Side Hustles to Try as a Nurse

Side Hustles to Try as a Nurse

As a highly specialized skill set, nursing is in high demand. As such, nurses can make a lucrative career by their full-time work alone, and by supplementing it with a variety of nursing side hustles. For those entrepreneurial spirits, there is seemingly no limit to the possibilities.

Home Health Care

There are certain areas of nursing where per diem work is more abundant. Many specialties within the hospital, such as critical care, emergency, surgery, and telemetry, require specific skill sets that the only nurses who fill in are already trained in that specialty. This is because per diem work comes with the expectation that minimal training is required.

There are however, some areas where skills do translate from one area of nursing to another.  This is especially true outside the hospital. For example, adult inpatient nurses can work as a home infusion nurse, or in other home health care work, such as overseeing ancillary nursing staff, doing intensive assessments, and advocating for patients with their providers and insurance carriers.

Home health care is a growing field of opportunity as it benefits the patient by allowing them to maintain quality of life in their home; it can also help reduce the logistical strains on the health care system to provide inpatient care.

Aesthetic Nursing

For nurses with an eye for beauty, aesthetic nursing offers a wealth of opportunities. As technology advances, there are more and more non-surgical procedures with anti-aging and aesthetic benefits. Nurses are increasingly able to perform or assist physicians with such procedures in medical spas and dermatology clinics.  Furthermore, often this work is available as part-time or per diem. This allows nurses to build up a clientele through a side hustle that works with their schedule and is generally high-paying. Qualifications and credentialing for work as an aesthetic nurse vary by location, but frequently nurses go through certification programs in order to attract employers for this type of work.


Working as adjunct faculty is the side hustle of the teaching world. Many nursing schools offer opportunities to instruct a limited number of courses per semester on a part-time basis. This allows nurses with specialized knowledge or skills to disseminate what they know to the next generation of nurses. There are opportunities for both online and classroom teaching today.  Requisites for teaching vary by state, school, and specific courses. For example, many nursing schools require five years of experience in a given specialty or an advanced degree in nursing, in order to teach.


Coaching is another growing field for nurses. For coaches who are nurses, they mostly function as health coaches or career coaches to other nurses. In the former role, nurses work with clients to mobilize them in the direction of their own personal and health goals. This is done through motivational interviewing, establishing accountability, goal-setting, and most of all-empowering the client to be experts on their own lives and bodies.

This role does not involve medical oversight and instead draws on the nursing skill of patient education combined with the holistic approach to patients that is fundamental to nursing. Nurse career coaches are often experienced and successful nurses who have built lucrative and fulfilling careers in nursing and coach other nurses or aspiring nurses to do the same.

Legal Nurse Consultants

Legal nurse consultants (LNCs) serve as expert nurses that work in medical-legal matters. LNCs are usually experienced nurses that can address technical matters specific to nursing, which a layperson may not know. They may work in law offices, HMOs, hospitals, risk management, workers’ compensation, and so on.

The legal nurse consultant utilizes their clinical and logistical expertise to extrapolate or clarify matters related to medical-legal cases. There are many full-time legal nurse consultants but it is incredibly valuable as a side hustle because it allows the nurse the opportunity to simultaneously work clinically, honing expertise and skills, while contributing the value of such real-time experience to their work in legal matters.

Nursing is a growing field for many reasons, not the least of which is that it offers a multitude of avenues by which to obtain a high income and a fulfilling career. For the nurse who wants to branch out beyond what they specialize in full time, there is certainly no lack of side hustles in nursing for them to explore.

Job Shadowing: Get the Career Truth

Job Shadowing: Get the Career Truth

One of the best ways to find out what a nurse’s day is really like is to shadow a nurse for the day. Whether you are a nursing student, a new nurse, or a nurse with many years of experience, job shadowing someone before you venture into a specific arm of nursing is a smart career move.

Kathy Quan, RN, BSN, PHN, author of The Everything New Nurse Book, and founder of The Nursing Site, says she thinks shadowing is particularly important for home health nurses and those considering something like hospice nursing.

I loved the home health rotation in college,” says Quan. “You have that one-on-one with patients that you don’t get in the hospital. You can spend that time with the family and with the patient.” And although that one-on-one time is what Quan wanted to have, a more experienced nurse explained the reality of home health to her so she could understand the big picture and what the job really required. “She said, ‘If you want this for a Monday to Friday, 8 to 5 job, this probably shouldn’t be your primary goal.’”

Home health jobs, Quan learned, are really 24/7, because of the very relationship you build with the patient. If a patient needs you or has special needs that you don’t want to hand over to someone else, you need to be available, she says. You also need to be able to let some responsibility fall to a patient. “You have to have faith that they can do this,” Quan says. For instance, you have to trust they will take their medication and keep an eye on an IV if needed.

And, surprisingly, the amount of paperwork for home health is greater than it is in a hospital, says Quan. If that’s not something you think you could keep up with, it’s certainly good to know before you look for a job in the field. When you shadow someone for a day, whether as a home health nurse, in a hospital, or in the field, you’ll have a concrete understanding of what their tasks are.

Shadowing a nurse also gives you an incredible perspective that you would never get from a job interview process. For instance, if the paperwork seems endless at first, it helps to know how another nurse handles it. For Quan, seeing how the paperwork in home health care is built around the nursing process made it easier for her. “It is a lot, but after you get used to it, it’s old hat,” says Quan.

And hospice nurses use their nursing skills in a way that is different from something a nurse in a cardiac unit might do. There is an intimacy to discussing and helping with end-of-life care for patients. If you are considering hospice nursing, you would benefit greatly from shadowing a hospice nurse for a couple of days. By doing so, you can see how nurses engage with patients and families and use their nursing skills for comfort. You will be able to gauge if that’s something you could and would want to do full time.

The extra time spent job shadowing a nurse can help point you down the right career path.

Public health nursing showcased in museum exhibition

New York City’s museums are some of the most well known, distinctive, and influential in the world. Now, they’re commemorating the life and influence of the “mother of public health nursing,” Lillian Wald, as well as the organization she founded, the Visiting Nurse Service of New York, the largest nonprofit home health care organization in the United States.

This past summer, the Museum of the City of New York added a permanent display in its new Puffin Foundation Gallery for Social Activism documenting Wald’s life and the 119-year history of the VNSNY. The display is a part of the Activist New York exhibition and was assembled with help from current VNSNY staff. Open every day from 10:00 a.m.–6:00 p.m., the museum can be found at 1220 Fifth Avenue, New York, New York.

VNSNY staff also worked with the Yeshiva University Museum in its exhibition “Trail of the Magic Bullet: The Jewish Encounter with Modern Medicine, 1860 to 1960.” Though that show concluded in August 2012, visitors can still explore other exhibits at the museum, open Sunday through Friday, located at 15 West 16th Street, New York, New York.

Where the Heart Is

Where the Heart Is

When Ran Li, MSN, RN, entered the home of her elderly Chinese patient, she wasn’t surprised when the woman refused to make eye contact. While some nurses might have assumed the patient was being rude or trying to hide something, Li understood that in traditional Asian cultures it is considered disrespectful to make eye contact with a person of authority.

Ran Li, MSN, RNRan Li, MSN, RN

“In Asian cultures, to look someone directly in the eye implies equality,” says Li, who works for Addus HealthCare, a home care agency in Concord, California. “Since [Asian] patients often consider a physician or a nurse to be superior, lack of eye contact is their way of showing respect.”

Li is one of many minority nurses across the United States who are employed in the field of home health care. Experts say nurses like Li, who have firsthand knowledge of ethnic minority patients’ language and cultural needs, can eliminate barriers to care and improve patient-nurse communication, resulting in better patient outcomes.

Home health nursing in the U.S. began about 100 years ago with visiting nurses who dedicated themselves to providing care for frail elderly and other homebound patients. Today, according to the National Center for Health Statistics (NCHS), the nation has more than 11,000 home care and home hospice agencies in operation, providing a range of services designed to care for chronically or terminally ill patients who wish to remain in their own homes or in assisted living facilities. In the year 2000, approximately 1.4 million Americans were home care patients, according to a National Home and Hospice Care Survey conducted by NCHS.

And the field continues to grow by leaps and bounds. The Bureau of Labor Statistics predicts that the number of patients receiving home health care will continue to increase dramatically through the year 2012, as baby boomers continue to age and more patients opt to remain in the familiar, independent environment of their homes.

Flexibility and Opportunity

Nurses who work in home health care enjoy flexibility, autonomy and opportunities for career growth, as improved medical technology allows for more complex procedures, such as dialysis, to be performed in homes. The burgeoning growth of the home health industry, combined with the nursing shortage, is creating a tremendous need for more nurses to enter this specialty. And with the nation’s ever-increasing racial and ethnic diversity, there is an urgent need for more minority nurses who can bring culturally and linguistically competent care directly into patients’ homes.

“Caring for patients at home requires much more than knowledge of disease

processes,” says Geri-Ann Galanti, PhD, a medical anthropologist who teaches courses on cultural competence at the UCLA School of Nursing. “Home health nurses can play an important role in decreasing health disparities among underrepresented minority groups.”

Galanti notes that attending to the special needs of racially and ethnically diverse patients requires respect, sensitivity, patience and awareness of cultural differences. Yet she also cautions nurses not to stereotype ethnic groups.

“Patients from different countries and ethnic groups have different attitudes toward the health care system,” she explains. “You can’t make a sweeping generalization about an entire culture. While Asian immigrants from rural villages of China may be unfamiliar and fearful of Western medicine, patients from Hong Kong are usually very comfortable with American treatments and practices.”

When Li visits patients in the local Chinese American community, she brings with her a sense of familiarity and comfort. Li, who speaks Mandarin, understands not only the patients’ language but also the cultural beliefs that shape their lives. Before emigrating to the U.S. from China in 1991, Li worked as a pediatrician in her native Shanghai. Upon her arrival in the San Francisco Bay Area, she enrolled in nursing school and received her MSN from San Francisco State University. After graduation, she began working as a home health nurse.

“I love working in the field of home health,” she says. “As the mother of two young children, my job gives me a lot of flexibility.”

Her workday typically begins at 8:30 a.m. and ends at 2:30 p.m., leaving her time to pick up her children from school and take them to extracurricular activities in the afternoon. She often completes her charting at night after the children have gone to bed.

Because she is a home health case manager, Li also oversees the work of other home health nurses who perform a range of skilled nursing services, including hydration, pain management and wound care. The nurses also assess each patient’s living situation and make recommendations for personal care aides, physical therapists, meal programs and other social services.

“There are tremendous opportunities for nurses who want to work in the home

health field,” Li emphasizes. She notes that most home health agencies only require that nurses have one year of experience working in either a skilled nursing facility or a hospital. And with no end to the nursing shortage in sight, many agencies have begun to waive this requirement by offering home health training programs for new nursing graduates.

In the diverse Bay Area, Li has encountered many situations where her cultural background and language skills have proven beneficial in helping Asian patients. “Patients from various cultures can have a different way of doing things,” she says. “I look at my job as being a liaison between the patients and their doctor. [I’m there to] help make their transition from hospital to home as easy as possible.”

Part of the Family

Privately owned home care agencies and hospices aren’t the only places where nurses can find rewarding careers in home health care. Many home health nurses work for Visiting Nurse Associations (VNAs), which are not-for-profit, community-based home health organizations. According to the Visiting Nurse Associations of America, VNAs care for nearly four million people each year.

As both a visiting nurse and the national secretary of the National Association of Hispanic Nurses (NAHN), Jennifer Figueroa, BSN, RN, hopes to see more nurses of color enter the field of home health.

“We’re seeing more elderly Hispanic patients and fewer Hispanic nurses,” says Figueroa, who works for the Visiting Nurses of Westchester in White Plains, N.Y. “Cultural competency requires more than just being able to speak [an ethnic minority patient’s] native language. It also means understanding cultural differences, such as customs, traditions and taboos.”

As an example, Figueroa, who is of Puerto Rican descent, cites the increasing number of Hispanic patients who are being diagnosed with diabetes and cardiovascular problems. “Most diabetics are told to control their intake of complex carbohydrates,” she says. “But for Hispanic patients, complex carbs are a big part of their diet. Rather than saying don’t eat carbs, I work with patients to cut their portion sizes and add vegetables.”

Providing culturally competent care can also extend to a patient’s family members. “In the Hispanic culture, discussions of death and dying often involve family members rather than the patient,” Figueroa explains. “They want to shield their loved one from bad news.”

While it’s a subject she approaches carefully with the families of patients who are terminally ill, she believes it’s important to be honest with the dying person. “I don’t push too hard, but I also tell families I’m not going to lie or withhold information from the patient,” she says. “Sometimes patients really want to know their prognosis so they can say their goodbyes and put their affairs in order.”

Prior to becoming a visiting nurse six years ago, Figueroa worked in medical-surgical nursing. Now, she says, she has found her niche in the home health specialty.

“I see patients ranging from babies to seniors,” she declares. “We typically care for patients for a five to seven-week period of time. During that time you truly become a part of their family. I still keep in contact with many of my former patients.”

Figueroa thinks the home health field is a perfect fit for nurses who have strong assessment and time management skills and who desire flexibility and the opportunity to work independently. “It’s the best of both worlds,” she says. “You have autonomy, but you’re supported in your job by a team of other medical professionals. The patients are always happy to see you and they’re thankful for the care you provide.”

Home Care for Kids

Pearl Boone, RN, loves caring for children. Boone, who is African American, has been a nurse for 18 years and began working in home health care two years ago. She divides her time between working in the neonatal unit at Texas Children’s Hospital in Houston and serving as one of the hospital’s home health nurses.

Pearl Bonne, RNPearl Bonne, RN

During the past two decades the demand for pediatric home care has exploded. According to the federal Centers for Medicare & Medicaid Services (CMS), this is the fastest-growing segment of the home health care industry. CMS anticipates that the pediatric market will represent a $3.5 billion business in the next decade.

Most of Boone’s home health charges are infusion patients who have metabolic diseases. She also treats young children who have sustained wounds and infants who require apnea monitors.

With a maximum patient load of 10, Boone makes home visits on her days off from the hospital. “I love the flexibility of working in home health and the bond you have with your patients and their families,” she says. “As a home health nurse, you have the benefit of working with patients for an extended period of time. I have two families that I’ve been with for over a year.”

Boone thinks some nurses might be hesitant to explore careers in home health care because of misconceptions about the field–misconceptions she is quick to dispel. “I know with rising gas prices, many nurses worry about paying for their own gas and the wear on tear on their cars,” she says. “My employer reimburses for mileage, and because there is such a severe need for home health nurses, most of them can opt to work in areas in close proximity to where they live.”

In addition, the growing use of telehealth technology allows nurses to spend less time on the road. In some rural home health programs, for example, patients are equipped with audio and video devices in their residences, which enable them to interact with their home care nurses via computer. This also lets nurses augment their regular home health visits. Whereas a nurse in a rural area might spend hours driving from one location to another, telehealth technology gives nurses the opportunity to check in with 15 to 20 patients a day without physically traveling to their homes.

For Boone, one of the most enjoyable aspects of home health nursing is patient education. “I love having the time to teach patients about hygiene, nutrition and coping skills,” she says.

While the flexibility of working in home care makes this career appealing for nurses who have young children, Boone, a single mom with a daughter in college, says it’s also the perfect fit for her lifestyle. “You work your schedule around what is convenient for both you and the patient,” she explains. “And the interaction with patients is priceless. They are all part of my second family.”

Bringing It Home: Getting Started in Home Health Nursing

Home health nurses make visits to a variety of acute and chronically ill patients who are “homebound” and in need of skilled nursing care under a treatment plan that is developed and signed by the patient’s physician. Nurses in this specialty can choose from a variety of employment options, including hospitals’ home health departments, private home health agencies, hospices, Visiting Nurse Associations and public health departments.

Although some nursing schools–such as the University of Michigan and the University of Pennsylvania–offer master’s-level programs in home health nursing, there are currently no specific educational requirements for working in this specialty beyond a BSN degree and basic licensure as an RN. Most home health employers require or prefer at least one year of hospital experience, particularly in critical care. However, many home care agencies have begun to offer on-the-job training programs for new nursing grads.

Home health nurses must have strong clinical and communication skills, including competency in teaching patients various medical procedures and self-care activities. They also need excellent assessment skills in order to detect early signs of potential or actual problems and alert the physician that a change in the plan of care is needed. Documentation of care is also important in this specialty. In addition, home health nurses need to be self-directed and must be able to work both independently and in collaboration with a multidisciplinary team.

More information about home health nursing is available from:

• Home Health Nurses Association,

• Visiting Nurse Associations of America,

• Hospice and Palliative Nurses Association,


Charts Are Going Mobile

New nursing technology has opened endless opportunities for superior care, says Susan R. Stafford, R.N., B.S.N., M.P.A., M.B.A., Associate Chief Nursing Officer of Nursing Informatics at the Cleveland Clinic Stanley Shalom Zielony Institute for Nursing Excellence. The Zielony Institute oversees the practice and education of more than 11,000 nurses in all aspects of the Cleveland Clinic health system, including inpatient, outpatient, rehabilitation, and home care fields. “From recently introduced innovations to those that are on the horizon, enhanced technology gives nurses the ability to integrate so we can focus on delivering quality, safe, world-class care,” Stafford says.

Nurses have always been information managers at the center of a wheel, according to Patricia Abbott, Ph.D., R.N., associate professor and Co-Director of the World Health Organization/Pan American Health Organization Collaborating Center for Nursing Knowledge, Information Management, and Sharing at The Johns Hopkins University Schools of Nursing and Medicine, and chair of the 11th International Congress on Nursing Informatics in 2012. Everybody touches base with the nurse to get the latest information on a patient, says Abbot. “We’ve always had technology in our lives.”

“Our students come in with every piece of technology known to man hooked on their belt. Sometimes it’s like Jeopardy—we’ve got the answer; now what’s the question?” Abbott says. “We’ve got the technology; now show me how to apply it.” Abbott says the younger generation was raised with technology, impacting the way they communicate and conceptualize. “It’s fundamentally changing the way you think and your belief networks,” she says. “What’s happening is a lot of people are starting to look at this and see they have to adapt or leave.”
As U.S. Secretary of Veterans Affairs General Eric Shinseki once said, “If you dislike change, you’re going to dislike irrelevance even more.”

What follows are some of the top trends in nursing technology today, from the macro-level, government-funded changes to the little gadgets you might soon find in your hand.

Nursing informatics

Nursing informatics is a growing field that supports nursing processes through technology, including telehealth, home health, ambulatory care, long-term care, education/research, acute care, outpatient settings, software development, and work flow redesign.

“Technology has been growing and work has been done for 40 years, but people didn’t know about informatics education and it was not that widely available,” says Bonnie Westra, Ph.D., R.N., F.A.A.N., associate professor and Co-Director of the International Classification of Nursing Practice Research and Development Center for Nursing Minimum Data Set Knowledge Discovery at the University of Minnesota School of Nursing. She says she’s suddenly seeing informatics classes that previously attracted three people grow into classes of 25. “Now programs are crawling out of the woodwork,” says Westra, also co-chair for the Alliance for Nursing Informatics (ANI).

The Healthcare Information and Management Systems Society (HIMSS) 2011 Nursing Informatics Workforce Survey reported that nurse informaticists play a critical role in the implementation of various clinical applications, including clinical/nursing documentation and clinical information systems, computerized practitioner order entry (CPOE), and electronic health records (EHR). The 2011 data also suggests a substantial increase in salary for nurse informaticists, which is up 17% from 2007.

Kathryn H. Bowles, Ph.D., R.N., F.A.A.N., associate professor of nursing at the University of Pennsylvania School of Nursing, says there are a few programs in the United States for nurses holding a master’s or Ph.D. She added the American Medical Informatics Association (AMIA) is doing a lot of work to promote nursing and medical education in nursing informatics, and the Technology Informatics Guiding Educational Reform (TIGER) Initiative is transforming informatics.

The TIGER Initiative aims to identify information/knowledge management best practices and effective technology to help practicing nurses and nursing students make health care safer, effective, efficient, patient-centered, timely, and equitable. “Nurses are out doing 50%–80% of all care in the globe, and many times they are in the field or in the bush,” Abbott says. “As technologies have gotten smaller, powerful, and more mobile, if we combine a huge workforce with more powerful technologies, we are enabling nurses, birth attendants, and midwives to practice better. When you do that, you improve care to an entire community.”


Telehealth promotes lower-cost health care through mobile communication and video. Laptops, tablets, and smartphones offer video conference capabilities that allow face-to-face visits without travel costs and complications, and provide vital signs and medical history for remote diagnosis and monitoring.

“Telehealth provides specialty services on the turn of a dime without the patient being shipped off to another facility,” Westra says. Telestroke robotics is one example, where practitioners use robotic technology to manage stroke victims in remote areas. Telehealth also is being used for psychiatric consults in prisons, a less expensive and equally effective treatment option.

Abbott worked on a National Institutes of Health–funded study involving implementing telehealth services for minority patients suffering from congestive heart failure. The program placed telehealth monitors in patient homes for remote monitoring, allowing patients to Skype with nurses regarding their health concerns. “Some of my patients are geriatric African American folks with heart failure, and they don’t have transportation, and they might be in the only occupied house in an area of burned-out homes,” Abbott says. Telehealth also can be a lifeline for entire communities, scaling up knowledge levels of community health workers in low-resource areas without a formally trained nurse on site.

“We know there are not enough doctors to go around, and also not enough nurses,” Abbott says. “In reality, when you start looking at the large provider groups that exist around the world, you look at ways you can reach and teach. Many of these folks, both nationally and internationally, cannot travel to the bricks and mortar model of a school to get additional training.”

Mobile technology

Gartner Inc., a Connecticut-based information technology research and advisory company, says mobile health, or mHealth, is one of the top 10 consumer mobile applications for 2012. According to the 2009 American Academy of Nurse Practitioners (AANP) Membership Survey, 60% of respondents indicated they used a PDA or smartphone in clinical practice. Applications do not require a large, up-front investment and are simple to download. Health diaries, medication reminders, exercise tips, and applications to track food intake, pain levels, and sleeping habits are helping people monitor their own health.

Cell phones facilitating mHealth are proving to be powerful tools in the Latino and African American communities, particularly with illegal aliens afraid to participate in a formal health care system. Abbott says she’s involved in a movement surrounding texting for health, in which nurses reach out to minority populations with health tips and reminders concerning maternal health, HIV/AIDS, and drug addiction. The National Healthy Mothers, Healthy Babies Coalition text4baby’s Hispanic Outreach program, for example, supports mothers by providing 140 characters of health information and resources to a pregnant woman’s cell phone.

“They don’t have home phones—a lot don’t even have a home—but they have a cell phone,” Abbott says. “We are getting messages to them about appointments and medication refills. We let them text in questions or problems they have because they won’t come to the clinic. It’s a way to reach people through something so many people have these days.”

Over the past two years, the University of San Diego’s Hahn School of Nursing and Health Science has required an iPod Touch for incoming RN pre-licensure students. Instead of carrying multiple books to clinical sites, the iTouch provides clinical reference tools and pharmacology manuals with the tap of a finger.

“They find that having those clinical reference tools available to them very quickly while seeing patients is easier than having to look something up in a book,” says Karen Macauley, D.N.P., F.N.P.-B.C., Director of the Simulation and Standardized Patient Nursing Laboratory and clinical associate professor. The school developed an nTrack application for the iTouch with Skyscape Medical to help students document clinical experiences in hospital sites. Once they graduate, students can compile the data into an e-portfolio for potential employers.

“We decided to require it because it forces students to really embrace technology,” Macauley says. “Once they get into the hospital sites, you’re really looking at the best evidence-based practice and how to apply it to their clinical practice. Without having something at their fingertips to look at right away, they are at a loss.”

Another mobile tool growing in popularity is the electronic tablet. “The whole iPad application, how it will affect patient teaching and patient interaction, will be huge,” Westra says.
Abbott says mobile technology is especially important for nurses, who are incredibly mobile themselves. “We are running from bed to bed to bed, from unit to unit to unit, from clinic to clinic to clinic, from house to house to house,” Abbott says. “Records never seem to go with us, which has caused a lot of errors, redundancy, and wasted effort. Now when you put mobile technology in a nurse’s hand or in her pocket, it allows her to do her job, help her patient, right at the patient’s side instead of running back to the nurses’ station and grabbing a chart or looking on a computer.”

Mobile technology can also be a lifeline for remote nurses in “frontier environments” with less than seven people per square mile, Abbott says. A mini clinic with connectivity enables nurses to provide more services, find the help they need when they need it, and quickly connect through Skype with a specialist to find an answer.

Electronic health records

The federal government set aside $27 billion for an incentive program, as part of the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, to encourage hospitals and providers to adopt electronic health records systems (EHR). Policymakers continue to work toward establishing a Nationwide Healthcare Information Network to standardize EHRs, which would provide a seamless exchange of data among physicians, hospitals, laboratories, pharmacies, and other health care organizations.

At the Cleveland Clinic, electronic documentation includes computerized provider order entry (CPOE), nursing care documentation, medication dispensing and administration, and results reporting. The technology improves access to patient information at the point of care and enhances the ability to benchmark, monitor, audit, and report quality measures while offering quality data to support nursing-led research.

The Cleveland Clinic has been implementing EHR technology in stages over the past six years. The most recent implementation was the ICU nursing documentation with device integration. With this implementation, vital signs go directly from the cardiac monitor at the bedside into the EHR.

At the University of Pennsylvania, Bowles’ is examining decision making supported by information technology to improve care for older adults. Her ongoing study, funded by the National Institute of Nursing Research, focuses on the development of decision support for hospital discharge referral decisions. Using an electronic record, patients are asked a series of questions, ranging from their ability to walk to whether they have a caregiver available at home.  Through statistical analysis of the answers and information already contained in the EHR, clinicians can make an informed decision regarding a patient’s needs. “Decision support, in general, is a new phenomenon,” Bowles says. “As we start using electronic records, more and more patient data will be available electronically and more developed to remind clinicians of the right thing to do.”

In May 2010, the Office of the National Coordinator for Health Information Technology (ONC) estimated an additional 50,000 health information technology workers will be needed over the next five years to satisfy meaningful use criteria. Abbott is the principal investigator on a HITECH grant to create a six-month, non-degree program for the unemployed to be qualified to build, upgrade, and maintain the implementation of health information technology programs, including EHR systems, at hospitals and clinics.


Centralized monitoring of intensive care units in remote areas is the health care delivery of the future. FHN Memorial Hospital in Freeport, Illinois, is collaborating with the University of Wisconsin e-Care team of intensivist physicians and critical care nurses in Madison, Wisconsin, on eICU care. Small microphones and cameras in each ICU patient room provide a constant link to the e-Care team at UW Hospital. Patient vital information, including heart rate, blood pressure, medications, and test results, are monitored in the FHN ICU and shared in real time with the e-Care team.

If a patient’s condition suddenly changes, the FHN physician and nurses can touch a button and activate a two-way visual and audio link for an immediate consultation with e-Care specialists.

Social media

The Mayo Clinic health guide used to be the go-to guide at everyone’s bedside. But the introduction of social media has both patients and caregivers logging onto sites like WebMD and Patients Like Me for health information, advice, and forums to share experiences.

A 2008 Edelman Health Engagement Barometer found the Internet has become the “new second opinion.” Patients with a diagnosis are barely out of the exam room door before typing status updates on their smartphones and searching for support groups via social media.

Many nurses have taken to Facebook and Twitter to promote accurate medical information to help the general population make healthy lifestyle choices, as well as to promote their profession.

Virtual reality simulations

Imagine being in the operating room and making a devastating decision that risks the life of a patient. Now imagine being given a do-over and figuring out the best way to proceed.

Such is the scenario in Second Life, a 3D virtual world becoming popular in nursing education. Westra says universities are buying islands and creating communities in which students develop avatars and run through different scenarios to see the consequences of their decisions. She’s even seen a virtual theater set up where students in their avatar personas can “attend” an author interview on a virtual theater stage. “It’s a chance to have people practice skills and make decisions and study consequences and not kill patients,” Westra says.

Radio frequency identification

Radio frequency identification (RFID) has been traditionally used for tagging equipment, but it’s starting to replace bar coding for patient identification. Westra says she is seeing RFID in nurseries to prevent kidnappings and tagging breast milk to ensure it goes to the right baby. Alzheimer’s units are using it as well to monitor patients prone to wandering.

Experimentally, it also is showing up in operating room equipment. A wand with an RFID reader is replacing X-rays to pick up any sponges or instruments left in patients before they are sewn up. Another experimental use is with intubating patients to check placement rather than using X-ray.

Judy Murphy, R.N., F.A.C.M.I., F.H.I.M.S.S., Vice President of Information Technology for Aurora Health Care in Wisconsin and co-chair of ANI, says RFID is a lot like Global Positioning System (GPS), but added there isn’t a lot of penetration of the technology at this point due to the expense. But it may be something more institutions turn to down the road.

Smart pumps

Almost every IV these days is connected to a smart pump integrated with a computer that handles drug infusion calculating. Computerized infusion pumps with dose error reduction systems were developed to alert nurses if a programmed fusion dosage exceeds the hospital’s best practice guidelines.

Some organizations are integrating the pumps with EHRs, allowing physicians to enter information electronically and pass it along via computer to the pump, Murphy says.
Cleveland Clinic is rolling out new IV digital smart pumps designed specifically for high-volume medication infusions. This imitation will be completed and fully implemented in 2012. The Clinic will also be using new smart syringe pumps and smart pain pumps.

Wireless voice-over-IP phones

Through wireless voice-over-IP phones—voice carried over Internet protocol networks—nurses can be more easily reached when they are caring for patients in various rooms throughout a unit. This technology eliminates the need for unit secretaries to make announcements over a loudspeaker. The phone, according to the Cleveland Clinic, helps with noise control, improves efficiency in communication between staff and patients, and streamlines processes.

Electronic patient tracking boards

Similar to wireless voice-over-IP phones, electronic patient tracking boards facilitate ease of communication and coordination of patient care with a quick status display of current activity on a unit. A combination of wireless communication, barcode, and Internet technology, electronic patient tracking boards are replacing white boards in many settings.

Cleveland Clinic first used patient tracking systems in the emergency department and operating room areas. In 2010 the hospital system rolled out a new patient tracking board system to all of the main campus inpatient units.

Electronic patient tracking boards, according to Stafford, decrease the need for phone calls or meetings to find information about patients as they are coming and going. The systems give nursing units a one-stop shop for critical information on patients. A nurse, for example, can easily see if patients are at risk of falling or need extra precautions in isolation.

Point-of-care technology

Point-of-care technology offers access to patient records, labs, medication information, and even second opinions, all from the patient’s bedside. A wireless network and computer allow nurses to access and receive a wide array of information without leaving the patient’s side.

Wireless point-of-care glucometers, for example, submit blood glucose results to the electronic medical record as soon as the clinician checks a patient’s blood sugar level. This technology offers completed reporting and documentation immediately upon the docking of the wireless device into its cradle. The information transaction can also be sent into the electronic medical record.

Workstations on wheels are also used for bedside and point-of-care documentation and information retrieval. Cleveland Clinic has one workstation on wheels for each caregiver working a shift on a nursing unit, providing instant access to a patient’s medical records at the bedside. The Cleveland Clinic finds the system helps nurses confirm all patient information is accurate, including medical history and medications, and improves patient safety for medication administration.

Web-based self-scheduling

Cleveland Clinic is also rolling out a new Web-based self-scheduling platform for all caregivers. The system offers nursing caregivers convenience and flexibility through the ability to select shifts based on competencies. Nurse managers can now spend less time filling shifts and making phone calls. This technology is relatively new and still uncommon among most health systems, but it is a growing trend and anticipated to be coming to more health systems over the next few years.

“We look at the opportunities that are possible because of technological advancements,” Stafford says. “The common thread is that many of these advancements were developed to help nurses give the patient a positive experience. An enhanced patient experience is very valuable, creating a healing environment that contributes to overall positive patient outcomes.”

While all of this technology is meant to create efficiencies, improve outcomes, and ease the workload, Macauley says it all comes down to how medical professionals communicate with each other. The future of medical technology lies within professionals and students who will embrace it and create a system that lowers health care costs by reducing redundancy.

“Those people who leave the program in technology are thinking out of the box on using mobile devices and mobile technology and looking at ways of being innovative in using technology we’re all exposed to,” Macauley says.