Why I left the bedside to build software

I'm a nurse. I have been a nurse for twenty-one years, twelve at the bedside, then in leadership, education, and research. I went into nursing because I wanted to help people, and I stayed in nursing because the work, the actual work, at the bedside, with patients, turned out to be the most meaningful thing I have ever done.

So when people ask me why I left to build software, I tell them the truth: I didn't leave because I stopped loving the work. I left because I love the work too much to let it keep failing nurses.

The slow realization

I worked through three EMR rollouts during my career. Each one was sold as the answer to the previous one's failures. Each one promised to give nurses back their time, to reduce errors, to coordinate care across settings. Each one delivered, at best, marginal improvement, and at worst, a new set of problems we hadn't had before.

By the third rollout, I started paying closer attention. I watched how my nurses interacted with the new system. I watched what they did when the system fought them. I watched what they did when the system didn't have a workflow for what they actually needed to do.

What I saw was nurses adapting. Memorizing things the EMR should have surfaced. Carrying paper notes for handoffs because the electronic version was too clunky. Staying late to chart care they had already delivered hours earlier. Pretending the alerts were useful when they were just noise.

They were holding the system together with their own labor. And the system was, in return, slowly burning them out.

"The software wasn't failing because the engineers were bad. It was failing because the engineers had never worked a twelve-hour shift."

Software built far from the bedside

Here is the thing nobody in the EMR industry likes to say out loud: the software was not built around how care actually happens. It was built around how care is billed.

That distinction sounds technical. It isn't. It is the entire problem.

When you build software around billing, the data model is patient-encounter-charge. Every clinical action is a thing that produces a revenue capture event. The nurse's job, in that model, is to generate the documentation that justifies the bill. The fact that the nurse is also delivering complex clinical care, coordinating across specialists, educating families, catching errors, and being the constant across shift changes, none of that is in the data model. None of that gets supported.

When you build software around how care actually happens, you start somewhere else. You start with the nurse, because the nurse is the constant. You build the workflow first. You let the documentation fall out of the workflow as a byproduct. You let the billing fall out of the documentation as another byproduct. Care comes first. Everything else is downstream.

Why I had to build it myself

For a long time, I thought somebody else would build this. I am a nurse. I am not an engineer. I am not a software founder. I had a career. I had a family. Surely someone else, somewhere, was already working on it.

But year after year, I watched the same software fail in different buildings. And year after year, I watched smart, well-meaning healthcare technology companies optimize for the wrong things, because the people designing them had never had the wrong thing optimized against them.

So eventually I made the decision. I left direct patient care. I started building MyNursePal. I learned what I needed to learn, about product, about engineering, about company-building, and I hired people who knew the things I did not.

It is the hardest thing I have ever done.

What I know now

I know that nurses are not stakeholders to be consulted. They are the primary users. The system should be built around them.

I know that physicians need their workflows respected too, but as a complementary lens, not as the dominant one. Care is team-based. The software should be team-based.

I know that patients and families deserve transparency. They deserve to see what is happening with their care. They deserve to participate. They are not afterthoughts to be served with a portal nobody updates.

I know that decentralized care, care that happens at home, in the community, across settings, is the future. And it cannot work without infrastructure that follows the patient instead of stopping at the hospital door.

I know that healthcare software built only for Western markets leaves two billion people worldwide without infrastructure the rest of us take for granted. That is not acceptable. We can do better. We will do better.

"Nurses already run healthcare. They just don't control the infrastructure. We're changing that."

The work continues

I have not stopped being a nurse. I think about my old patients often. I think about the colleagues I worked with, some still at the bedside, some who left the profession entirely. I think about the next generation of nurses coming in, and I think about what kind of software they will inherit if we do not change the trajectory.

That is what gets me up in the morning. That is what keeps the work going on the hard days. The conviction that nurses deserve better than what they have been given.

I left the bedside to build software. But really, I left the bedside so I could build the bedside back better.