The Intranet: A Communication Tool for Nursing
James P. Smith MSN, RN, CNA, BC
Today’s healthcare organizations are placing increased emphasis on
expenditure control and cost reductions. In a typical hospital environment,
human resources represent approximately two-thirds of expenses (Fottler,
Hernandez, Joiner (1994) p. 167).
In response to external market forces during recent times, healthcare
organizations have reduced their human resource budgets, including clinical
staff, to levels that support only
the tasks required to provide patient care.
Healthcare organizations are being driven to work smarter and more
efficiently and must do everything possible to improve the efficiency of
their employees and control other expenses.
It is abundantly clear that one way in
which organizations can improve the efficiency of their employees is through
the use of technology. It is
also clear that “Automation
offers many solutions … that
allow the nurse to work more efficiently, allocate resources more
effectively, and improve client care” (Hebda, Czar, Mascara, 1998, p.3).
Most healthcare organizations have a technology infrastructure in
place to support patient management and finance functions. Lately, most
modern healthcare organizations have invested heavily in automated systems
in support of its departments with the exception of the Nursing Department.
However, these applications have little impact on the accessibility of
information to the bedside clinical nurse. Commercial software developers
have not created applications to support the Nursing Department’s vital
need to communicate to its working professionals and provide
nursing-specific information such as policy and procedure documents in an
organized and efficient manner. The technology to support these
communication needs is currently available in most healthcare organizations,
but it is under-utilized, primarily because the individuals who control this
technology are unaware of Nursing’s communication and informational needs
and of the environmental and practice specific restrictions related to the
clinical setting of the bedside nurse.
The implementation of automation in
support of Nursing’s communication needs can take many forms. In the
remainder of this article, the author describes the project and process that
led to the creation and implementation of an intranet-based technology tool
devoted entirely to the Nursing Department’s communication needs.
The initial scope of the project was the
development of a method to convert into electronic format the paper-based
policy and procedure manuals of a community-based hospital’s Division of
Nursing. The existing paper-based format for these manuals required that
each nursing unit have a minimum of three, five-inch
binders containing the Division of Nursing’s Policies and Procedures
along with the Departmental Plan for the Provision of Care. Some of the
shortcomings of this paper-based approach were that the binders required
were heavy, cumbersome, and difficult to maintain since pages were often
removed and not replaced. This
resulted in information not being easily available or current when needed.
The paper-based approach was also a drain on the organization’s
resources because whenever a new policy or procedure was written or an
existing document was updated, each new document had to be duplicated and
inserted into the proper manual in each of the 15 locations the manuals were
kept. The author believed that converting these documents to an electronic
format that could be made available through networked personal computers at
each nursing station would eliminate the problems associated with the
paper-based approach and make these documents more accessible to nurses in
their clinical work areas.
Initially, the author anticipated setting up a common hard drive on one of
the organization’s network servers to hold all the electronic policy and
procedure documents, which were at that time written in Microsoft Word â.
A method then would need to be developed and implemented to
facilitate accessing those documents from the multiple PCs located on each
Nursing Unit. In light of
the fiscal constraints facing the organization, it was necessary to find a
method that would enable ease of accessibility without adding considerable
additional costs. This
requirement prohibited the installation of specific application software on
each PC because of the prohibitive additional costs associated with an
additional 20+ end user licenses.
While reviewing the literature for potential technologies to implement as a
solution to the process of converting paper documents to an electronic
format, the author became aware of the concept of “intranets.” “Intranets are networks that are accessed using a web
browser but are only available within a specific organization. They are
useful in making information that is needed by those within an organization
freely available” (Thede, 1999, p. 2280).
According to Hebda et al, “Intranets are private computer networks
that use Internet protocols and technologies, including Web browsers,
servers, and languages, to facilitate collaborative data sharing” (Hebda
et al., 1998, p.65). “Web technologies promise to help unblock the
information flow, redesign business processes, and improve productivity for
all users” (Intramark, 1999). “Companies that have invested in an
intranet are finding great benefits in reducing the cost of paper document
distribution, increasing communication, and improving access to current
information” (Microsoft, 1999).
intranet, or internal web site, offers many and distinct advantages to
users. Habda et al., (1998,
p.66) indicate that an intranet:
Can provide for the paperless distribution of internal documents
Permits rapid retrieval of information
Is easy to use
Provides users with a familiar user interface requiring little
Provides inexpensive access to corporate data
Is relatively in expensive to implement
Provides support for multi-platform integration
Fits well with newer client server architecture
intranet appeared to be an ideal infrastructure for Nursing to use to
improve communication and efficiency through automation. The use of this technology would enable Nursing to
communicate quickly and efficiently and also control the materials costs
associated with a paper-based approach.
Once the decision was made to focus on the development and implementation of
an intranet, it was necessary to identify what specific technology would be
employed to carry out the project. The two technology approaches considered
were document conversion to Adobe Acrobat® format and document conversion
to HTML format.
The use of Adobe Acrobat® as a conversion methodology would require the
purchase of Adobe Acrobat® and the installation and maintenance of the
Acrobat Reader® on all the facility’s desktop PCs. Additionally, a
distribution methodology such as a shared network hard drive arrangement
would need to be developed.
The second approach considered was to convert all paper documents to HTML
(Hyper Text Markup Language) and to develop and implement a web-technology-
based delivery system. Both solutions provided similar characteristics
throughout the conversion process as well as maintaining the security and
integrity of the documents. However, the HTML conversion process had the
following additional benefits over Acrobat Reader Ò:
lower cost, a more familiar end-user interface, no additional end-user
software to be maintained, and most important of all,
the ability to easily expand the project to encompass the delivery of
other vital Nursing information beyond electronic policy and procedure
manuals. By employing HTML conversion
technology, it would be possible to develop a full intranet devoted to the
present and future communication needs of the Division of Nursing well
beyond the dissemination of electronic policies and procedure manuals. Once
the underlying technology was chosen, Microsoft Front Page 2000® was
purchased. This application is a web site designer as well as an HTML
editor. As the author had never undertaken an endeavor such as this, a few
weeks were needed to become familiar with the application software and to
develop the structure of the soon-to-be-constructed “web.”
The implementation phase began with the
design of the basic structure of the intranet or internal web site. Initially the
web site was designed with a simple structure consisting of a home page for
users to use as a starting point and six additional pages to be used for
index pages. The index pages would provide the links to the converted
The second step in implementation was
conversion of the approximately 180 Nursing policies into HTML by using the
“save as HTML” command within Microsoft Word 2000®.
Following the HTML conversion process and the creation of the
hyperlinks between each index page and its associated documents, an external
person knowledgeable in the construction of web sites conducted a review.
This review revealed faults within the design of the navigation structure
that would impact on operability by a novice level user.
Based on this feedback, the web
site’s organization was re-designed in a more hierarchical structure with
a more formalized parent-child page relationship.
This more formalized web site structure resulted in the creation of a home
page for the intranet.
This change also resulted in the need to insert a page into the
basic web for each document that would be included. Once the 200 additional
pages were inserted into the web site within the new hierarchal structure,
the process of converting each structure standard (policy) into HTML and
importing the converted document into its designated page was initiated.
This change in design structure allowed for the Front Page 2000®
application to combine into one process the process of conversion into HTML
and insertion into an individual web page. Upon completion of the conversion
/ insertion process, each new web page required formatting adjustments to
correct any errors generated by the conversion as well as to standardize
The next part of the project implementation encompassed the creation and
testing of all the hyperlinks between the home page, the index pages, and
the individual document pages. At this point in the project it was also
necessary to develop a method to import and link additional supporting
documents into the web’s structure. These documents were often forms or
flowcharts related to the policies or procedures. Since the process of conversion to HTML format did not
maintain the formatting of the original documents, especially forms; it was necessary to scan these
additional documents into a graphic format. These documents, now converted to
graphic images, were then linked by hyperlinks to the policies they supported.
This process maintained the formatting of the documents as well as the general
navigation structure of the intranet as a whole.
Based upon the work already done, it was decided at this time to expand
the intranet into areas beyond the project’s original scope of creating
electronic manuals. The project was now beginning to take advantage of the
expandability inherent within the creation of an intranet.
Within the intranet, areas were created for the soon-to-be-released
Clinical Practice Guidelines for the Division of Nursing and for materials to
support staff and patient education. An area was also created for electronic
distribution and archiving of the Division of Nursing’s quarterly
Additionally, a tutorial was created and included on the intranet’s
homepage which described the intranet concept and provided directions on how
to navigate through the intranet for those not familiar with web surfing. The tutorial was created using Microsoft PowerPoint 2000â
which allowed for the tutorial to
be saved as a web page and viewed within a web browser without the need for
installing additional application or viewer software.
The completed intranet, the organization’s first internal web site,
was installed on a dedicated web server set up by the hospital’s Information
The last step in the implementation phase was to introduce the intranet and
train users. A series of
“Welcome to Your Intranet” parties were held for the Division of Nursing
staff. These parties consisted of ten events totaling 16 hours spread over two
days and on all shifts. This allowed the staff to see and have a hands-on
experience with their new intranet.
The development and implementation of this
intranet project were successful. The initial intent of the project, the
creation of electronic policy manuals, has been achieved and surpassed by the
creation and installation of a fully functioning intranet or internal web site
devoted to the Division of Nursing. As pictured in Appendix
A the clinical bedside nurse now has full access to a dedicated internal
web site that contains information in the following areas: Polices,
Procedures, Clinical Practice Guidelines, Staff Education, Patient Education,
and the departmental newsletters. Reception
by staff who attended the welcome parties was positive and generated much
discussion as to potential future enhancements to their intranet.
While the roll out of the intranet appeared to be well received by the
nursing staff initially, as with the introduction of many new technologies of
this sort, actual utilization of the intranet site as a communication tool was
low in the beginning. As many of
the Division of Nursing’s departments such as the Department of Education
and Professional Development as well as the Wound, Ostomy, Continence Nurse
and the Oncology Clinical Nurse Specialist have begun using the intranet as a
primary means of making information available for use in both staff and
patient education undertakings the staff’s usage patterns have slowly but
steadily increased over the past six months.
This information can now be easily accessed from any desktop within the
facility as well as at the bedside once RF (radio frequency) wireless
technology is implemented.
this project was initiated in response to the author’s desire to improve the
Nursing Department’s communication with its professionals and increase the
accessibility and ease of use of information for nurses by nurses, future
development and enhancement of the intranet will be incorporated in response
to suggestions from the bedside nurse.