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The Inclusion of Nurses in the Systems Development Life Cycle
     In the development and implementation of change within any corporation, careful planning and execution are essential.  Healthcare is no exception, and the ramifications can weigh heavily on a health care facility.  The application and understanding of a systems development life cycle (SDLC) is vital in a successful implementation.  There are many forms, or models, of SDLC, including the waterfall model, rapid prototyping or rapid application, object-oriented, and dynamic systems development (McGonigle & Mastrian, 2017).   The story of an SDLC will usually involve a mixed method of these. However, I will focus on the principal elements and steps overall.  These steps are as follows; understanding the need, understanding a solution or how to address those needs, developing a plan, implementing the plan, evaluating the implementation, and maintenance, review, and destruction (McGonigle & Mastrian, 2017).  As McGonigle and Mastrian discuss, this process is much like the nursing process as it involves identifying the issue, diagnose, plan, implement and evaluate with possible revision.
Understand the Problem or Need
                The initial step is to identify the problem or identify where the need is.  This is commonly brought forth and introduced by nursing to help address a possible issue they have experienced during their shifts.  For example, the implementation of electronic medicine scanning may be much more efficient as the order goes straight to the pharmacy for profiling and delivery to the nurse for administration.  This is a process that nursing has a very long history of information about, and their opinions and input are highly valuable.  As Torbic et al. explained, understanding where the problems arise in the development of eMAR systems may be more readily understood with nursing input from the start (2018). This is just one example, of course, but many areas of concern center around the nurse’s processes and efficiencies.  Nurses provide valuable information on the concerns that need to be addressed.  The initiation of understanding the real problem or source of the problem is of utmost importance in a quality “fix.”
A Solution or How to Address the Need
                Sometimes, a solution is not always readily visible.  For many issues, there is a complex and multifaceted fix or repair of the problem.  Even so, nurses are at the center of most of these interventions and the problems at hand.  When we discuss the possibility of implementing a change or enhancing a system, it is vital that we discuss it with those who will be utilizing the systems daily.  This includes not only nursing but respiratory, physical therapy, providers, and every staff member who may be affected.  Not necessarily to get approval or personal opinions, but to provide a more robust outlook on the technology in question.  Nurses are at the bedside, and lots of technology seems to be pulling them away more and more.  It is imperative we include nursing in these discussions to help understand the effect on quality and efficiency of delivering the care. 
Developing a Plan
                Nurses are key in the development of plans for patient care and may offer many valuable avenues for a successful implementation of a clinical system.  Once a problem is identified, and a solution is generated, the plan is quite possibly the most critical step remaining.  Again, nurses are going to be surrounded by the change process and involved in every step, so it is important to include them in the planning phase.  The workflow planning is vital to success and needs to be carefully planned and executed.  Careful planning, considering all interoperability of systems, and the safety involved should be given priority during the planning phase, and nursing can offer many valuable insights (Laureate Education, 2018). In addition, training and support need to be planned to ensure successful project completion.
Implementing the Plan
                When a plan is implemented, there is a certain level of pride and responsibility in the results.  Not only does the patient benefit, but so do the organization and the individuals involved.  Nursing should certainly not be eliminated during the implementation phase.  More often than not, nursing is the backbone of the implementation and super-users of the systems.  Eliminating nursing from the implementation phase doesn’t make sense and would likely cause significant changes in the attitudes of users and the feasibility and longevity of the solution. 
Evaluation, Maintenance, and Review
                A robust evaluation and revision process, if needed, are important for any successful implementation.  Once again, we need to include the users of the system involved.  More often than not, it is nurses who reap the benefits or suffers the consequences of a change in the process.  From medicine dispensing machines to HIPAA compliant text messaging systems to bedside monitoring of vital signs, nurses are always involved in the process.  It is imperative that we include nursing in the evaluation phase, including interviews and direct observation.  Nursing offers more insight into the ramifications of change on patient care than anyone else in the organization. 
Being Included in a Systems Change
                During my tenure in healthcare IT, I have been lucky to have a CNO who has a master’s degree in informatics.  She not only understands the impact on the care of patients, but she acknowledges that nursing satisfaction and a sense of security are important.  We included nursing in every step of the process for the implementation of computerized provider order entry.  This was a multi-year-long process, and nurses from every unit in the hospital were involved in almost every decision made.  Nurses can be opinionated and sometimes loud in response to uncertainty but never backed down from challenging any decision made for the better of patient care.  We had a team of approximately 50 nurses and unit clerks for our super-user team.  This number was higher when you consider our ancillary staff that was part of the team as well.  We had a successful implementation, albeit difficult, mostly because of the sharing of knowledge, ideas, and responsibilities.

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