The Inclusion of Nurses in the Systems Development Life Cycle Discussion Essays

By Day 3 of Week 9
Post a description of what you believe to be the consequences of a healthcare organization not involving nurses in each stage of the SDLC when purchasing and implementing a new health information technology system. Provide specific examples of potential issues at each stage of the SDLC and explain how the inclusion of nurses may help address these issues. Then, explain whether you had any input in the selection and planning of new health information technology systems in your nursing practice or healthcare organization and explain potential impacts of being included or not in the decision-making process. Be specific and provide examples.

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The Inclusion of Nurses in the Systems Development Life Cycle

The process of system development life cycle usually takes into account for major steps that helps in defining its success; they are analysis, design, development and implementation. If I was part of this system development process firstly I would include two more phases in the overall process, they would be testing process before implementation and maintenance process after implementation. This would help in ensuring that the system that has been developed is completely safe and thoroughly tested before its implementation, as it will bring down the risk factors related to system development and its usage by a huge margin. Further as a nurse I can also contribute to the system development life cycle process by providing inputs from the daily experiences in handling patient on a regular basis. This knowledge input would ensure a practical understanding that would help in improving the overall system development life cycle, further providing flexibility to the structure of SDLC as nurses are continuous contact line between patient and hospital and between changing duty of attendant for patient. This would allow everyone in the process to stay updated with any change related SDLC.

However in case of absence of participation from nurses in the process of system development life cycle, it can result in development of major gap, as practical knowledge input, testing, implementation and maintenance process will be thoroughly affected, since the contribution of the nurses are major in these segments. This in turn will impact the overall structure along with lack of knowledge input from nurses in SDLC it can also impact the design, which is basic source to successful functioning of SDLC, since nurses are the primary source of contact.


McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning. Chapter 9, “Systems Development Life Cycle: Nursing Informatics and Organizational Decision Making” (pp. 175–187)

Agency for Healthcare Research and Quality. (n.d.a). Health IT evaluation toolkit and evaluation measures quick reference guide. Retrieved September 27, 2018, from

Agency for Healthcare Research and Quality. (n.d.b). Workflow assessment for health IT toolkit. Retrieved September 27, 2018, from

sample 2

Health care organizations across the country and world are choosing to implement electronic medical records (EMR) into their practice. “ In 2008, The New England Journal of Medicine reported that 82% of EHR users report improved clinical decision-making, 92% report improvement in communication with other providers and their patients and 82% of users report a reduction in medication errors”(Palabindala et al., 2016, p. 1). The choice to move away from pen and paper to a more organized system is based on governmental guidelines and the necessity to keep pace with the demands of safety and the best interest of our patients. Without system-wide input from all end-users, the implementation and results of unilateral decisions could be devastating.

       Many organizations realize the importance of EMRs but some don’t understand the consequences of input from nurses during the Systems Development Life Cycle (SDLC). “ Fifty percent of information system projects fail because of a lack of staff acceptance and willingness to use the system.’ A crucial step in the design, implementation, and reception of an EMR is for administrators and project managers to assess the attitudes of all staff within the organization. (“Nursing Leaders Serving as a Foundation for the Electronic Medical Record,” 2012, p. 111). Starting with the planning phase the nurse’s input could shed light on what specific functions are necessary to have and gain buy-in from staff at the beginning.  I have never been in the planning stage but have seen nursing administration joining project teams to add input.  On an administrative level, the analyst phase is a crucial piece to know.  Working with the informatics team to understand what systems interact with each other is key.  If one system doesn’t have the correct interface scheduling won’t be able to talk with registration.  In wound care our EMR system is separate from the hospital EMR system and without recognition and nursing input data wouldn’t manually flow through. The design and implementation phases are the two most crucial aspects nurses need to be involved with.  As nurses make up the majority of end-users in the hospital, their comfort, usability, and comfort with the EMR are critical in its success. “Sociotechnical theory suggests that EHR systems cannot be designed or implemented successfully without thoughtful consideration of the “fit” of the technology with the people providing care and the existing context of care delivery, including the work environment”(Kutney-Lee et al., 2019, p. 131). Without our input on how the design looks, feels, and operates will lead to dissatisfaction and poor adoption.

      I am currently in the process of converting a paper system to an EMR system in one of my centers in NY.  This center has decided to choose a wound care-specific EMR that I was able to help re-tool to make the system function better.  What I enjoy about the system I am using is that it is easy to adjust to fit the needs of the staff and that the nurse’s input matters.  We went live on conversion last week and in real-time were able to make changes to help flow and output better.  We were able to redesign the product list to match the centers.  We were able to re-organize workflow in the system and build workflows specific for users.  The nurses requested the ability to fax from the program and we enabled that capability for them.  The ability for me and my team to get input from the staff and make changes based on their unique center has lead to what I believe is a more positive transition and hopefully better long-term adoption to it.


Kutney-Lee, A., Sloane, D., Bowles, K., Burns, L., & Aiken, L. (2019). Electronic health record adoption and nurse reports of usability and quality of care: The role of work environment. Applied Clinical Informatics, 10(01), 129–139.

Nursing leaders serving as a foundation for the electronic medical record. (2012). Journal of Trauma Nursing, 19(2), 115–116.

Palabindala, V., Pamarthy, A., & Jonnalagadda, N. (2016). Adoption of electronic health records and barriers. Journal of Community Hospital Internal Medicine Perspectives, 6(5), 32643.

sample 3

Week 9 Discussion

One of the major consequences of not involving nurses when purchasing and in SDLC purchasing and implantation can have adverse effects. Nurses’ area the front line, and when deciding on implementing or purchasing a program, nurses should be consulted, along with providers. The program should be user friendly long with supportive soft wear to where the nurse is accurately able to chart on each patient. “Nurses are well qualified to assume this responsibility. They are intimately aware of the failings of paper records and spend far too much of their own time on clinical documentation – time that could be better spent on providing care to patients. And, as key staff involved in patient intake and information management efforts, they also know that well-designed IT systems are essential to support their own workflows as well as those of other care providers.” (Rein, A., 2017) I know from personal experience that when we went live with the new EHR, it was noted that there were several “bands” with duplicate charting. This led to increased charting, and les time to assessing and spending time with patients.

Potential issues could be “EHR implementation can mess up the workflow in a practice entirely if it is not customized to fit its purpose properly.” (Kressly, S., 2021) Messing up the workflow for nurses and providers could potentially not only cause harm to the patient but will cause the nurse to work twice as hard. This can lead to decreased nurse satisfaction.

I did not have a say in the design of the EHR that we implemented 3 years ago, but I was part of the training. I was a trained as a super user and was working the day we went live. The EHR that the hospital that I currently work for chose Cerner. While over the last 3 years there has been updates and changes, there are still several areas that we are duplicating charting, the notes system is not user friendly, and over all the program is mediocre. While I know this sounds harsh, it is better than the Meditech that we had previously. The pros to Cerner are that the program “offers strategic advisory services, performance improvement, revenue cycle management, practice management, community care management, wellness and scorecards and registries.” (Cerner Review) Overall, I am not disappointed in the system, I just wish they would have tried to include more nurses, not only from ED, but from OR, PACU, Radiology, Cath Lab, and floor nurses. The pros to Cerner are that the program offers strategic advisory services, performance improvement, revenue cycle management, practice management, community care management, wellness and scorecards and registries.

Rein, A. (2017, March 17). Early and often: Engaging nurses in health it. RWJF.

Kressly, S. (2021, April 16). 6 common challenges in EHR IMPLEMENTATION. Office Practicum.

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