Digitization calls for new skills in nurses

A study from Lund University, published in BMC Nursing, shows that nurses need to expand their professional competencies beyond their traditional skills. 

A significant part of nurses' work in healthcare centres involves assessing patients' medical needs through in-person meetings or phone calls. This form of prioritisation, known as triage, serves as a crucial first step in guiding patients to the appropriate level of care without unnecessarily burdening the healthcare system. However, as triage began shifting to digital platforms a few years ago, it introduced an entirely new way of working. Using text-based digital healthcare systems (such as 1177 or Mitt PTJ), patients describe their symptoms and respond to questionnaire prompts, which nurses then review, assess, and act upon. Communication between patients and nurses takes place via chat, where the healthcare decision is relayed back to the patient.

"Among nurses, there has been strong resistance to this new way of working. It is a completely new method that requires different skills from usual. Suddenly, they must communicate and provide care in writing instead of listening and speaking with patients. Some nurses appreciate this new approach, but most find it challenging and uncomfortable", says Ester Rydell. She is a district nurse at Hälsocentralen Sankt Hans in Lund and a researcher affiliated with Lund University. She believes that the increasing demand for digital healthcare makes it essential to understand how it affects nurses' work. She led a qualitative research study conducted at three different healthcare centres in Skåne, which included interviews with district nurses and general nurses. 

"Assessing patients via a chat function requires experience and different skills from traditional triage. It is more complicated, and information about the patient’s general condition feels flatter and therefore harder to interpret. The clinical eye—the nurse’s ability to form a comprehensive assessment by observing, speaking, and listening to what is said between the lines—is lost", says Sigrid Stjernswärd, a researcher at Lund University and co-author of the study.

According to the study, digital triage is particularly suitable for tasks such as prescription renewals and minor ailments, where questions can be clearly standardised. However, for more complex cases involving a long history of comorbidities, multiple medications, or difficulties in written communication, digital triage is not ideal. It risks missing crucial nuances and makes it difficult to obtain a holistic view of the patient's health status. In cases of uncertainty, nurses often end up calling the patient anyway to make a more accurate assessment. This suggests that digital triage, when additional information is needed, is neither efficient nor safe. Due to its communicative limitations, digital triage alone can lead to a disrupted workflow, reduced care quality, and compromised patient safety, as well as reinforcing digital exclusion, according to the researchers. 

At the same time, digital triage has advantages, such as allowing more time for reflection or the opportunity to consult a physician—compared to a short phone call, which generally should not exceed seven minutes. It can also enhance care by allowing the attachment of images or other relevant information and may be convenient for those accustomed to written communication. 

"The study is small, but the results indicate a significant shift in the professional skill set required of nurses, demanding abilities beyond those they are traditionally used to. They need to develop proficiency in interpreting text and expressing themselves in writing. There are benefits to digital triage that we should absolutely take advantage of, but it cannot replace physical meetings or phone contact", concludes Ester Rydell. 

Source: Lund University

07.03.2025

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