Arlene Keeling, RN, PhD, Audrey Snyder,RN, ACNP, ACNP & Suzanne Burns, RN, ACNP, all of the Virginia SON have made history by making the use of mobile computing a requirement in both the acute and primary care nurse practitioner programs.

Early in 2000, Arlene Keeling, the director of the Acute Care Nurse Practitioner program and her co-investigator Audrey Snyder, conceived the idea to introduce mobile computing to the school of nursing. Arlene had noticed a group of student nurses fumbling through their lab coat pockets which were overflowing with notepads, and snippets of paper, looking for their dog-eared, outdated pharmacology reference texts. She started thinking that there must be a better way of doing things.

There was a time, not that long ago, when nursing students could reasonably expect that the information and theory contained in their drug reference texts would remain relevant for years to come. Not any more. In today's furiously changing healthcare environment, old ideas, paradigms and information are being overturned and replaced with regularity. The result: the shelf life of the average drug reference has shrunk dramatically.

Arlene knew that if nursing schools continued in their use of the paper bound reference materials they would be graduating nurses with equally outdated and obsolete information and skills. She then set out to bring nursing education into the 21st century. Handheld computers caught her attention as a possible solution to the dilemma.

The SON applied for and received a grant from the University of Virginia Alumni Association to implement their innovative teaching methods utilizing handheld devices in the graduate NP program. In the initial grant, provisions were made to loan the students handheld computers to use for the semester, and while they were involved in clinical course work supervised by Suzanne Burns. (In the Spring of 2001 all NP students taking the advanced pharmacology course taught by Shelley Huffstuttler and Audrey Snyder were required to purchase their own handheld in place of the standard reference texts.)

Early planning included assisting the faculty in use of these devices. Thanks to a donation from Palm, the faculty had access to 8 handheld computers. This afforded the faculty an opportunity to learn firsthand about the highest and best use of handhelds. Additionally the faculty had the opportunity to trial a variety of programs prior to making a decision on what reference materials the students should be required to use.

Initially the NP students were to use ePocrates and the Tarascon ePharmacopoeia for their mobile drug references. However the school is currently investigating nursing specific drug references such as Lexi-Comp's NursingDrugs.

Students comments have been more than favorable, regardless of the initial learning curve required to master the devices:

• "I use it all day long!"

• "I look up drugs about 15 times a day!"

• "I can't get along without it anymore."

Students participated in a post use survey questionnaire where they are asked for examples where the handheld was valuable. A compleling example was cited by a NP student in her ER rotation.

• A baby was brought into the ER and immediately had a generalized seizure. The staff, aware that the ACNP student used a handheld computer, asked if she would check the correct pediatric dosing for Dilantin. What would normally have taken time to access via the "normal channels" of asking the pharmacist or leaving the room to check a reference book, was accessed with a few pen strokes in less than two minutes.

Future uses for the PDA are coming to fruition. Examples are programs that cluster symptoms and provide information on differential diagnoses, resuscitation application, and lab value norms. The newest use will be mobile wireless connection for the latest in clinical literature and studies that can be rapidly accessed anywhere, anytime. Handheld database development is also under consideration. Decreasing faculty time for tracking student, experiences/procedures etc., is a possibility, information could be beamed with a bi-directional response as to schedule changes or site assignments. Using their innovative imagination, the faculty and students will create limitless possibilities for use of their PDAs.

These NP students are society's future primary health care providers. As they enter the healthcare arena they will bring firsthand knowledge and experience with mobile devices along with the ability to access resources that technology provides. They will possess the skills necessary to compete in today's revenue seeking and cost containment healthcare model along with compliance knowledge for current and future regulations.

Sylvia Suszka-Hildebrandt, MN, ARNP, Editor PDA cortex