Jul 31, 2020

Nurses Can’t Be Good Advocates Without Good Data

During a pandemic, data can make the difference between life and death. The worldwide outbreak of COVID-19 is teaching us this lesson yet again. We need accurate information on where a disease has been, who has it, and how many infected people are dying in order to stop its further spread.

Unfortunately, this pandemic has also revealed serious deficiencies in the public commitment to good data in the United States. For several reasons, the collection of data connected to COVID-19 was inadequate from the start. Early on, the federal government was reluctant to collect or publish data on the unequal impact of COVID-19 by race, which we now know is key to understanding the disease’s toll. Political considerations and a general lack of coordination continue to prevent the collection of adequate data on a national scale. Finally, responding to the data being collected remains difficult because of the lag in testing times; even when a new outbreak has been confirmed, that information often comes too late to do anything about it.

Nurses across the United States are feeling the impact of this problem and are rightly outraged. We can contribute to the solution by advocating for better data practices in our own care settings as well as at the local, state, and federal levels. However, to be effective advocates for better data collection, nurses also need a sufficient understanding of how data contributes to population health.

In our report Population Health and the Future of Nursing: Conclusions published earlier this year, we called for a new era of “quantitative reasoning” in nursing. Starting with the observation that most assessment of social factors in health is done by nurses, we argued that all members of our profession need a basic sense of how the data they collect might be used to develop a picture of health in a population or community.

While we do not believe that all nurses need to be statisticians, all nurses should be able to use the data they collect to advocate for patients on the population level. They should also be able to comprehend the data collected by others and interpret what it means for those individuals in their care.  Since much of this data is married to new technologies, nurses also need to be at the table when those technologies are being designed or improved.

Unfortunately, it is difficult to realize this kind of ambitious agenda while also fighting a pandemic. But based on what we are seeing on the ground and hearing from our colleagues, we see a few points that all nurses should keep in mind as they deal with data during the pandemic. Thank you to informaticist Marisa Wilson DNSc, MHSc, RN, associate professor and chairperson at the University of Alabama, Birmingham, for sharing her thoughts on nursing and data skills, which informed this list.

  1. Data has consequences — Many of us are used to focusing on the chart as the beginning and end of patient data. But in the age of electronic medical records, data is being combined and analyzed in many different ways. Accurate data on all patients will be essential for us to better understand how COVID-19 is impacting communities across demographic, geographic, and economic lines. If data is collected in ways that are inconsistent or arbitrary, it is worse than useless. Every nurse should understand that collecting reliable data contributes to the greater good of population health. Education and training must reinforce this.
  2. Technology is our friend — Let’s face it, we all hate it when computers get in the way of caring interactions with patients. But these days we are also constantly refreshing multiple tabs in our web browsers to get the latest data on COVID-19. As long as the pandemic is a part of our lives, we will be using technologies to understand it and manage it. New technologies will also emerge in response to this challenge. Nurses should take this opportunity to get comfortable with those technologies and seek opportunities to provide feedback on them whenever possible. Additionally, anyone developing new apps and devices to deal with COVID-19 needs to include nurses as a key user group.
  3. We have to reckon with risk — When caring for our patients, we try to eliminate every risk. “Probably” is not a word we like to hear when caring for patients. But when processing the kind of data needed to understand COVID-19, dealing with probability is unavoidable. Patients are asking us for advice about how to live their everyday lives when almost no social activity is completely free from the risk of infection. Nurses who work in schools and other public settings may need to assess risk just to provide basic care. Because of changing regulations as well as inadequate personal protective equipment (PPE), many of us have also been forced to calculate the risk of infection in our own lives. All of this is scary, but we need to approach the situation using the best of our training. That means grounding our opinions in science and working in consultation with colleagues to gather the most valid and reliable information.

We know that during this harrowing time, many nurses are too busy to acquire new skills. Many nurses who are treating COVID-19 patients are lucky to catch a few hours of sleep. But we must also recognize that this pandemic will change the future of nursing in America. Remaining open to opportunities to effectively use data will help us make that future one we want to live in.

Mary Sue Gorski, RN, PhD,  is the director of Advanced Practice, Research and Policy for the Washington State Nursing Care Quality Assurance Commission in Tumwater, Washington and and an advisor to the Campaign for Action.