While it is true that most Americans (96%) own a mobile phone, the prevalence of smartphones has risen dramatically over the past 10 years to over 81%, according to surveys by Pew Research Center. That said, nurses are not immune to the draw of immediate information and connectivity offered by a smartphone which provides the user immense options for applications (apps) across all boundaries of the current technology landscape. The question becomes: is the use of personal smartphones during work hours helping or harming patients?

In November 2016, the International Journal of Medical Informatics published an analysis of the sociotechnical use of personal cell phones by nurses. Sociotechnical refers to the interactions of the users (nurses), technology (cell phone) and the institutional policies or guidelines. During the study, it was revealed that 88% of the nurses surveyed regularly use apps on their personal phone while at work to research names of medications or review how to perform various nursing procedures. Another 69% stated they used their device for colleague communication such as calling a physician, the charge nurse, or the nurse's aide. Researchers concluded that it is possible for nurses to use their personal cell phone at work to enhance their clinical performance and improve patient care by using the phone as a technical tool.

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However, are these perceived efficiencies and shortcuts appropriate? Organizations spend enormous amounts of time and money to research the latest and best online reference materials. When the nurse conducts a quick Google search on their phone in order to provide in-depth patient education or learn how to perform a procedure, is the information valid and current, utilizing evidence-based studies? Calling the physician from a personal cell phone and bypassing call schedules and processes could be interrupting the doctor during surgery or a sensitive conversation with a patient. Nurses must consider that there are processes in place for a reason, and just because the nurse can use their personal cell phone, does not mean that they always should.

One way to mitigate some obstacles while still maintaining protocol is for organizations to issue smartphones to nurses each shift, similar to the paging devices of the past. Institutions can pre-load approved applications for medication and procedure references as well as high-quality patient education websites and resources. The device can also connect to an online call schedule and directory for nurses to text information to members of the care team using a secure network that is compliant with HIPAA and other privacy standards. Also, these devices could be regularly disinfected upon checkout to reduce the spread of organisms that are common on phones.

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There are several reasons why nurses should refrain from using their personal mobile devices at work, and nurse distraction is at the top of the list. Many studies have shown that distractions of any kind can be the catalyst for major errors and injuries. Constantly being connected with issues outside of work while on duty, whether through text or perusing social media, causes the nurse's attention to be everywhere but on their patients. Errors are not the only risk of constantly focusing on a device; according to Dr. Michael Francis, "As we're integrating technology into practice more and more, were removing opportunities to actually care for people, and for one another… Nurses are missing opportunities to connect with the hearts and minds of their patients – the foundations of nursing."

Personal cell phones can also be a breeding ground for bacteria and act as a portable petri dish. According to an article in Hospitals & Health Networks in November 2003, a study in Israel found that 12% of healthcare workers' phones carried Acinetobacter baumannii, a drug-resistant bacterium that can survive on dry surfaces for many days. While disinfecting the cellular device is possible, it is doubtful that this process is occurring routinely given the ongoing challenges of basic hand hygiene among healthcare workers. The infusion of technology to the bedside is occurring with greater fervor every day for nurses and healthcare providers. If unable to provide approved devices to nurses each shift, at minimum, organizations should have policies that designate when nurses are permitted to use their personal cell phones and for what purpose. As most nurse leaders do not wish to be the "phone police" to their skilled and professional staff, it is up to the individual nurse to self-regulate for appropriate use of these devices, while still maintaining personal connections with patients and peers.

Amanda Bucceri Androus, RN, BSN

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