Chapter 8 Nursing Informatics Roles, Competencies, and Skills

Objectives Provide an overview of nursing informatics’ historical development. Explore the concept of nurses as knowledge workers. Discuss the evolving roles and competencies of nursing informatics practice.

Introduction The world has witnessed an unprecedented number of technological advances during the last 100 years. The early 20th century witnessed the invention of the car and the airplane. These modes of transportation drastically changed how people work and play. The entertainment world was dramatically altered by the invention of radio and television. The introduction of the computer altered the way data and information were viewed and utilized and changed the way business was conducted. The computer is changing nursing and health care.

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).

History Health care began to use computers in the 1950s. Computers, in this era, were typically used in the business office to track financial aspects of health care (Saba & McCormick, 2006). In the 1970s, 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, 2006). In the 1980s, medical and nursing informatics specialties emerged. The personal computer was introduced, which allowed for flexibility in how these clinical systems were used. It also brought to everyone’s attention that not just NI specialists, but all healthcare personnel, would need to know about these systems (Hannah et al., 2006; Saba & McCormick, 2006).

History (con’t) The first certification exam for NI was taken in 1995 (Saba & McCormick). The post-2000 era saw an unprecedented explosion in the number and sophistication of both computer hardware and software. Electronic patient records became an integral part of clinical information systems. Telemedicine became possible and was recognized as a specialty in the late 1990s (Saba & McCormick,2006). NI has experienced rapid growth in the last 40 years, and it does not appear to be slowing. It will be interesting to see what will happen over the next 40 years.

Goal of Nursing Informatics In 2008, ANA updated the Scope and Standards of Nursing Informatics Practice. ANA lists the goal of NI as: “The goal of NI is to improve the health of populations, communities, families, and individuals by optimizing information management and communication (p.1)”.

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. 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 term knowledge worker was first coined by Peter Drucker in his 1959 book, Landmarks of Tomorrow (Drucker, 1994). Knowledge work is defined as nonrepetitive, nonroutine work that entails a significant amount of cognitive activity (Sorrells-Jones & Weaver, 1999a). Drucker (1994) describes a knowledge worker as one who has advanced formal education and is able to apply theoretical and analytical knowledge.

The Knowledge Needs and Competencies of Nurses The amount of information available is vast and expanding exponentially, which makes the healthcare industry the most knowledge-intense environment (Snyder-Halpern, Corcoran-Perry, & Narayan, 2001). Computers, technology, and the informatics fields are assisting healthcare workers in dealing with this information explosion.

Knowledge Needs Nurses rely on an extensive amount of clinical information and specialized knowledge in order to evaluate the processes they have implemented and measure the corresponding outcomes (Snyder-Halpern, Corcoran-Perry, & Narayan, 2001). 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. A national survey was conducted and found that consulting a peer was the most frequent way that information was obtained.

Nursing Informatics Competencies One challenge that health care 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 (2001) believe that nursing students and practicing nurses should be educated on core NI competencies.

What Is Nursing Informatics Specialty Practice? NI is an established and ever-evolving profession that began when computers were introduced into health care. Nursing Contributes to Healthcare Informatics Scopes and Standards: NI is important to nursing and health care as it focuses on representing nursing data, information, and knowledge.

Nursing Informatics Roles The roles that the INS may engage in are numerous. 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).

Specialty Education and Certification Nurses who choose to specialize in nursing informatics have two certifications available to them. The first is through the American Nurses Credentialing Center (ANCC). The ANCC exam is specific for the informatics nurse. The applicant must be a licensed registered nurse (RN) with at least 2 years of recent experience and have a baccalaureate degree in nursing (BS/BSN). The applicant must have completed 30 contact hours of continuing education in informatics. The second certification exam is sponsored by HIMSS. Candidates who successfully pass this exam will carry the designation of certified professional in healthcare information and management systems (CPHIMS).

Rewards of NI Practice The INS participates in informatics organizations that allow INSs to network and share experiences with each other. This allows them to bring these new solutions back to their respective organizations and improve informatics issues.

Summary Nursing informatics is an emerging relatively nursing specialty that combines nursing science, information science, and computer science. Informatics practices support nurses to effectively and safely care for their patients as the information that they need is made more readily available. Nurses have been actively involved in this field since computers were introduced to health care. With the advent of EHRs, it became apparent that nursing needed to develop its own terminology and NI has been instrumental in this process..