Nursing Informatics Roles, Competencies and Skills 8

Key Terms Defined

• Advocate/Policy Developer –A nurse informatics specialist who is key to developing the
infrastructure of health policy. Policy development on a local, national, and international level is an
integral part of this role.
• Certification - Validates that a nurse possesses certain skills and knowledge or is competent to
complete a task; competence and skill level determined by or based on an external review,
assessment, examination or education.
• Cognitive Activity - any process or task (activity) that involves the capacity to think, reason, imagine
and learn.
• Consultant - A person hired to provide their expert advice, opinions, and recommendations based on
their area of expertise.
• Continuous Learner - Gleans lessons or learns from success as well as failures; constantly searches
for information to add to their knowledge base.
• Core Sciences - Nursing, computer, and information sciences are considered core sciences for
nursing informatics (NI); some believe, including the editors of this text, that cognitive science
should also be included in the core sciences.
• Data - Raw fact; lacks meaning.
• Data Gatherer - Direct procurement of raw facts (data); raw fact (data) collector.
• Decision support - A single recommendation or series of recommendations implying next steps
based on care protocols; the computer reminders and alerts to improve the diagnosis and care of a
patient including screening for correct drug selection and dosing, medication interactions with other
medications, preventive health reminders in areas such as vaccinations, health risk screening and
detection and clinical guidelines for patient disease treatment (IOM, 2003).
• Educator - Sage, leader and/or guide who assists in the process or practice of learning.
• Entrepreneur -One who assumes the risks of beginning an enterprise or business and accepts
responsibility for organizing and managing the organization.
• Industrial Age - Late 18th and early 19th centuries when there were major changes in
manufacturing, farming and transportation, inventions and innovations led these changes.
• Informatics - A specialty that integrates the specialty's science, computer science, and information
science to manage and communicate data, information, knowledge and wisdom in a specialty's
practice; Nursing informatics facilitates the integration of data, information, and knowledge to
support patients, nurses, and other providers in their decision-making in all roles and settings.
(cont’d)
• Informatics - (cont’d) This support is accomplished through the use of information structures,
information processes, and information technology; “a specialty that integrates nursing science,
computer science, and information science to manage and communicate data, information, and
knowledge” (Staggers & Thompson, 2002, p. 260); synthesis of nursing science, information science,
computer science and cognitive science to facilitate the management of healthcare data for the
improvement of patient care and advancement of the nursing profession.
• Informatics Innovator - Process of making enhancements or improvements; creative, novel and
inventive solutions in the informatics specialty.
• Informatics Nurse Specialist (INS) - An RN with formal, graduate education in the field of
informatics or a related field and is considered a specialist in the field of nursing informatics.
• Information - Data that are interpreted, organized, or structured; data that is processed using
knowledge or data made functional through the application of knowledge.
• Information Age - At the end of the 20th century, information was easily accessible using computers,
networks and Internet.
• Information User - The person who accesses and makes use of information made available to
her/him.
• Informatique - French term that refers to the computer milieu.
• Interdisciplinary Knowledge Team - A team composed of members of various disciplines in a
health care organization who each contribute their unique knowledge to the team in problem-solving
or management situations.
• Knowledge - The awareness and understanding of a set of information and ways that information can
be made useful to support a specific task or arrive at a decision; abounds with others’ thoughts and
information; information that is synthesized so that relationships are identified and formalized;
understanding that comes through a process of interaction or experience with world around us ; info
that has judgment applied to it or meaning extracted from it; processed information that helps to
clarify or explain some portion of our environment or world that we can use as a basis for action or
upon which we can act; internal process of thinking or cognition; external process of testing, senses,
observation, interacting.
• Knowledge Builder - Nurses will transition from knowledge users to knowledge builders when they
examine clinical data and trends across groups of patients. These trends are interpreted and compared
to current scientific data to determine if this data would improve the nursing knowledge domain. An
example of the transition to knowledge builder would be an observation of patients’, diagnosed with
chronic high blood pressure, medication compliance rates over a specified time period and then
comparing these rates to evidenced based literature to determine if this information would improve
the nursing knowledge-base (Snyder-Halpern, et al.).
• Knowledge User - Individuals or groups who benefit from valuable, viable knowledge.
• Knowledge Worker - Work with information and generate information and knowledge as a product.
• Medical Informatics - A specialty that integrates medical science, computer science, cognitive
science and information science to manage and communicate data, information, knowledge and
wisdom in medical practice; collected informational technologies which affect the medical decisions
made regarding patient care (Hannah, Ball, & Edwards, 2006).
• Nursing Informatics Competencies - Abilities to perform NI tasks.
• Product Developer - Designs, creates and builds a product, for example, a computer program,
network and/or system; user that employs productivity software to create a product.
• Project Manager - Responsible for the success of a project by managing the planning and enactment
of the project.
• Researcher - Conducts research or investigates phenomena.
• Technologist - Person skilled in the use of technology.
• TIGER Initiative - They were called the Technology Informatics Guiding Education Reform or
TIGER Team. This group determined that “utilizing informatics” was a core competency for all
healthcare workers. They also determined that many nurses lack IT skills which limit their ability to
access evidenced based information that could be incorporated into their daily practice. (cont’d)
• TIGER Initiative – (cont’d) This group is currently working on a plan to incorporate informatics
courses into all levels of nursing education and then they will look at how to get the information out
to practicing nurses who are not currently enrolled in an academic program (TIGER Initiative, 2007).
Many of the items identified as lacking in both nursing students and practicing nurses are items that
Staggers, et al. (2002) determined to be NI competencies.
• Introduction
• Nurses have historically gathered and interpreted data.
• Nurses are able to access information quickly and easily.
• Accessing the information via the internet or the electronic health record (EHR) allows the nurse to
provide the best possible patient care.
• Nursing recognized early on that computers would change healthcare and became actively involved
in shaping how computers were used in healthcare.
• The American Nurses Association (ANA) first recognized Nursing Informatics (NI) as a specialty in
1992 (Saba & McCormick, 2006; American Nurses Association [ANA], 2001).
• What is Nursing Informatics?
• The term informatics was derived from the French term informatique, which means to refer to the
computer milieu (Saba, 2001).
• The Health Information and Management Systems Society (HIMSS) defines informatics as “the
discipline concerned with the study of information and manipulation of information via computer-
based tools” (2006, p. 44).
• What is Nursing Informatics?
• Graves and Corcoran define NI as a “combination of computer science, information science and
nursing science designed to assist in the management and processing of nursing data, information and
knowledge to support the practice of nursing and the delivery of nursing care” (p.227).
• What is Nursing Informatics?
• The ANA points out that even though NI is based on science, it is an applied science and not a basic
science.
• Graves and Corcoran (1989) and the ANA (2001) both believe that data, information, and knowledge
are key components of NI practice.
• What is Nursing Informatics?
• Data, information, knowledge, and the core sciences, when combined, represent the foundation of NI
practice.
• History
• Healthcare began to use computers in the 1950’s.
• Computers, in this era, were typically used in the business office (Saba & McCormick, 2006).
• In the 1970’s, nursing began to realize the importance of computers to the nursing profession and
became involved in the design, purchase, and implementation of information systems (Saba &
McCormick).
• History
• In the 1980’s, medical and nursing informatics specialties emerged.
• 1995 saw the first certification exam for NI (Saba & McCormick).
• The post-2000 era saw an unprecedented explosion in the number and sophistication of both
computer hardware and software.
• History
• Telemedicine became possible and was recognized as a specialty in the late 1990’s (Saba &
McCormick).
• NI has experienced rapid growth in the last 40 years which does not appear to be slowing.
• The Nurse as a Knowledge Worker
• It has been established that nurses use data and information.
• This information is then converted to knowledge.
• The nurse then acts upon this knowledge by initiating a plan of care, updating an existing one or
maintaining status quo.
• The Nurse as a Knowledge Worker
• Knowledge can be defined as “the distillation of information that has been collected, classified,
organized, integrated, abstracted, and value added” (HIMSS, 2006, p. 49).
• A worker is “one that works especially at manual or industrial labor or with a particular material”
(Merriam-Webster, 2007).
• The Nurse as a Knowledge Worker
• Drucker (1994) describes a knowledge worker as one who has advanced formal education and is able
to apply theoretical and analytical knowledge.
• The knowledge worker must be a continuous learner and a specialist in a field.
• Knowledge Worker Concept
• Many industrial workers are finding it more and more difficult to obtain jobs as they do not have the
educational base or mind set required of knowledge workers (Drucker).
• The technologist is no longer trained on the job as were the industrial workers which can cause
significant problems for the industrial worker who does not have the education required to transition
to a knowledge worker position (Drucker; Sorrels-Jones & Weaver, 1999a).
• Knowledge Worker Concept
• Knowledge workers are innovators and the work they produce is the foundation for organizational
sustainability and growth.
• Knowledge workers are most efficient when they are working in a multi-disciplinary team.
• Leadership will shift and change as the team tackles different parts of the project, with the topic
expert taking the lead.
• A well-functioning team will consistently outperform an individual (Sorrells-Jones & Weaver,
1999b).
• A key impediment to an effective team is a lack of understanding between team members as well as a
lack of respect for each other’s knowledge and experience (Sorrells-Jones & Weaver, 1999a).
• Companies that employ knowledge workers have had to change their management structure to
support the knowledge workers.
• Loyalty is no longer purchased with a paycheck but is earned by giving the knowledge workers the
ability to use their knowledge effectively and innovatively (Drucker, 1992).
• Knowledge Workers and Healthcare
• Healthcare needs to begin making the transition from the Industrial Age to the Information Age.
• Healthcare can begin this transition by adopting a new philosophy that recognizes that employees are
mature, self-reliant, independent-thinking adults who function as partners in carrying out the work of
the organization.
• Management needs to understand and support the knowledge work and non-knowledge work that is
performed daily in healthcare.
• Organizations must switch from measuring the number of tasks completed to measuring the outcomes
obtained by knowledge workers (Sorrells-Jones & Weaver, 1999b).
• Nurses as Knowledge Workers
• Nursing entails a significant amount of knowledge and non-knowledge work.
• Knowledge work would include such things as interpreting trends in labs and symptoms.
• Non-knowledge work would include such items as calling the lab to check on lab results or making
beds.
• Nurses rely on their extensive clinical information and specialized knowledge in order to implement
and evaluate the processes and outcomes related to patient care.
• Nurses are data gatherers by nature.
• Nurses collect and record objective clinical data on a daily basis (Snyder-Halpern, et al., 2001).
• Nurses will transition from knowledge users to knowledge builders when they examine clinical data
and trends across groups of patients.
• The data gatherer requires a system that will capture and store data accurately and reliably and allow
the data to be readily accessed.
• The information-user role requires a system that can transform clinical data into a format that allows
for easy recognition of patterns and trends.
• The knowledge-user role is the least supported role and many systems are currently looking at ways
to support the nurses in this role.
• The knowledge-builder role is typically seen in conjunction with the nurse researcher role and quality
management roles.
• The knowledge needs of nurses will continue to improve as the systems improve.
• Nursing Challenges
• In order for nurses to be treated as a knowledge workers, nurses must first be recognized as
knowledge workers (Snyder-Halpern, et al., 2001).
• Nursing still has a long way to go before being accepted as an equal participant in the
interdisciplinary knowledge team.
• The Nurses Knowledge Needs
• Computers, technology, and the informatics fields are assisting healthcare workers in dealing with
this information explosion.
• Nurses deal with a vast amount of information and knowledge every day which they use to care for
their patients.
• Nurses rely on their own knowledge but there are times when this is not adequate and they must
access information in order to provide safe patient care.
• Decision support systems (DSSs) may be incorporated into the EHR.
• One challenge, that healthcare is currently facing, is the vast differences in computer literacy and
information management skills that healthcare workers possess (McNeil, Elfrink, Beyea, Pierce, &
Bickford, 2006).
• Staggers, Gassert, & Curran (2002) conducted a Delphi Study to validate the placement of the
competencies into the correct skill level.
• Of the 305 original competencies identified, 281 achieved an 80% approval rating for both
importance as a competency and for placement in the correct practice level.
• Nursing Informatics Specialty Practice
• NI is an established and ever evolving profession which began when computers were introduced into
healthcare (Belanger, 2006).
• Nursing has been involved in the purchase, design, and implementation of Information Systems (IS)
since the 1970’s (Saba & McCormick, 2006).
• Nursing Informatics Specialty Practice
• Nursing is involved heavily in the design of educational materials for practicing nurses, student
nurses, other healthcare workers, and patients.
• Computers have revolutionized the way patients access information as well as revolutionized the
educational process (Saba).
• Nursing Informatics Specialty Practice
• NI is important to nursing and healthcare as it focuses on representing nursing data, information, and
knowledge.
 • NI has become a viable and essential nursing specialty with the introduction of computers and the
electronic health record (EHR) to healthcare.
• Nurses who enter this field may have done so by accident because they were comfortable working
with computers and their co-workers used them as a resource for computer related questions.
• Assisting nurses to incorporate this new technology into their daily workflow is one of many
challenges that the nurse informatics specialist (NIS) may tackle.
• Nursing Informatics Specialty Practice
• One position that nurses do quite well in is the role of the project manager which is a result of their
ability to manage multiple complex situations at one time (HIMSS Nursing Informatics Awareness
Task Force).
• The first two graduate NI programs were introduced at the University of Maryland and the University
of Utah in 1989.
• The first doctoral program was offered in 1991 at the University of Maryland (Duke University
School of Nursing, 2007).
• Local colleges and universities should be researched to see which may have added informatics
programs.
• NI is a nursing specialty that does not focus on direct patient care but instead focuses on how to
improve patient care and safety as well as improving the workflow and work processes of nurses and
other healthcare workers utilizing technology.
• Nursing Informatics Specialty Practice
• Continuing education allows the NIS to improve a process or workflow within the hospital or to
change the way a system upgrade is rolled out.
• Thought Provoking Questions
Hospital C is looking to implement an EHR. It has been suggested that a NIS be hired. This position does
not involve direct patient care and the administration is struggling with how to justify the position. How
can this position be justified?