What It Does

NurseMind is a dynamic to-do list with timings and a unique graphical user interface. It knows not only what the nurse needs to do but also when.

It supports her in her delicate time management balancing act. It has the potential to create a small revolution in the way nurses do their work.  (For ease of writing, we refer to nurses with the feminine pronoun though of course many are male.)

It is especially useful to:

  • nursing students internalizing their new job's routine
  • nurses who float to new units and need to work according to those units' procedures
  • every nurse who grapples with the heavy cognitive load of this difficult job...  in other words, all of them!

NurseMind helps her to:

  • Prioritize ("What must I do next?")
  • Manage time ("How much time do I have? How long will this take?")
  • Anticipate bottlenecks ("I see a cluster of task icons half an hour from now, I'd better get started on those so I won't fall behind.")
  • Take breaks appropriately ("Here is an opening in my work timeline; it's a good time for coffee.")
  • Organize tasks by patient ("What does this patient need now?")
  • Organize them by room ("What are all the things I can do while I'm here?")
  • Optimize task steps such as anticipating and fetching the supplies for several tasks with a single trip to the supply room
  • Shave seconds off record-keeping tasks by recording patient data more efficiently and more accurately than on scraps of paper (no more deciphering hasty scribbles).
  • Recall essential patient data for:
    • A call to the doctor to discuss a patient's change in status and perhaps to request a change in medication orders
    • Charting -- every nurse knows that "if it's not documented it didn't happen"
    • Report/handoff at the end of my shift
  • Keep track of patients' special needs ("The meal cart is here but this icon by his name reminds me that he's NPO for surgery this afternoon").
  • Check off (with a timestamp) tasks I've completed.
  • Remember (using the "Remind Me" function) tasks that come up during a shift such as following up with the pharmacy that hasn't called me back, a patient whose pain med isn't working after a half hour, etc.
  • Be certain none are forgotten.

For nurses who subscribe to the online service, NurseMind keeps a diary of:

  • Shifts worked (hospitals, units, dates, hours)
  • Tasks performed
  • Summary reports about patients, e.g. percentage requiring diabetes care, wound care, etc.
  • The app collects data that's never been available before.

The subscription also enables access to:

  • Updated nursing protocols (mini to-do lists)
  • Shared shift definitions (shift-length to-do lists)
  • Newly-added patient precautions
  • Hospital Quick-Refs (frequently-needed phone numbers, door codes, computer logins, acronyms, and more)

A Researcher's View of NurseMind

A Researcher's View of the NurseMind Tool
Marcelline Harris, RN, PhD
Univ. of Michigan, Fall 2011

The mobile application ("app") is a dynamic to-do list with timings and a unique graphical user interface. This version is for use by inpatient nurses in acute care hospitals to support the time management aspect of their work. By addressing the need for nurses to manage their workload within the context of time, it fills a gap in the set of tools and resources available to nurses.

While the personal experience of Dan Keller motivated the development of this app, his experience is not unique. Nurses commonly describe their work as complex, challenged by increasing volumes of data and information to remember, frequent interruptions, and rapidly-changing demands throughout the course of a shift. These features of nursing work impose a substantial cognitive load with often-overlooked opportunities to optimize the management of an individual nurse’s workload.

Ref: What's Hard about Nursing

The most common solution that nurses employ to deal with this situation is to develop some sort of paper document that helps them organize their work for the upcoming shift that can be carried in a pocket. Nurses commonly refer to this document as a “brain sheet”. Unfortunately, these brain sheets are developed anew on every shift by every nurse, are not easily shared with co-workers, and are usually discarded at the end of a shift.

A review of the research on work environments and working conditions for nurses noted that while nursing work in the inpatient care setting has long been recognized as stress-filled, that stress has escalated since the mid-1980s due to changes in health care financing and the increasing use of technology and turbulence within the work environment. The research evidence suggests this situation has contributed to increased role stress, absenteeism, less teamwork, increased turnover and burnout, and importantly has had a negative effect on patient care quality and safety.

Ref: Nurses: Role of the Work Environment and Working Conditions

More recently, another team of nurse researchers have identified and defined the concept of missed nursing care. Missed nursing care is an error of omission in which an aspect of required patient care is omitted (either in part or in whole) or delayed. Investigators noted that the concept has been "conspicuously absent" in quality and patient safety literature, with individual aspects of nursing care left undone given only occasional mention.

Ref: Missed nursing care: a concept analysis

The tools and resources most commonly available to nurses are limited in several ways:

  1. They focus on individual patients over a hospital stay (e.g., care plans and worklists) and not a group of patients over a shift,
  2. Highly "local" procedures for a particular work area (e.g., policy and procedure guidelines) may not be included in the care plan and are rarely included in worklists, and
  3. Even if electronic tools are available, they are modeled after the types of paper documents currently in use. Most importantly, none of the current set of tools and resources was specifically designed to meet the need of nurses to manage their work from a time management perspective.

We believe that this app has potential to meet a critical gap in the toolset available to nurses, and will contribute to the problem of missed care and stressful work environments that are associated with compromised patient quality and safety.

The key function of this app is the generation of time-oriented "to-do" lists in the context of specific patient care units, specific shifts, and one or more specific patients. The application presents the to-do list with a dynamic graphical display including look-ahead and look-back features for purposes of time management. The "to-do" list includes specific treatments and cares required by patients (e.g. mobilization, wound care, medication administration, etc.), as well as critical surveillance and precautionary activities to reduce the risk of specific complications.

In addition, the app "knows" what a nurse needs to do in the course of a shift for a single patient or a group of patients.< Each task has a start time and duration, and the nurse checks it off once it is completed. If a task is late, it turns red. New tasks can be added on the fly. Task lists ("shift definitions") vary to meet local routines related to the type of patient care unit and shift, a feature of particular value to nurses who may be floating from another patient care unit, and to student nurses.

Thus, the app promises to help the nurse to:

  1. Be certain that no tasks are forgotten,
  2. Manage workflow by anticipating bottlenecks,
  3. Optimize task combinations such as trips to the supplies room,
  4. Prioritize by being able to see all pending tasks at a glance and choose what’s most important, and
  5. Keep track of what’s done and when.

The expectation is that using this app will result in less missed care, lower cognitive burden, and less stress.

New Data

NursesGetItDone supports the nurse on the job and collects data that's never been available before, about what nurses actually do, how often, when, and where. The working nurse will know more about what she or he has done than ever before. Aggregating this data will yield more information about the work nurses do than has been available before.

In addition to the program that runs on the iPhone or iPod Touch in the nurse's pocket, this web site has a database that collects aggregate data. Industry standards of privacy, security, and nursing nomenclature are supported:

  • Data collection is HIPAA-compliant.
  • Tasks are defined using NANDA terminology.
  • Electronic communication is secured by means of Secure Sockets Layer (SSL) encryption for protection from eavesdropping, tampering, or message forgery.

The benefits to the nurse are subtle but valuable: NurseMind lets the machine keep track of the details. It spares the nurse the remarkable effort that she has traditionally sustained to remember all the details of the myriad tasks she does. At last, she can devote all her mental energy, experience, and skill to her clinical work and to her patients!