Comment on ‘What Can We Learn From Nurses' Experiences of Digital Technology Implementation During the COVID‐19 Pandemic? A Qualitative Study’

We read with interest the qualitative study by Dowding and colleagues, which examined UK nurses' experiences of adopting, implementing and using digital technologies during the COVID-19 pandemic through free-text survey responses and in-depth interviews interpreted with the NASSS framework (Dowding et al. 2025). Their findings show that rapid digital implementation helped sustain care under exceptional circumstances, while also exposing infrastructural weakness, workload strain and uneven organisational readiness (Dowding et al. 2025). To extend the clinical and practice implications of this important work, we wish to draw attention to three issues that merit further consideration: the clinical appropriateness of digital substitution, the invisible nursing labour generated by implementation and the need for participatory governance if digital nursing is to remain safe and sustainable beyond the emergency phase. First, the findings suggest that the central post-pandemic question is not whether digital care can be delivered, but when it should be delivered. This distinction matters because the study contains repeated indications that the appropriateness of digital care is conditional rather than universal. Participants described clear benefits for some patients, including reduced travel burden and improved continuity of psychological support, but they also identified circumstances in which remote care might be clinically inadequate or even counterproductive, such as care involving patients with paranoia associated with psychosis, frail or acutely unwell individuals given limited digital guidance and consultations in which nurses feared that virtual encounters might miss something important (Dowding et al. 2025). These observations should not be treated as marginal exceptions. Rather, they suggest that digital models may fail not because the technology is unavailable, but because the mode of care is poorly matched to the clinical task, the patient's functional status or the point reached in the care pathway. A recent systematic review of virtual-care appropriateness identified six recurring determinants of suitability: patient characteristics, clinical presentation, timepoint in the care process, burden of care, provider factors and the technology platform (Abd Alras et al. 2025). Taken together, these findings support the view that the choice between virtual and in-person care should be approached as a clinical triage decision rather than an operational default. This consideration is especially relevant to nursing, in which relational assessment, behavioural observation, recognition of subtle physical cues and family engagement frequently inform judgement before a diagnosis is revised or escalation is initiated. Future research should therefore move beyond documenting acceptance or uptake alone and instead evaluate nurse-led appropriateness pathways for hybrid care. Such work could help define which encounters are suitable for digital-first follow-up, which require planned face-to-face review, and which need explicit escalation triggers based on symptom burden, cognitive status, communication difficulty or safeguarding concerns. Second, although Dowding and colleagues note that new digital processes were sometimes added to pre-existing work rather than replacing it, this point warrants deeper consideration because it speaks to a form of nursing labour that often remains unseen (Dowding et al. 2025). In practice, digital implementation frequently creates hidden work: orienting patients and carers to unfamiliar platforms, repeating instructions delivered only by text or email, resolving connectivity failures, duplicating documentation across poorly integrated systems, reconciling remotely generated data with existing records and sustaining parallel analogue pathways for those unable to participate digitally. The original study reflects this clearly in participants' descriptions of technology adding to already busy caseloads, the strain associated with continual change and the consequences of poor interoperability across organisations (Dowding et al. 2025). However, the implications extend beyond inconvenience or inefficiency. Invisible digital labour may displace activities that are central to nursing care, including detailed symptom exploration, anticipatory education, escalation planning and the relational work that often safeguards quality in complex care. A qualitative systematic review of hospital professionals' experiences with digital tools found that inadequate workflow integration, insufficient training and poor usability were associated with frustration, feeling overwhelmed, increased workload and concerns about safety (Wosny et al. 2023). This evidence suggests that implementation success should not be judged primarily by whether a system is switched on or widely used. For nursing, the more meaningful question is whether the technology reduces the total burden of care or simply redistributes that burden into fragmented and less visible forms. Future implementation studies should therefore incorporate explicit measures of digital work burden, including duplicated tasks, time spent on patient onboarding and troubleshooting, after-hours message management and documentation fragmentation. Linking these measures to nursing-sensitive outcomes such as missed care, delayed escalation, patient confusion and burnout would yield evidence of greater clinical value than adoption metrics alone. Third, the study offers an important, though still underdeveloped, insight into governance. Dowding and colleagues argue that the pandemic lowered barriers and accelerated change, yet their own data also show that frontline staff were not always meaningfully involved in selecting technologies or shaping their use in practice (Dowding et al. 2025). Several participant accounts indicate that implementation was experienced unevenly across organisational hierarchies, with lower-power clinical settings bearing the burden of piloting technologies while more influential services retained greater autonomy (Dowding et al. 2025). This is not simply a matter of staff satisfaction. It is a substantive implementation problem because technologies introduced without frontline co-design are more likely to reflect managerial priorities than nursing workflow, thereby increasing adaptation work, resistance and inconsistency in care delivery. Recent umbrella-review evidence from nursing settings shows that workload burden, limited technological confidence and perceived threats to professional autonomy are major barriers to adoption, whereas leadership support, positive organisational culture and nurses' participation in decision making are consistent facilitators of implementation (Walzer et al. 2025). The implication is that emergency deregulation should not become the default model for long-term digital transformation. What is now required is not less governance but better governance, specifically governance that gives nurses a substantive role in procurement, usability testing, local workflow redesign and post-implementation evaluation. One practical step would be to require a nurse-defined minimum implementation dataset before scaling any digital intervention: which nursing task is being altered, what work is being removed or added, which patients are at risk of exclusion, what escalation pathway exists when digital assessment is insufficient, and how frontline nurses can report safety concerns in real time. Such an approach would position nurses not as passive recipients of technological change but as active contributors to sustainable service redesign. In summary, Dowding and colleagues make a valuable contribution by documenting how nurses maintained care through rapid digital adaptation during the COVID-19 pandemic (Dowding et al. 2025). To translate these lessons into durable post-pandemic practice, future work should move in three directions: from digital availability to digital appropriateness, from visible adoption to invisible nursing work and from emergency roll-out to participatory governance. These extensions do more than identify barriers to implementation. They reframe digital nursing as a matter of clinical judgement, labour distribution and professional authority, three considerations that will shape whether digital transformation ultimately improves care or merely changes how pressure is experienced within nursing practice. The author has nothing to report. The author has nothing to report. The author has nothing to report. The author declares no conflicts of interest. The author has nothing to report.