How does the Nanda NOC NIC electronic grading system save nurses’ time

How does the Nanda NOC NIC electronic grading system save nurses' time

The application of ICT to introduce nursing diagnoses in a structured manner into the digital patient file is increasing in more and more hospitals. Those who use it regard it as a tribute to their profession.

A nurse practices with a patient after a stroke (stock image)

NANDA, NOC, NIC is a classification system that is processed in a database integrated into the EPD. The system is part of the nursing process. Nurses systematically identify nursing problem (NANDA) and define goals (NOC) and interventions (NIC). NNN was originally developed in the 1970s by nursing scientists in the United States.

Medical Spectrum Twenty

NNN has been operating in Medisch Spectrum Twente since December 3, 2021. It employs 1,500 nurses, and this is unique, ICU nurses. Diane ter Huurne-Oude Lenferink, nurse and CNIO: “It was a very long process for a while.”

two hospitals

MST nursing staff deliberately chose to enter the NNN at the same time as the new EPD. This entire process was performed with Hospital Group Twente (ZGT). Both hospitals have established their own EPD at the regional level. There has been much discussion about the essence of the profession, as Ter Huurne-Oude Lenferink says: “We asked ourselves: How do we want to work in relation to the patient? How do we do it and how do we want it? We wanted to be able to consistently measure our results, so the NNN is really The only system that can do this well.

with the patient

The idea is that the nurse enters all the data with the patient. Suppose the patient is admitted with unexplained pain. The nurse and patient together look for activities in daily life that are hampered by pain. Ter Horne: ‘The nurse is looking at what she can do for the patient. For example, determining when to take painkillers: long before the activity so that the patient can perform that activity optimally. Or she wants to do something with the experience of pain, eg she can deliver music. Although the implementation is still in full swing, there are already positive feedback from patients, who note spending more time on them.

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Nursing Leadership

The NNN Coordinator has been appointed at MST to assist in working with this system. 1,500 nurses had to be trained. It all takes extra time, says Ter Huurne-Oude Lenferink, but it also saves time. The nurse can organize her time more efficiently. Filling out the diagnosis is pre-ordered. You don’t have to write anymore, just sign up. So it says only what is necessary. Ter Horne: “It’s a very great tool to emphasize one’s nursing leadership. And prove the value of nurses. Healthcare isn’t just a medical story; the nursing part is essential.”

Jeroen Bush Hospital

Chief Professional Nurse and Medical Oncologist Brett Van Merenburger, Functional Director Nils Schramm, and Nurse and Nursing Staff Council member Marieke Bevers still meet biweekly to discuss progress on the NNN project. Jeroen Bosch Hospital was the first hospital to start theoretical preparations for Nanda NOC NIC in 2009. The actual go-live program was followed in 2016. Nearly 1,000 nurses work with it every day. The reason for switching to NNN was the moment when JHA became completely paperless. NNN was installed at the same time as the new EP was installed. Van Merrienboer: We chose NNN because of the good Guide In the basics and because nurses are already learning this system during their HBOV training.

NNNN Ambassadors

JHA has invested heavily in setting up the new system and an entire organization has been set up. Through the three-year Nursing Leadership program, 250 HBO nurses have been appointed as ambassadors for NNN and subsequently contribute to hospital-wide implementation. Specially appointed Operations Supervisors who supported the departments were active through 2022. Additionally, a steering group was established in which Van Merrienboer and Bevers sit alongside the Business Manager, Quality and Safety Consultant, ICU Heads, and the Functional Manager. A working group of thirteen female nurses and ICT staff has been formed. Finally, there is a nationwide consultation with representatives from all hospitals using digital NNN. The first five years were dominated by the proper use of systems during the nursing process, under the motto “everything is with the patient and with the patient”.

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behavioral change

To increase adoption, a diluted form of Nanda NIC NOC has been initiated. After one year, all functions of the system were implemented. Correct and consistent entry of all input fields requires a significant change in the behavior of nurses. Bevers: Nurses were used to enter large portions of text. This is no longer necessary. They wondered if they were still registering enough to properly register and convert their work. The purpose of data collection also had to be emphasized, van Meirenbauer says: “Filling out the lists does not affect the nurses’ passion for their profession. But if you make it clear that you can treat the patient better if you fill in everything correctly, so that the patient can experience pain Less for longer, the nurses will understand the importance of changing their behaviour.


Not everyone realizes how much nursing has advanced as a result, says Schramm: “By presenting the process in this structured way, the quality of care has improved. We can now prove this with numbers. This makes the quality of nursing care tangible.”

JHA has entered the recalibration phase. Now nurses can reap the rewards of all their efforts. Schramm: The great advantage of NNN is that everything is encoded down to the last detail. By linking codes together from one large database, you can do scientific research on them. A wealth of real live hospital data is now available. Two nursing researchers are actively working on the development of prediction models. Because, wouldn’t it be nice to be able to predict the length of stay or readmission based on the occurrence of post-operative nursing diagnoses? Or use artificial intelligence as a decision support tool?

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For hospitals that don’t know if they want to invest in such a nursing system, the folks at JHA still have some advice. Bevers: Don’t be afraid to innovate. We were afraid of the extra registration burden. Indeed, learning a new system takes time, but in the end it pays off. Van Merenbauer: Make sure the choices to work with the system are based on a strong vision of nursing practice. Otherwise, you will not get your supporters. Working with this system really contributes to improving patient outcomes. In this way we were also able to convince the board of directors.

Although Bohn Stafleu van Loghum is licensed by Nanda, NOC, and NIC, Zorgvisie’s editors work independently and choose their own topics.

know more? You can order the white paper with tips on the successful joint implementation of NNN here.

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