Before any new technology gets implemented in the clinical arena, a lot of work has already gone into identifying the problem or need for such new technology, picking the right tool, programming or tweaking the tool for use in a particular setting, having users test the tool, and training the end-users. Nursing informatics staff may be involved in some or all of these phases.
In the very beginning, analysts and project managers may help to design and build the system with clinical subject matter experts (SMEs), and then eventually trainers or educators teach the end-users how to use the technology. In between, different types of informaticists may initiate or facilitate phases such as validation and testing of the technology. In the end though, when the technology is given the green light for implementation, it is the superusers’ turn to step in.
Just what is a nurse superuser?
Simply put, a nurse superuser is a clinical end-user who gets additional training on a specific technology that enables her or him to provide support and teaching to colleagues at the bedside. The superuser is first of all a member of the clinical staff – she or he is expected to provide patient care as her or his primary role. Aside from that however, she or he is also expected to answer questions, troubleshoot problems, and even resolve issues regarding the new technology. When something is beyond her or his knowledge to answer or resolve, she or he is expected to escalate the issue to the appropriate people.
Unlike most informaticists, superusers usually remain clinicians. They are the front-liners, the on-the-ground, real-time experts who support and teach their colleagues even as they provide patient care. Superusers need clinical competence, technical expertise, and teaching skills, as well as a lot of empathy and patience, in order to perform their jobs effectively.
SAMPLE DAY FOR AN EHR SUPERUSER DURING GO-LIVE OR IMPLEMENTATION PHASE
(The Go-Live/Implementation Phase usually lasts 2 – 4 weeks after a major new technology, such as Barcode Medication Administration (BCMA) or Computerized Order Entry (COE), or even an entirely new electronic health record (EHR) system is introduced. The example below is for a 12-hour shift. Please note that this is just an example of a “typical” day for a certain kind of nurse superuser, and is no means a detailed or exact description of any particular shift, nor does it cover everything that nurse superusers do.)
6:45 Conducts a quick in-service to both outgoing and incoming staff regarding an issue that was resolved in the previous shift
7:00 Goes around the unit to check if anyone needs any assistance with documentation or finding information while the other staff nurses are doing or completing shift (hand-off) report
8:00 Gets paged to assist a nurse who is having an issue with barcoding medications. The superuser evaluates the situation to check if there is an issue with the barcode scanner, the documentation or electronic MAR system, or with the medication barcodes. After a quick assessment, she notes that the issue seems to be with some of the medication barcodes. She notifies the Pharmacy and the Charge Nurse, and opens up an issue log (sometimes called “tickets” ) so that the back-end staff can look at this more closely.
9:00 – 11:00 A patient’s status is deteriorating, and a couple of extra nurses as well as the superuser is paged into the room. Upon arrival, she notes that one of the additional nurses is helping with patient care, while the other nurse is making sure that the patient’s vital signs are getting documented. The primary care nurse tells her that because of the nature of the emergency situation, the physicians in the treatment team are giving several verbal orders and she needs help getting them into the system. The superuser then assists with putting in the verbal orders and making sure they are carried (and helping to do some of them, such as sending blood specimens to the lab).
11:00 The patient finally gets stabilized. However, the primary care nurse has not had a break since 7am, and there are no other floats/break nurses available at this time. Since she has had a quick break earlier, the superuser volunteers to give the primary care nurse a break. She is able to do this since she is part of the unit’s patient care team.
11:30 There is a lull in the unit, and everything seems to be working smoothly. The superuser takes some time to sit down and check her work email. She notes that an email was sent out by the EHR team informing all the staff that some medication barcodes were identified as not functioning properly, and that the EHR team is working with Pharmacy to replace those barcodes.
12:00 She informs the Charge Nurse and her fellow superusers about the medication barcodes email, so that they can help disseminate the information.
12:30 Gets a page to help give a lunch break in a patient room. While giving the lunch break, she documents appropriate information about the patient. She also reviews the primary nurse’s documentation, and notes down items that she thinks were missed. When the primary nurse comes back after lunch, she shows him her notes about the items she recommends being documented. They discuss them and he agrees with most of them and thanks her for the help.
1:00 Takes a lunch break.
1:30 Gets paged to the nurses’ station. When she gets there, the Charge Nurse explains that a physician has said that she wrote orders for a patient in the system a few minutes ago. However, the primary care nurse could not find the orders mentioned. The superuser reviews the patient’s chart and helps find the orders.
2:00 Helps with giving breaks.
3:00 A new admission has come in from the PACU. The primary nurse is doing the admission workflow and requested for assistance in making sure that she has not missed any important documentation.
4:00 Another patient is being discharged home. The primary nurse taking care of the patient cannot recall how to put in discharge instructions using the system, and asks for help. The superuser provides assistance until the whole discharge workflow is completed.
5:00 Helps give more breaks.
5:30 The primary nurses are starting to give the scheduled medications for this time of day. The unit’s superusers make their rounds to make sure the medication barcode issues from earlier is no longer happening.
6:00 It is almost the end of the shift. All the superusers are busy helping the primary care nurses make sure that their clinical documentation is complete. They also assist with patient care requests, as needed.
6:30 The superusers for the next shift have started to arrive, and the previous shift’s superusers give them a hand-off report of the issues of the day, highlighting the one about the medication barcodes so that they could help keep an eye on it.
6:45 All the superusers do one more round to check if any of their colleagues need any help with the system.
7:00 The shift ends and it’s time to go home.