Informatics & the Future of Nursing Practice

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Technology is being integrated into every area of healthcare. What does that portend for nursing?

From meaningful use to accountable care, healthcare trends are transforming nurses’ roles, responsibilities and career trajectories. Key to being part of this change is nursing informatics.

The field has already begun to flourish.

The American Nurses Association has developed standards for nursing informatics. The American Organization of Nurse Executives has endorsed principles to enhance clinical outcomes by leveraging technology.

Another guidepost is the Technology Informatics Guiding Education Reform (TIGER) Initiative Foundation, which recommends educators adopt informatics competencies for all levels of nursing education and practice, and reform the nursing curriculum by integrating healthcare information technology.

Achieving success in developing nursing informatics will also require collaboration between hospital executives, nursing leaders, nursing management, nursing staff and nursing schools.

Forces of Change

ANA in 1992 first defined the nursing informatics role as one which “supports the nursing process by helping to integrate the data, information, and knowledge required for clinical decision making.”

In 2001, ANA further defined nursing informatics, releasing the Nursing Informatics: Practice Scope and Standards of Practice. A revision of the nursing informatics scope and standards followed in 2008.

The American Organization of Nurse Executives’ Guiding Principles to enhance clinical outcomes by leveraging technology. Among them:

  • a well-defined governance model that defines strategic vision, roles, responsibilities and measures for success;
  • a roadmap with iterative steps for adopting and integrating of enabling technologies; and
  • a model to facilitate collaborative among the CNO, CIO and technology industry partners.

Making it all happen is the emerging CNIO.

According to one 2011 job description, the CNIO is “part of an interdisciplinary team, collaborating with the regional chief nursing officer and nurse executives to lead the strategy, development and implementation of information technology to support nursing, nursing practice, clinical applications and clinical/administrative decision-making.”

Relationships are critical. Many CNIO job descriptions refer to a professional who not only leads strategy, development and implementation of information technology to support nursing, nursing practice and clinical applications, but also collaborates with CNOs on the clinical and administrative decision-making process and develops clinical systems strategy with a regional CMIO.

The need to raise nurses as key leaders in informatics was heralded in June 2011 when HIMSS released a position statement, Transforming Nursing Practice through Technology and Informatics.

HIMSS’ position ends with a call to action for vendors, provider organizations, government agencies and academic associations to foster the evolution of the chief nursing informatics officer and other ways to support the role of nursing informatics to transform practice through technology and informatics.

A TIGER’S Tale

TIGER’s mission is simple: “To advance the integration of health informatics to transform practice, education and consumer engagement.”

TIGER encourages educators to adopt informatics competencies for all levels of nursing education (undergraduate/graduate) and practice (generalist/specialist) and reforming the nursing curriculum “through integration of information technology (IT), information literacy and informatics, and the infusion of technologies for learning.”

Hospital executives are encouraged to ensure all practicing nurses receive informatics education aligned with the three main TIGER informatics competencies: computer basics, information literacy and information management.

The TIGER initiative also encourages hospital executives – and all practicing nurses – to follow guiding principles and advocate on behalf of clinicians to health information technology (HIT) vendors.

One source is the TIGER Collaborative Report on Usability and Clinical Application Design.

This report is the result of a year’s worth of collaborative work with hundreds of nurses across the country. The collaborative studied the significance usability and clinical design principles have on the bedside practicing nurse using technology.

The report’s final recommendations included specific recommendations to clinicians and HIT vendors to ensure the end-product meet the needs of nurses, interdisciplinary teams and patients.

Additionally, TIGER encourages hospital administrators and executive teams to build and reinforce a vision for nursing that, “enables nurses and interprofessional colleagues to use informatics and emerging technologies to make healthcare safer, more effective, efficient, patient-centered, timely and equitable by interweaving evidence and technology seamlessly into practice, education and research fostering a learning healthcare system.”

The TIGER vision should be integrated with the organization’s mission, vision and values, and with division and department strategies, goals and objectives.

Building a New Future

Healthcare organizations can do much to support the evolving role of nursing informatics. Among the recommendations from nursing leadership organizations:

  • Advance nursing informatics education through partnerships with colleges of nursing. Among those promoting the TIGER Initiative, for example, are the National League for Nursing, which outlines nursing education competencies for nursing school executives and faculty, and the American Association of Colleges of Nursing, which has built informatics requirements into BSN and DNP programs.
  • Encourage hospital executives to ensure all practicing nurses adopt and adhere to all policies and principles of the TIGER Foundation Initiative.
  • Develop nurses’ potential to fulfill emerging informatics management roles by focusing on leadership skills such as communications, strategic and systems thinking, clinical, financial and business operations, and technical skills.
  • Leverage programs such as The Alliance for Nursing Informatics (ANI) Emerging Leader Program that encourages individuals to develop their leadership skills as a leader in informatics and involves them in a 2-year program. This is an ongoing program that elects new emerging leaders every 2 years.
  • Build a culture that supports nursing informatics through programs organized around reward and recognition, professional development, mentoring, performance planning and assessment, and career path development.
  • Conduct research and explore new models focusing on the roles, responsibilities, competencies of chief medical information officers (CMIOs), chief nursing informatics officers (CNIOs) and CNOs, as well as the function and scope of relationships with other members of the C-suite: CIOs, CEOs, CMOs, CFOs and CTOs. Explore new models that also create a strong tie between informatics and professional practice and interdisciplinary practice.
  • Develop and champion leaders with the ability to develop, deploy, re-engineer and integrate clinical information systems; function as members of strategic management teams; and collaborate on goals and implementation of clinical information systems.

As the healthcare landscape continues to shift, nurses are key leaders to navigate the need for coordinated care and enable better data infrastructure. The role of the nurse leader in informatics will most certainly be integral to the industry’s future.

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About Author

Michelle Troseth, DPNAP, MSN, RN

Michelle R. Troseth is the EVP and chief professional practice officer for Elsevier Clinical Decision Support and CPM Resource Center.

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