This groyning specialty

has the potential to

change your daily
practice for the better.
By HIMSS Nursing Informatics Awareness
Task Force

J
ust over a decade ago, the term nursing injbmwt- One estimate is that nurses spend as little as 15% of
ics might have drawn blank stares. Since then, their time on direct patient care, but 50% on documen-
this burgeoning field has become an essential ele- tation. A welcome outcome expected of the many infor-
ment of healthcare delivery. In the last decade mation technology (IT) initiatives is revitalization and
alone, there's been a significant increase in the redefinition of the role of nurses and nursing practice.^
demand for nurses whose knowledge of nursing and spe- The movement toward evidence-based practice drives
cialization in ijiformatics contributes to nursing practice, home the need for nurses to have the necessary infor-
leadership, education, and research throughout the United mation for decision making at the point of care.
States and other countries. Evidence-based clinical practice involves integrating
Wliat, then, is nursing informatics? The definition the best available evidence with clinical judgment,
adopted by the International Medical Informatics Associa- client values, and consideration of available resources.'^
tion's Interest Group on Nursing Informatics is "the inte- An expertly designed clinical information system can
gration of nursing, its information, and information man- serve as the integrator that supports clinical judgment
agement with information processing and communication and client values with proven outcomes and up-to-date
technology, to support the health of people worldwide."' evidence-based practice.
When evidence-based practice is coded to an appropri-
Knowledge explosion ate taxonomy system, computerized nursing documenta-
The introduction of robust and sophisticated clinical in- tion allows nurses to realign and track the care process,
formation systems has prompted significant transfor- focusing on improving outcomes by implementing ap-
mation in healthcare, along with increased attention to propriate nursing care for identified problems. The re-
patient safety and outcomes. In addition, there's been sult? Improved patient safety and care delivery through
increasing pressure for healthcare systems to improve decision support. Another measurable outcome from evi-
efficiency while standardizing and streamlining organi- dence-based care is the ability to demonstrate the value
zational processes and maintaining care quality. Tliis of nursing to the overall health and well-being of patients
"knowledge explosion" strains clinicians to learn and and families.
integrate information systems into their already de- Interest in implementing clinical information systems
manding daily practice. seems to have escalated since President Bush, in 2004,
There are many reasons why this transformation is called for the widespread use of EHRs within 10 years.
taking place. Catalysts include In response to the President's
Appointed by the Healthcare Information and Man-
federal initiatives that encourage agement Systems Society (HIMSS), task force mandate, the Office of the Na-
nationwide adoption of electronic members include Karen Carroll, RN.BC, PhD; Alicia tional Coordinator for Health In-
health records (EHRs) and reports Bradford, RN.BC, MS; Melissa Foster, RN.BC, formation Technology was cre-
such as the Institute of Medicine's CPHIMS, FHIMSS; Jim Cato, RN, CPEHR, CRNA, ated. Experts cite numerous bene-
MHS, MSN; and Josette Jones, RN,BC, PhD. You
that claim clinical information fits of EHR usage, but the driving
can contact the task force at informatics®
systems improve processes and himss.org. force appears to be improved care
ultimately save patient lives. quality and greater efficiency.

www.nursingmanagement.com March 2007 Nursing Management 39

 !\ 1\ l^' <) R M A T I C S
Specific roles
Nursing has heen carving out a spe-
cialty over the years, and nurses
have been informally practicing as
informaticists since the early 1960s.'*
Many nursing informatics (NI) spe-
cialists unofficially adopted the role
when they were selected to be the
nurse member of a hospital infor-
mation system team. Often these
nurses were already seen as the
"techy" or "go-to" nurses—and
were in the right place as a system
was being implemented. They had
a knack for making the system
work for their unit or area. After the
system was implemented, the nurse
remained in the role.
Information technology depart-
ments, as well as nursing depart-
ments, have learned the value of the
involvement and project manage-
ment skills provided by a clinically
knowledgeable nurse. In their every-
Informatic theories and competencies have started being
incorporated into basic nursing associate degree
and baccalaureate curriculums.
day clinical practice, nurses work
with patients and families to coordi-
nate multiple services and impact
patient care. These skills translate
well into implementing complex sys-
tems to patient care: Nurses make
great project managers.
In acute care and long-term-care
organizations, as well as industry or
vendor companies, nurse informati-
cists have held such diverse titles as
NI specialist, clinical analyst, clini-
cal project manager, and NI man-
ager. Some of these roles "live" in
the IT department; others report to
the chief nurse officer and have a
close working relationship with the
IT department and the education
staff. Nursing informatics positions
are also seen in practice as senior
managers holding titles such as
clinical IT directors, chief informa-
tion officers, and chief nurse offi-
cers. The Nursing Informatics
4 0 Nursing Management March 2007
Working Group of the American
Medical Informatics Association
maintains a repository of NI role
descriptions at http://www.amia.
org/mbrcenter/wg/ni/roles.asp.
Tlie job responsibilities can be var-
ied and encompass project manage-
ment, health information system
management, writing requests for
proposals or returns on investments,
developing educational programs,
evaluating work process flows, writ-
ing policies, aiding in the design and
content of an organization's intranet,
and making recommendations to
chief nurse officers/chief executive
officers on a preferred clinical system
for nursing.
Nurse informaticists ensure that
nursing is represented in decisions
that impact clinical systems in the
practice setting. As the largest
group of healthcare professionals,
nurses are the largest group of clini-
cal users. Nurse informaticists en-
sure that any system meets the
needs and fits the work flow of
nurses. Their ability to liaison be-
tween nursing and IT allows them
to prevent many costly errors:
• in system selection (choosing a
system that doesn't fit with the
nurse's work flow}
• in design (ensuring that the design
of screens works for nurses and
meets documentahon standards)
• in education (confirming that ed-
ucation addresses what nurses need
to know to use a system)
• during implementation (selecting
a suitable work flow for nurses)
• postimplementation (focusing on
system maintenance, optimiza-
tion—with input from clinical nurse
users—research and data informa-
tion, and knowledge management).
Outside hospitals and nursing
homes, the roles for NI positions also
offer a wide array of opportunities.
Nurses can work for vendors doing
clinical system design, implementa-
tion, customer trairung, testing, and
sales. Or they can target education,
research, and professional standard
development, working to standard-
ize nursing languages and represen-
tation to the national and interna-
tional informatics committees.
Educational programs
In 1992, the American Nurses Asso-
ciation (ANA) officially established
the role of the informatics nurse
specialist, shortly after which they
began offering the first credential-
ing exam in 1995. Although this
recognition of NI is fairly new
among the nursing specialty prac-
tices, skilled information manage-
ment has always been a cornerstone
of successful nursing practice.
Nurses spend a significant portion
of their time collecting and translat-
ing data for consumption hy other
providers, patients, and families. As
computers increasingly become a
tool for repositing healthcare infor-
mation, it's imperative that all
nurses have computer competen-
cies, just as they would with any
other healthcare instrument.
The ANA's Scope and Standards
of Nursing Informatics Practice
(2001) identifies three progressive
levels of NI competencies: the be-
ginning nurse, experienced nurse,
and informatics nurse specialist.^ As
the specialty of NI has become
more defined, nurses have sought
out more learning opportunities
and have benefited from the emer-
gence of more formal NI education
programs. Until the last decade,
there were few formal NI programs.
It's even more recent that informat-
ics theories and competencies have
www.nursingmanagement.com
started being incorporated into
basic nursing associate degree and
baccalaureate curriculums. Not sur-
prisingly, many practicing nurse in-
formaticists received their "formal"
training on the job, typically as a
necessity of their institution's sys-
tems implementation.
As we transform the healthcare
industry to this IT-enabled age, it's
vital to incorporate basic computer
skills and NI competencies into all
levels of professional nursing edu-
cation programs. For a comprehen-
sive list of programs for nursing,
medical, and health informatics,
visit http://www.amia.org/
informatics/acad&training/,''''^
Certification for NI
The American Nursing Credentialing
Center (ANCC) began administering
nn informatics nurse certification
exam in November 1995. The exam
topics cover areas of basic IT, infor-
mation and knowledge management,
system development, human factors
and NI models, theories, and profes-
sional practice.^ The ANCC Web site
details the nursing candidate's quali-
fications for the informatics nurse
certification exam as:
• a baccalaureate or higher
• an active RN license, with at least
2 years of professional practice
• practice of at least 2,000 hours of
NI within the last 3 years
or
• 12 hours of graduate work and
1,000 hours of NI practice
or
• completion of a graduate pro-
gram in NI that included at least
200 hours of clinical practicum
• completion of 30 continuing-
education contact hours in specialty
area within the last 3 years for those
who haven't completed a graduate
informatics program.**
Those RNs, with a baccalaureate
or higher degree in the field of nurs-
ing, who successfully pass the certifi-
cation exam are recognized as
"board certified" with the initials
"RN,BC." For RNs with baccalaure-
ate or higher degree in a nonnursing
field, their certification is recognized
as "certified" with an "RN,C."
Enhancing practice
As the healthcare industry contin-
ues to move toward utilization of IT
tools to shape healthcare decisions
and dehvery, it's essential that
knowledgeable nurse informaticists
work with other nursing specialties
to ensure tine discipline of nursing
is enhanced by new technologies.
The goal of nursing is to have these

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41
 One team. One purpose. J\ II R S t ^ G I ^ F O R \l A T 1

technologies enable and enhance and Standards of Nursing Informatics Prac-

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REFERENCES
1. Special Interest Group Nursing Informatics of
International Medical Informatics Association
1998. Available at: http://www.imia.org/ni/
index.html. Accessed March 4, 2006.
2. Mills ME. A growing role in system devel-
opment. In: Ball MJ, Waver C, Kiel J, eds.
Healthcare Information Management Sys-
tems. New York, NY: Springer-Verlag;
2004:320-331.
3. DiCensoA, Callum N. Implementing evidence-
based nursing: some misconceptions. Evid
Sased/Vtyra. 1998;1(1):38-40.
4. Saba V. Nursing informatics: yesterday,
today and tomorrow. Int Nurs Rev.
2001;48:177-187.
5. American Nurses Association, Scope
tice. Washington, DC: American Nurses
Publishing; 2001.
6, HIMSS News, Nursing informatics groups
form alliance through HIMSS and AMIA to
provide unified structure. Available at:
http://www.himss.org/asp/Content
Red i rector, asp?ContentlD=57813. Ac-
cessed January 30,2006.
7, American Medical Informatics Association,
AMIA 10x10 program. Available at:
http://www.amia.0rg/i 0x10/. Accessed
January 30, 2006,
8, American Nurse Credentialing Center, Infor-
matics nurse certification exam. Available
at: tittp://wvm.nursingworld.org/ancc/
certification/certs/informatics,html. Ac-
cessed January 30, 2006.
9, HIMSS. CPHIMS certification. Available at:
http://www,himss,org/ASP/certification_
cphims.asp. Accessed January 30,2006.
ABOUT THE AUTHORS
The HIMSS Nursing Informatics Awareness
Task Force works to support the practice
and discipline of nursing by increasing
awareness of informatics in nursing
communities.

NURSE
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