Imagine a woman lying unconscious in an intensive care unit with multiple IVs, on a breathing machine, and attached to monitors. Beside her sits another woman, perhaps her wife or sister, her brow crumpled with worry. On the other side of the bed is a table with a computer. A nurse is stationed there, studying his cellphone. What is he doing? Looking at a message from the patient’s doctor? Calculating her medication dosage? Reading a reminder from home to pick up diapers?
Smartphones have become our shopping cart, our bank machine, and our direct line to the people we love. They are also a major source of diversion, whether for watching movies, checking the news or scrolling through pictures on Facebook. We check our phones constantly—on average, we spend three hours a day on them. Most of us have both interrupted and been interrupted, or even ignored, on account of a cellphone alert. And yet, expecting people to put their phones away at the dinner table seems almost Victorian. They’re practically part of the place setting.
But what is it like for patients and families to see doctors and nurses on their phones? Should the rules be different in health care?
Staff on cellphones: A family’s perspective
Carrie Blais* describes the experience as “wounding.” Recently, her father was in intensive care in a Toronto hospital following a triple bypass operation. Blais, her mother and her sister were upset to see a few nurses assigned to his care use their phones to text or scroll through social media. When one of the nurses noticed that the family had seen her on her phone, she showed them pictures of her dog. “I was sitting there thinking, ‘Is my dad going to survive the next hour?’” says Blais. “And she’s looking at puppies on Facebook.”
Beyond wounding, she says, the experience was worrisome. “There were times when my father would be choking on his ventilator, and he suffered if someone wasn’t paying attention,” says Blais. “The machines would eventually alert the nurses to the problem, but it was very disconcerting for us to feel that the nurse who was stationed at the bedside, while she was in her working hours—not on her break—was not paying attention.”
Blais works in health care herself and says she understands that while families and patients in the ICU need a lot of reassurance, the staff have needs as well. “I recognize that every day cannot be the end of the world for the staff that work in the ICU,” she says. “[But] everyone [there] is in critical condition, and so there’s something about bedside phone use—text messaging and social media—that feels really inappropriate.”
Orla Smith agrees. She and her fellow clinical managers in the critical care department of St. Michael’s Hospital in Toronto have received complaints about staff using cellphones for personal reasons. Not only does this behaviour convey disrespect to patients and families, says Smith, it’s also antithetical to the purpose of intensive care. “In the ICU, things can change very subtly,” says Smith. “A subtle trending down in blood pressure, or oxygenation status, or heart rate, or a subtle change in neurological status. You’re expected to pick up on subtleties, to be able to apply critical thinking to understanding, ‘OK, what is happening here?’” This ability might be compromised, she says, “if you’re on your device, or pulled toward that device.”
It’s happened before: In December 2011, John Halamka, chief information officer at Harvard Medical School, wrote about an incident in which a resident responded to a text message just before discontinuing a patient’s anticoagulant. The resident forgot to order the change, and the patient wound up needing open-heart surgery.
A staff perspective
Smartphones have become integral to medical practice. There are apps that provide health care workers with access to information about diseases and treatments, as well as information about their patients’ drugs and lab tests. “Pieces of the job are being transferred to mobile devices,” says Mandy Tanner*, a nurse who works in the intensive care unit in a Toronto hospital. “[Cellphones are] important for communication purposes, especially in the ICU, [where] you can’t leave the patient’s bedside.”
But Tanner says she also uses her phone for personal reasons while on the unit, and so do many of her colleagues. “It definitely comes out in downtime or at four in the morning, when you’re trying to stay awake,” she says. She doesn’t look at her phone while at a patient’s bedside, but will take it out when she goes back to her desk (ICU nurses typically work one-to-one with patients and have individual stations beside or at the end of their beds) “if it’s quiet and no one else needs help,” she says.
Tanner understands the concerns about cellphone use on the unit. “I can definitely see how it could come across as unprofessional seeing a nurse look at their phone,” she says. “Or how, if someone was very engrossed by their phone, that could take their attention away from the room and that would definitely be very bad.”
She describes a specific moment, about a year-and-a-half ago, when she was on her phone “and things started happening,” she says. “The room started to get a bit busier, machines started beeping, patients needed things. So that was my cue to put my phone away. I remember having the thought, ‘Oh, phones can be really distracting.’”
Should cellphones be “banned”?
Seventy-eight percent of U.S. hospital nurses surveyed for a study published in 2015 reported using their cellphones for non-work-related purposes while working (excluding breaks). The most common reason was personal emails and texts (39 percent), but some said they used their phones to shop (almost 10 percent) and play games (almost seven percent). Another study, published in 2017, looked at both work-related and non-work-related usage of cellphones, and found lower numbers: 19 percent checked or sent personal messages, five percent shopped, and three percent played games. About 30 percent believed cellphone use helped reduce stress, but almost 70 percent said cellphone use was more negative than positive when it came to doing their jobs, and nearly 40 percent believed that phones were “always or often a distraction while working.”
Of course, this does not apply to nurses alone. In a survey of American physicians published in 2012, 37 percent of residents and 12 percent of faculty reported using their phones during inpatient rounds to read or respond to personal texts or emails. Nineteen percent of residents and 12 percent of faculty believed they missed important information as a result of being distracted by their devices.
So should cellphones be banned on patient wards? “I don’t think there’s any way that we would be able to tell staff, ‘You have to lock up your cellphone when you come to work and you can’t look at it.’ It’s just not reasonable,” says Cathy O’Neill, senior director of patient experience and community engagement for Providence Healthcare, St. Joseph’s Health Centre and St. Michael’s Hospital. The policy there is that “accessing the Internet on a cellphone or computer should not in any way distract a staff member from patient care and their duties and responsibilities” and it applies to “everyone—from employees and learners to managers and physicians,” according to communications adviser Michael Oliveira.
“It really is a collective responsibility, and I think people recognize that,” says Mandy Tanner. “I think you would need rules if people didn’t take responsibility to know when it’s appropriate or not. Maybe Facebook in the room right at the patient’s bed—maybe that could be a rule. But I really have seen that so rarely.”
O’Neill thinks it’s easy to make assumptions that staff are using their phones for personal reasons when in fact they may be using them for work. At the same time, she thinks health care providers need to be aware that using a cellphone in front of a patient or family may suggest that they are not fully present. It would be good to let patients know otherwise, O’Neill says. “I should be saying, ‘Hold on a second, maybe I can get an answer quickly, I’m just going to use my phone…’”
“We are going to continue to leverage technology and some of this is going to be through cellphones,” says O’Neill. “How do we educate patients and families about how we use technology to provide care? If we’re going to tackle this, we have to tackle it from both sides.”
But what about when staff really are using their phones inappropriately?
Orla Smith, the critical care manager at St. Michael’s Hospital, agrees that banning cellphones is not the solution. “We have to be pragmatic in 2018,” she says.“Devices are everywhere and we are using computers more and more for care purposes.” The first priority must always be the patient, says Smith, but all staff need breaks and time away from their assignments. “We need to make sure that we take these breaks to refuel. This is when we can check in on our personal lives and social media, or play a few rounds of Candy Crush.” Smith thinks device overuse is a widespread issue, hardly unique to hospital staff, and recently made a pledge for Change Day to reduce her own screen time “in order to be more present and engaged at work (with colleagues, patients, and families) and at home (with family and friends).”
For Andrew Baker, chief of the department of critical care at St. Michael’s, it’s helpful to think of cellphone use as being like an addiction. “The brain sort of gets into this mental pathway where it actually gets used to this rapid type of feeding,” he says. “I’ve witnessed it in myself. If I let myself not be mindful, I can find myself picking up my cellphone and looking at it just because, almost like a fix, to see what’s new, what’s a piece of information.”
On the other hand, he also knows what it can be like trying to talk to someone who’s distracted with their phone. “I feel it in my stomach,” he says. It’s a feeling of: “I wanted you to hear this and I know you’re not listening.”
Baker wonders about finding ways to help providers become more “self-aware and mindful,” to help them recognize that they’re driven to look at their phones, and at the same time to understand how patients feel when they do. “I don’t come at this from a blame thing,” he says. “I think we need facilitated ways to get to a new normal, to understand that something tenacious has come into our social, cultural, neurologic environment that we need to be aware of and control in ourselves.”
*Names have been changed to protect privacy
The comments section is closed.
Cellphone use by hospital personnel AT ANY TIME BE IT BREAKS OR WHATEVER IS INAPPROPRIATE! You cannot use them driving so these hospital administrating idiots can restrict their use. They merely don’t want to. It’s inconvenient not to Facebook. I am appalled.
Have you seen or heard of Docs, staff and nurses taking pics. of patents privates or wounds ? I have and they don’t do much to them do they. Wish there were some kind of accountability for professionals who do these things but I already know it’s deep under the rug.
Have your Employer or company issue a job phone. Use it for taking pics of wounds, communicating with job personnel ect. And when you do get a break , use your phone then if you need to check on something. What about the germs your introducing in the icu, ER, and during surgery. ( staff infections ) etc. I feel VERY uneasy when there are cameras present during any kind of health care I’m receiving.
I am very concerned about our smart phone culture among nurses and patients. I am nurse working on a busy cardiac unit. Unfortunately, majority of nursing staff is attached to their phones more than to their patients’ care. They act very upset when something or someone, either a nurse or a patient needing some assistance, requires that nurse to interrupt her precious time on her phone. It is disturbing. Patients, on the other hand, use their face time on the phone or speaker phone without headphones in semi private rooms or ward rooms which is super difficult for the sicker neighbour and the nurse who has to deal with it. People behave as if they live on planet “ME”.
I think there should be work phones supplied by hospital…where I work you use your phone on your break if you get caught with your phone while working you get written up
Smartphones themselves are not the root cause of the issue, as distraction while on the job has been present in many ways before computers became so sophisticated that they fit in the palm of our hand. (distraction isn’t even a technological issue, as it has been witnessed long before computers became common place in the health care environment, such as paying more attention to the daily crossword in the newspaper while at the patient bedside, or having a personal conversation on the unit phone during scheduled work hours). The question is how to support our fellow health care providers to balance their responsibilities to their patients with their responsibilities to themselves i.e. self-care in a manner that is not a compromise to patient care or to the health care organization.
There’s a lack of recognition of human needs at work. Physicians don’t have breaks built into their day the way that nurses do. They- and residents in particular- sacrifice a huge amount, working long hours, working weekends and holidays, and working shifts that run over 24 hours long to take care of patients. Taking away their cellphones or prohibiting them from texting people about personal things is unkind. Doctors, nurses, and other healthcare professionals have lives and human needs, too- they have families and friends they don’t see for sometimes days or weeks or months. The few non-work related messages they get are often their only thread to their sanity and rarely distract them from tasks at hand. Physicians in particular don’t have built in breaks the way that nurses do. And I have never seen one of them checking their social media while at a patient’s bedside, so to characterize this as a common problem is ignorant at best and simply a lie at worst. You can’t see this happen a few times and assume that everyone does it. Every other job allows for people to use their cellphones- this shouldn’t be any different. Patients need to recognize this as well.
Perhaps the best thing to do, if this is truly a concern, is to recognize the natural aspects of things like attention spans and account for them. Give people breaks every 15 minutes (our attentions wander otherwise, even if there’s no phone at hand, so chances are we’ll miss something anyway). Give physicians breaks, too, and don’t make them work such long hours. Recognize that having a nurse stare at a vitals screen for whatever part of their 12 hours a day when they aren’t cleaning the patient/administering medicaitons/getting medications drawn up (the latter is another time that they may be away and not paying attention, by the way, yet we don’t really talk about that) isn’t realistic. Because the reality is, even in a setting like the ICU, boredom sets in when you’re working a shift and not much is actually happening. And boredom is really bad for maintaining attention. Most patients aren’t actually crashing- they’re quite stable. Alarms are set up for a reason. And so maybe that Facebook page that’s open is actually better for the patient and not worse- but no one has the true data to show this one way or another, and anecdotes of how people who may not know what they’re talking about feel aren’t something we should look at to define policy.
Oh, and if you want to talk about distracting items, consider removing all pagers and work phones. These go off all the time at the patient’s bedside, and often necessitate that clinicians look at them to turn off the alarm. If distractions from work are such a concern, these are probably the single worst culprit, not the 2 text messages you got from your mom/spouse/kid wishing you a good day or asking you to pick up some milk on the way home. Especially given that most of the time the messages these work devices convey aren’t in any way urgent (patient has a potassium of 3.4! the blood pressure is normal! can I get a laxative order please? patient can’t sleep!). These are much, much worse than any personal device- any resident can tell you that.
In my opinion the health Authority should provide devices for hospital business. This legitimizes the staff use of technology and creates an official record of all actions taken. Hospital staff have breaks and can conduct personal business during those times, as it should be for all of us. It’s too easy for the lines to be blurred. My mom died after a routine thyroidectomy because her surgeon was too busy/complacent to come back to the hospital. He violated hospital policy and got the nurse to use her personal cell phone to text him a photo of the incision and made a diagnosis based on that photo. Since they were both using personal cell phones the photos were not under the care, custody and control of the hospital and they are not in my mother’s medical file. The health authority will not take any responsibility on this matter. I know for a fact, the surgeon and some of the nurses continue to operate this way. It’s unprofessional and dangerous.
Sorry about the loss of your mother. But I find it hard to believe that the cause of the death could be an image of the wound. The system of taking pictures without identifiable data is routine and is to be encouraged. It allows us to provide advise faster and efficiently.