You know what? This is going to improve my patients and their care and it's going to improve the hospital." I'm curious to hear how you were looking at the "why" you needed to change. What was on the line and what kind of improvements have you been able to see now that you've successfully made that transition?

Kristie: Well, as we all know, healthcare is constantly changing. Regulations are changing. Our accreditation standards – there are over 1300 accreditation standards through DNV that we have to meet and we've been credited through DNV for the last three years. When a surveyor comes in and sits down and says, "I need you to go into your record and show me where I can find" whatever it is that they're asking for, whether it's administration of the medication or documentation of vital signs or a physician's order, we need to be able to show them right then the information that they're looking for.

Kristie: Now, before we had the optimization process, before your team came in, there were several different ways that we were documenting our information. Just for instance, starting on IV, you could document that you started the IV in the nurse's notes. You could use a template. You could put it in the I&Os.

There was several different ways, but once that optimization team came in and showed us, "Hey, this is how the electronic medical record, the program that you're using was meant to be used." Once they showed us those tidbits of information, and the proper way to do the documentation, all the managers were able to go back to the staff and say, "This is where we are right now. This is what we've learned from the optimization process. This is where we want to be and these are the steps that it's going to take for us to get there."

So, it was great for us because we literally sat around the table, reinvented our orientation process, so any new nurse that comes in, we were going to be able to train them all exactly the same way. We added a day of orientation to our new employee process. That entire day consists of not only computer training on the electronic medical record, but specific information that they need to know in the clinical arena.

Just making that one change with the training of a new nurse – instead of immediately putting them on the floor with another nurse to train, when we didn't know if nurse A was doing it, this and this and this, and nurse B was doing it X, Y, and Z – we knew exactly that our new nurses were following the protocol that we had just designed and with the help of the optimization team, we were able to disseminate that throughout the entire organization.

So, now when I have a surveyor come in and ask, "Where is this order located? Where is this Foley catheter documented? Where is this set of vital signs?" We know exactly where to go to.

Host: I love how that has clearly brought a lot of ease, a lot more confidence, not only to you, but really, confidence to your team. And earlier, Kristie, you were saying something along the lines of, "these nurses, they went to school to learn to be professionals and to be professional healthcare providers." And what I'm also hearing from you is when they are able to focus more on that and decrease their time spent on a computer, because that extra day of training you're talking about and making it a little bit easier, it seems like you can feel that impact from the bottom up and the top down.

Kristie: Absolutely. Older nurses, even though they were stressed to begin with – they're the ones that have the 30 and 35 and 40 years of experience. They're the ones that teach these new nurses coming out of school. "Okay, I've been doing this for 40 years and this is the best way that I have found, and I've tried all different types of ways, but this is the best way that I found for you to do" whatever it is. They share their knowledge. They grow these new nurses.

Now they have the knowledge, but the new nurses that were graduating right now that we're hiring onto our team, they're the ones that have more computer knowledge. So, for this new generation that's coming in, the new nurses that are coming in, they're teaching that computer. Well, they have to, because all of the hospitals are going to electronic medical record. They're already there. They have to be able to perform and pick up these electronic medical records when they're in school as opposed to waiting until they're hired on their first job.

Host: Yeah, that top down and that bottom up approach was interesting because I think there's kind of two angles there. One, we're going to talk about this in just a moment, but from the top down, from you being one of the leaders, we'll talk kind of about how that's been beneficial to you. But I like how you were just calling out the top down in the seniority of these nurses and how there's that knowledge share and even though they were some of your more experienced nurses, they might've been a little nervous about it. It's really encouraging to see that they got it and they feel good about it.

Let's jump to you though. Clearly there's impact and improvement from the bottom up, but from you being a chief nursing officer, what kind of impact has this made on your role? And then maybe we'll talk a little about how or what advice you might give to other CNO folks out there who can maybe learn from what you've learned?

Kristie: My main focus as the chief nursing officer is to be able to provide our community, the patients that we serve, with the best possible patient care in a quality, cost effective manner. It's my responsibility to make sure that the nursing staff we have is competent, knowledgeable, caring, and can follow direction of the physicians, but make sure that they're also to the point where they can document, "I did this, I did that."

They have to be able to follow all the regulations. They don't know all the regulations. That's my job, but when I go back to the staff and say, "Come on Susie, let's sit down. I want to go over this chart with you," they know exactly what I'm looking for. They can point me in the right direction. So, everybody's on the same page and if they say, "Kristie, why are you wanting to know that information?" I can use that opportunity to teach them, "This is one of the things that DNV requires us in order for us to meet this requirement, we have to do this, this, and this."

I learn from my staff every day and I hope that my staff are able to say we learn something when Kristie comes back here, or when our CEO comes back here, we're learning something new and putting it together and working as a team to provide that care for our patients, for our community, the best way you possibly can in a quality, cost effective manner.

Host: That makes sense. And I think they definitely are learning from you and I like the approach that you outline of the mission you feel every day going to work and how you follow that mission every day when you're at work.

So, one of my final questions, I just mentioned this a second ago, but I want to get to this moment where – you've been doing this a while, right? You know how to be a successful chief nursing officer. What kind of advice would you, maybe if you could go back in time and give to yourself when you're just starting, what would that be? Maybe as it relates to day in the life, what's something that you'd want to share with other CNOs out there?

Kristie: Be patient, be fair, and take one incident at a time. Don't try to bite off more than you can chew. If it's a large project, just take one step at a time. That's the only way you can get through anything. Be very patient with you staff and remember that they have a life outside this hospital. You know, they have families, they have children, they have grandchildren. Sometimes on those really busy days when you're needing extra people to come in, you might have to step out on that floor and go administer some medicine, but that's okay. We've done it in the past.

I'm not going to ask my staff to do anything I'm not willing to do first. I think that's what's important for them to know. I normally sit in this office all day and work on the computer and I have deadlines to meet and I have phone calls to make and emails to return, but I don't think there's a staff member in this facility that doesn't know that if they pick up the phone and say, "We're in a bind, I need some help," I am not going to stop everything that I'm doing and get back on that floor and help them. I think that's very important.

Host: I love it. Kristie, thank you so much for taking the time. So my final question is: Anything else on your mind, on your heart, that you want to share before we wrap up?

Kristie: MEDHOST, the team that we've worked with has been great at answering our questions and helping us solve our problems. No hospital is perfect. No CNO is perfect. No electronic medical record, no company is ever going to be perfect, but I can say when we call and say, "We're having this problem, can you help?" MEDHOST is always on board trying to help us with whatever the need is.

Host: Thank you so much for saying that. I really appreciate it and I know it's been a joy to work with you and your team. Best wishes to you and I'm looking forward to hopefully talking again sometime in the future and keeping the conversation going.

Kristie: Okay, great.Host: Thanks for listening to Health IT on the Record presented by MEDHOST. For more stories and content like this, be sure to visit medhost.com/resources. Thanks.