Should hospital staff be allowed to use their phones for personal reasons?

Imagine a woman lying unconscious in an intensive care unit with multiple IVs, on a breathing machine, and attached to monitors. Beside her sits another woman, perhaps her wife or sister, her brow crumpled with worry. On the other side of the bed is a table with a computer. A nurse is stationed there, studying his cellphone. What is he doing? Looking at a message from the patient’s doctor? Calculating her medication dosage? Reading a reminder from home to pick up diapers?

Smartphones have become our shopping cart, our bank machine, and our direct line to the people we love. They are also a major source of diversion, whether for watching movies, checking the news or scrolling through pictures on Facebook. We check our phones constantly—on average, we spend three hours a day on them. Most of us have both interrupted and been interrupted, or even ignored, on account of a cellphone alert. And yet, expecting people to put their phones away at the dinner table seems almost Victorian. They’re practically part of the place setting.

But what is it like for patients and families to see doctors and nurses on their phones? Should the rules be different in health care?

Staff on cellphones: A family’s perspective

Carrie Blais* describes the experience as “wounding.” Recently, her father was in intensive care in a Toronto hospital following a triple bypass operation. Blais, her mother and her sister were upset to see a few nurses assigned to his care use their phones to text or scroll through social media. When one of the nurses noticed that the family had seen her on her phone, she showed them pictures of her dog. “I was sitting there thinking, ‘Is my dad going to survive the next hour?’” says Blais. “And she’s looking at puppies on Facebook.”

Beyond wounding, she says, the experience was worrisome. “There were times when my father would be choking on his ventilator, and he suffered if someone wasn’t paying attention,” says Blais. “The machines would eventually alert the nurses to the problem, but it was very disconcerting for us to feel that the nurse who was stationed at the bedside, while she was in her working hours—not on her break—was not paying attention.”

Blais works in health care herself and says she understands that while families and patients in the ICU need a lot of reassurance, the staff have needs as well. “I recognize that every day cannot be the end of the world for the staff that work in the ICU,” she says. “[But] everyone [there] is in critical condition, and so there’s something about bedside phone use—text messaging and social media—that feels really inappropriate.”

Orla Smith agrees. She and her fellow clinical managers in the critical care department of St. Michael’s Hospital in Toronto have received complaints about staff using cellphones for personal reasons. Not only does this behaviour convey disrespect to patients and families, says Smith, it’s also antithetical to the purpose of intensive care. “In the ICU, things can change very subtly,” says Smith. “A subtle trending down in blood pressure, or oxygenation status, or heart rate, or a subtle change in neurological status. You’re expected to pick up on subtleties, to be able to apply critical thinking to understanding, ‘OK, what is happening here?’” This ability might be compromised, she says, “if you’re on your device, or pulled toward that device.”

It’s happened before: In December 2011, John Halamka, chief information officer at Harvard Medical School, wrote about an incident in which a resident responded to a text message just before discontinuing a patient’s anticoagulant. The resident forgot to order the change, and the patient wound up needing open-heart surgery.

A staff perspective

Smartphones have become integral to medical practice. There are apps that provide health care workers with access to information about diseases and treatments, as well as information about their patients’ drugs and lab tests. “Pieces of the job are being transferred to mobile devices,” says Mandy Tanner*, a nurse who works in the intensive care unit in a Toronto hospital. “[Cellphones are] important for communication purposes, especially in the ICU, [where] you can’t leave the patient’s bedside.”

But Tanner says she also uses her phone for personal reasons while on the unit, and so do many of her colleagues. “It definitely comes out in downtime or at four in the morning, when you’re trying to stay awake,” she says. She doesn’t look at her phone while at a patient’s bedside, but will take it out when she goes back to her desk (ICU nurses typically work one-to-one with patients and have individual stations beside or at the end of their beds) “if it’s quiet and no one else needs help,” she says.

Tanner understands the concerns about cellphone use on the unit. “I can definitely see how it could come across as unprofessional seeing a nurse look at their phone,” she says. “Or how, if someone was very engrossed by their phone, that could take their attention away from the room and that would definitely be very bad.”

She describes a specific moment, about a year-and-a-half ago, when she was on her phone “and things started happening,” she says. “The room started to get a bit busier, machines started beeping, patients needed things. So that was my cue to put my phone away. I remember having the thought, ‘Oh, phones can be really distracting.’”