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With the strategy of clearance, we saw the complete wiping clean of a historical slate. This made it possible for a single origin for nursing science to be created. From that point of origin nursing actions could be coded and remembered in an organizationally and scientifically useful fashion. A second mode of directed forgetting in organizations is erasure: the constant filtering out of information deemed not worthy of preserving for the organization's future purposes. |
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Historically, the selective erasure of nursing records within hospital information systems has been drastic. Nursing records are the first destroyed when a patient is released. The hospital administration does not require them (nursing is lumped in with the price of the room), doctors consider them irrelevant to medical research, and nursing theorists are not well enough entrenched to demand their collection. Huffman (1990: 319), in a standard textbook on medical records management writes: |
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As nurses' notes are primarily a means of communication between the physicians and nurses, they have served their most important function during the episode of care. Therefore, to reduce the bulk and make medical records less cumbersome to handle, some hospitals remove the nurses' notes from records of adult patients when medical record personnel assemble and check the medical record after discharge of the patient. The nurses' notes are then filed in chronological order in some place less accessible than the current files until the statute of limitations has expired and they are destroyed. (Huffman 1990, 319) |
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Traditionally nurses have been facilitated out of the equation: though they may not have an official trace of their own past, their duty is to remember for others. In one of those vague but useful generalizations that characterize information statistics, it was asserted, in a book on next-generation nursing information systems, that 24 percent of total hospital operating costs were devoted to information handling. Nursing "accounted for most of the information handling costs (28 percent to 34 percent of nurses' time);" and what is worse, "in recent years, external regulatory factors, plus increasing organizational and health care complexity, have augmented the central position of information in the health care environment" (Zielstorff et al. 1993, 5). The nursing profession acts as a distributed memory system for doctors and hospital administrators. Ironically, in so doing, it is denied its own official memory. |
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Even when the erasure is not mandated, it has been voluntary. One text on a nursing classification system cites as a motif of the profession |
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