Position Statement
MOBILE ELECTRONIC DEVICE USE IN THE
EMERGENCY SETTING
Description
Nurses’ use of mobile electronic devices at the bedside is quickly gaining momentum.1 The rapid
growth of technology in health care is providing nurses and other health care professionals
access to current evidence-based information on demand. These handheld devices combine
mobile phone or other wireless functionality with access to the Internet, medical software
applications, clinical reference guides, clinical calculators, clinical guidelines, medical
dictionaries and diagnostic tools, and more.1–5 Prior to the availability of mobile electronic
devices, nurses spent valuable time searching for hard copy reference manuals and textbooks or
waiting for a computer to become available to obtain necessary information.2,3 According to
recent surveys, up to 71% of nurses currently use a mobile electronic device in their work
setting.6,7
The rate of new medications challenges health care professionals to remain current with
important drug information. Recognizing this safety issue, the Institute of Medicine (IOM)
endorsed the use of point-of-care technical resources for all health care providers to reduce risk
and prevent medication errors.8 Drug references are among the most accessed mobile apps used
by health care providers.1–3
Many barriers to the use of mobile electronic devices at the bedside are organization-dependent
and include financial resources, network compatibility, device battery life, information
technology (IT) support and infection control issues.2,5,6 Additional concerns include the
potential risk of violating patient privacy3 and the challenge of safeguarding patients from
potential injury or even death.9–11 At least one report mentions a risk to patient satisfaction,
because patients may interpret nurses’ use of devices as recreational.
When nurses have the ability to access evidence-based clinical information at the point of care,
errors may be reduced resulting in increased patient safety.2,6 Improvements in nursing
productivity and time efficiency have also been demonstrated.2,6
ENA Position
It is the position of the Emergency Nurses Association that:
1. Emergency nurses’ access of mobile electronic point-of-care, evidence-based clinical
knowledge can provide information essential to their practice.
2. Emergency nurses’ use of mobile electronic devices has the potential to increase patient
safety and emergency practice efficiency.
Emergency Nurses Association | 915 Lee Street | Des Plaines, IL 60016-6569 | 847-460-4000
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Position Statement
3. Emergency nurses acknowledge that patient safety is paramount and develop awareness to
the potential limitations within mobile information programs and the impact on patient safety
when accessing and using mobile medical information that is not from a content-validated
source. 4,9,10,12
4. Emergency nurses participate in the development of organizational guidelines or policies
regarding the use of mobile electronic devices at the point of care.11,13
5. Emergency nurses work collaboratively with leadership and advocate for use of personal
electronic devices to access content-validated mobile medical apps in patient care settings
when mobile electronic devices are not provided by the facility.2,3,5,6
6. Emergency nurses champion for the provision of easily accessible, current and evidence-
based electronic tools, available at the bedside, for reference or as an adjunct to their clinical
practice. 1–5,14
7. Emergency nurses adhere to their organization’s personal electronic device policy when
using mobile electronic devices in the patient care setting.14–16
8. Emergency nurses practice appropriate infection control measures, following institutional
guidelines, when using a mobile electronic device at the point of care.12,17
9. Emergency nurses receive education regarding the appropriate use of these devices and the
accessibility of valid, evidence-based resources.
10. Where mobile electronic devices are used in a patient care setting, emergency nurses request
that methods to maintain security and integrity of protected health information (PHI) are
addressed in organizational policies and/or procedures.14,15,18
Background
Efforts to implement a program of mobile electronic device use to enhance patient care and
safety in the emergency department will be most successful when the benefits outweigh the
risks.2, 14 Successful implementation of such a program depends on addressing multiple issues,
including:

Patient privacy: Some mobile medical apps allow for remote consultation or diagnosis via
pictures taken with a device’s camera feature.2,4,12,14,16 When used for this purpose, there is
potential risk of violating patient privacy.3 Additionally, the use of personally-owned devices
is discouraged for this purpose, unless PHI can be kept secure with data encryption.2,3,5,12,14,16

Protection of health information: Hospitals and other health care facilities have a legal
obligation to keep a patient’s PHI confidential.14,16,18 However, in the presence of social
media such as Facebook, Twitter, and YouTube, misuse of a mobile device’s camera and
other features by health care workers is a security and privacy threat to patients,
organizations and the workers themselves.12,14,16,18
Emergency Nurses Association | 915 Lee Street | Des Plaines, IL 60016-6569 | 847-460-4000
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Position Statement

Patient safety: The U.S. Food and Drug Administration drafted regulatory guidance in July
2011 on apps that met specific medical device criteria.9–11 However, the agency reports that
not all mobile medical apps will fall under this regulation. Those covered include those that
(1) are accessories to a regulated medical device; (2) convert a mobile platform (smartphone,
tablet, etc.) into a regulated device by using display screens or sensors; and (3) allow for
patient-specific information to be entered, which generates a formula or algorithm that is
used to get a result that affects diagnosis or treatment decisions.9–11

Regulation of content validity: Due to the potential for inaccurate content or software defects
in mobile medical apps, some recommendations call for a formal review process to evaluate
content prior to app utilization by health care providers.3,9,12 Additional recommendations
call for software developers to include health care professionals in all aspects of medical
software development before they become available for use.9

Infection control issue: Perhaps easily overlooked is the fact that mobile electronic devices
can be carriers of bacteria. Development and enforcement of guidelines and protocols for
appropriate cleaning of equipment as well as emphasis on hand hygiene may help to reduce
risk of spreading infection via a mobile electronic device.5,7,12

Education: Vital to a successful implementation is the provision of education and guidance in
device use and access of appropriate apps, communicating pertinent policies and ensuring
dedicated technical support.2,12,15,18

Health care facility cost of providing mobile electronic devices: A benefit of the health care
facility owning and providing mobile electronic devices is the authority and ability to
regulate the device and data, to track and secure information and to provide theft/loss
protection and to remotely shutdown a device if necessary.5,15,18
References
1. Wyatt, T. H., & Krauskopf, P. B. (2012). E-health and nursing: Using smartphones to
enhance nursing practice. Online Journal of Nursing Informatics, 16(2). Retrieved from
http://ojni.org/issues/?p=1706
2. Johnson, C. (2008). Nurses and the use of personal digital assistants (PDAs) at the point of
care. Scroll, 1(1). Retrieved from http://fdt.library.utoronto.ca/index.php/fdt/article/
view/4906/1766
3. Koehler, N., Vujovic, O., & McMenamin, C. (2013). Healthcare professionals’ use of mobile
phones and the internet in clinical practice. Journal of Mobile Technology in Medicine, 2(1),
3-10. doi10.07309/jmtm.76
4. Ozdalga, E., Ozdalga, A., & Ahuja, N. (2012). The smartphone in medicine: A review of
current and potential use among physicians and students. Journal of Medical Internet
Research, 14(5), e128. doi:10.2196/jmir.1994
Emergency Nurses Association | 915 Lee Street | Des Plaines, IL 60016-6569 | 847-460-4000
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Position Statement
5. Predhomme, J. (n.d.). How personal digital assistants can increase the quality of nursing care
provided in the hospital setting. RN Journal. Retrieved from http://rnjournal.com/journal-ofnursing/how-personal-digital-assistants-can-increase-the-quality-of-nursing-care-providedin-the-hospital-setting
6. Spyglass Consulting Group. (2012, November). Healthcare without bounds: Point of care
computing for nursing 2012. Retrieved from http://spyglassconsulting.com/Abstracts/Spyglass_PCOMP_Nursing_2012.pdf
7. Lippincott Williams & Wilkins. (2012, April). As smartphone usage expands, survey says
nurses and nursing students want mobile access to credible drug data. Retrieved from
http://www.wolterskluwerhealth.com/News/Pages/As-Smartphone-Usage-Expands,-SurveySays-Nurses-and-Nursing-Students-Want-Mobile-Access-to-Credible-Drug-Data.aspx
8. Institute of Medicine. (2006, July). Preventing medication errors [report brief]. Retrieved
from http://www.iom.edu/~/media/Files/ Report%20Files/2006/Preventing-MedicationErrors-Quality-Chasm-Series/medicationerrorsnew.pdf
9. U.S. Food and Drug Administration. (2011, July 20). Draft guidance for industry and food
and drug administration staff: Mobile medical applications. Retrieved from
http://www.fda.gov/medicaldevices/
deviceregulationandguidance/guidancedocuments/ucm263280.htm
10. Gilmer, E. (2013, April 16). Developing mobile apps as medical devices: Understanding U.S.
government regulations. IBM DeveloperWorks. Retrieved from
http://www.ibm.com/developerworks/mobile/library/mo-fda-med-devices/index.html
11. Institute of Medicine. (2010). The future of nursing: Leading change, advancing health.
Retrieved from http://www.iom.edu/~/media/Files/Report%20Files/2010/The-Future-ofNursing/Future%20of%20Nursing%202010%20Recommendations.pdf
12. Franco, O. I. (2013). How helpful are mobile healthcare apps? AAOS Now, 7(3). Retrieved
from http://www.aaos.org/news/aaosnow/mar13/managing5.asp
13. Porter-O’Grady, T. (2011) Future of nursing special: Leadership at all levels. Nursing
Management (42)5, 32–37. Retrieved from
http://www.nursingcenter.com/lnc/journalarticle?Article_ID=1163290
14. Markus, P., & Zuiker, E. (2008). Cell phone camera use in healthcare facilities: Shutter it.
HIT News: American Health Lawyers Association, 12(1), 12–14. Retrieved from http://
www.smithmoorelaw.com/pubs/xprPubDetailSmithMoore.aspx?xpST=PubDetail&pub=233
15. Gill, P. S., Kamath, A., & Gill, T. S. (2012). Distraction: An assessment of smartphone usage
in health care work settings. Risk Management and Healthcare Policy, (5), 105–114.
doi:10.2147/RMHP.S34813
Emergency Nurses Association | 915 Lee Street | Des Plaines, IL 60016-6569 | 847-460-4000
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Position Statement
16. National Council of State Boards of Nursing. (2011, August). White paper: A nurse’s guide
to the use of social media. Retrieved from https://www.ncsbn.org/Social_Media.pdf
17. Singh, A., & Purohit, B. (2012, March 1). Mobile phones in hospital settings: A serious
threat to infection control practices. Occupational Health & Safety. Retrieved from
http://ohsonline.com/Articles/2012/03/01/Mobile-Phones-in-Hospital-Settings.aspx
18. U.S. Department of Health and Human Services. (n.d.). Your mobile device and health
information privacy and security. Retrieved from http://www.healthit.gov/providersprofessionals/your-mobile-device-and-health-information-privacy-and-security
Authors
Emergency Nursing Technology and Informatics Work Team
Michael Seaver, BA, RN
Nicholas Chmielewski, MSN, RN, CEN, CNML, NE-BC
David Holman, MNSc, RN
Jeanette Jeffries, RN
Dagny Scofield, RN, CEN, CPEN
ENA 2013 Board of Directors Liaison for Position Statement Review Committee and Emergency
Nursing Technology and Informatics Work Team
Ellie Encapera, RN, CEN
Reviewed by the Position Statement Review Committee
Diane Gurney, MS, RN, CEN, FAEN
Todd Baxter, MS, BA, RN, CEN
Katie Bush, MA, BS, RN, CEN, SANE-A
Judy Crook, PhD, MSN, RN, CNS, CEN
Kathleen Patrizzi, MSN, RN, ACNS-BC, CEN
ENA Staff Liaisons
Kathy Szumanski, MSN, RN, NE-BC, Director, Institute for Quality, Safety and Injury
Prevention (IQSIP)
Catherine Olson, MSN, RN, Senior Associate, IQSIP
Dale Wallerich, MBA, BSN, RN, CEN, Senior Associate, IQSIP
Leslie Gates, Senior Administrative Assistant, IENR
Leslie Talbert, Senior Administrative Assistant, IQSIP
Developed: July, 2013.
Approved by the ENA Board of Directors: September, 2013.
©Emergency Nurses Association, 2013.
This position statement, including the information and recommendations set forth herein (i) reflects ENA’s current position with respect to the
subject matter discussed herein based on current knowledge at the time of publication; (ii) is only current as of the publication date; (iii) is subject
to change without notice as new information and advances emerge; and (iv) does not necessarily represent each individual member’s personal
opinion. The positions, information and recommendations discussed herein are not codified into law or regulations. Variations in practice and a
practitioner’s best nursing judgment may warrant an approach that differs from the recommendations herein. ENA does not approve or endorse
any specific sources of information referenced. ENA assumes no liability for any injury and/or damage to persons or property arising from the
use of the information in this position statement.
Emergency Nurses Association | 915 Lee Street | Des Plaines, IL 60016-6569 | 847-460-4000
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