Invisible work and changing roles: Health information technology implementation and reorganization of work practices for the inpatient nursing team

• Published in: Social science & medicine (1982) 2019-08, Vol.235, p.112387-112387, Article 112387
• Main Authors: Bergey, Meredith R., Goldsack, Jennifer C., Robinson, Edmondo J.
• Format: Article
• Language: English
• Subjects: Articulation; Clinical outcomes; Delegation; Electronic medical records; Health care delivery; Health information; Health information technology; Health research; Health services; Hospitals; Implementation; Information technology; Leadership; Medical technology; Nurse managers; Nurse patient relationships; Nurses; Nursing; Occupational roles; Organizational change; Organizational power; Patients; Prioritizing; Reorganization; Roles; Staffing; Teams; Uncertainty; Unit clerks; United States; Visibility; Work; Work organization
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/j.socscimed.2019.112387

Hospitals have invested heavily in health information technology (HIT) which has been promoted as an integral component of quality, safe, and efficient health-care delivery. Research on the expanding use of such technology, however, has shown that user/technology interactions are shaped through practices of use that can yield far from normative, even unexpected outcomes. Drawing upon focus group and interview data from an inpatient, two-hospital health system in the United States, this paper considers the perceived impact of HIT implementation on work practices and roles for nurse managers and unit clerks. We find that HIT implementation generated significant reconfigurations of work practices at the expense of nurse/patient interaction. Following such changes, nursing leadership described re-prioritizing patient care and interaction - perceived to them as essential to the patient experience and unit functioning - through realignments in staffing that prioritized more versatile staff and task delegation of largely invisible, articulation work to unit clerks. Despite maintaining an integral role as “gatekeeper” and the “face on the floor,” unit clerks experienced significant reconfigurations of their work and some concomitant uncertainty about their role. We consider the implications of our findings for literature on the socio-materiality of HIT, with particular attention to literature on work practices, roles, and the visibility of work within organizational power hierarchies. •HIT has been promoted as integral to quality, safe, efficient health-care delivery.•HIT implementation challenged inpatient nursing team work practices and roles.•Nursing leadership took steps to re-prioritize patient care and interaction.•Realignments in staffing and task delegation of largely invisible work occurred.•Unit clerks remained integral to the unit but had work and role alterations.