ADVANTAGE FOR ADVANCEMENT TOWARDS NURSES

Nursing informatics, as defined by the American Nurses Association (ANA), is a specialty that integrates nursing science, computer science and information science to manage and communicate data, information and knowledge in nursing 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. This support is accomplished through the use of information technology and information structures, which organize data, information and knowledge for processing by computers.¹
An international viewpoint was adopted at the 1998 meeting of the International Medical Informatics Association Workgroup on Nursing Informatics in Seoul, Korea: Nursing informatics is the integration of nursing, its information and information management with information processing and communication technology, to support the health of people worldwide.
Informatics is modeled after the French word informatique and was first used as medical informatics in the late 1970s, followed by use in nursing in the 1980s. The ANA designated nursing informatics as a specialty practice in 1992, although nurses had earlier incorporated informatics concepts. Subsequently, volunteer ANA members have developed a scope and standards for practice, which serves as guides for the practice.^2,3
The standards of practice created by the ANA in 1995 reflect professional performance common to informatics nurses. For example, the informatics nurse contributes to the professional development of peers, colleagues and others.³ In 1995, a certification examination was created at the generalist practitioner level and since that time more than 400 nurses have been certified in nursing informatics.
Using Information Management
All nurses can utilize information management concepts to help identify, collect and record data pertinent to nursing care. Regardless of the practice setting - clinical practice, administration, research or education - technology can be used to support nursing in direct and indirect care practice.
The beginning nurse needs to have basic competencies such as computer literacy and protecting confidentiality of health care information while using the information system. The experienced clinician builds on the competencies of the beginning nurse and also must be able to identify data elements necessary for practice and documentation activities. The informatics specialist needs to possess knowledge of the system life cycle, which is initiation, development, implementation and operation of the information system; hardware and software, process design, systems analysis and project management. The highest level of ability and knowledge for an informatics nurse is that of innovator. The innovator may create informatics theory or new knowledge.⁴
Many activities undertaken by nurses can be enhanced using computer technology. Nurses in clinical practice can document patient care as well as access reference materials and databases via the World Wide Web. They can monitor their patient outcomes by using automated clinical pathways. The use of personal digital assistants with reference and charting information is now growing. Nurses use hospital computers to place nursing orders and plan care.
An informatics nurse in a clinical role may work in a hospital and be known as a clinical nurse analyst or clinical informatics specialist. Typical responsibilities include data collection, outcome reporting, designing and managing clinical databases, creating quality surveys, creating communications using desktop publishing, and designing forms.
The nurse analyst has little or no patient contact but concentrates on the work processes, understanding how to improve them using technology and data management concepts. A component of the role involves education of clinicians in information system concepts and, conversely, educating the technical people about health care.
Nursing administrators can manage department finances by using software that provides for budgeting and cost accounting. Staffing, scheduling and resource use can be managed with computer programs. Office automation incorporating word processing, electronic mail, spreadsheets, presentation graphics and databases make the work easier for the nurse administrator.
Nurse researchers can access decision support systems, such as knowledge about diabetic care, or maintain information using database management tools. Quality monitoring can be enhanced by documenting risks and incidents. A major emphasis now is on the use of technology to prevent medication errors by having the ordering provider directly enter an order into the computer system.
Educators in nursing can utilize technology-driven instruction for both nurses and clients. More and more online classes are being conducted using the Internet. Nurses can obtain bachelor's, master's and even doctoral degrees using technology. Computers can help to manage the data surrounding courses such as registration, maintenance of student grades and course certificates.
An educator can work for a vendor, health care agency or school of nursing. The educator may teach the technical components of how to use a particular software application. An informatics educator also teaches nursing staff and students about the clinical, legal and ethical standards behind the documentation and methodology.
Variety and Work Setting
Not all informatics nurses have the same title, role, work setting or salary. There are many roles and responsibilities a nurse can undertake within the nursing informatics field. Education, project management, product design and development, consulting, system selection, system testing, system implementation, research, maintenance, evaluation and theory formulation are among the many jobs an informatics nurse can undertake. The nurse is uniquely qualified for these positions, as the nursing process parallels the systems analysis process. The systems analysis process includes a requirements definition, analysis, design phase, coding, testing and implementation. The nursing process is similar, where the nurse observes, assesses, diagnoses, plans, implements and evaluates.
The work setting for informatics nurses can be any health care agency - hospital, clinic, ambulatory care, home care, school of nursing, vendor or consulting organization. Clinical experience is a sought-after criterion in hiring an informatics nurse. In the past, many informatics nurses have obtained their positions by "being at the right place at the right time" and then having on-the-job training or training from a product vendor.
A typical career pathway for an informatics nurse would be as follows: The nurse in a hospital is hired to help implement a nurse documentation system in that organization. After gaining some implementation experience, the informatics nurse may be hired by the vendor of that product to install systems at other hospitals in the region or nation. These positions require travel away from home up to 100 percent of the time. With experience at multiple sites, the installation specialist may then work for a consulting firm advising clients how to implement the system.
Educational Options
There are traditional education programs available for nurses specifically in the field of nursing informatics. The University of Maryland, Baltimore, School of Nursing offered the first master of science in nursing degree in nursing informatics starting in 1989. The PhD program in nursing informatics followed in 1992. Other schools of nursing now offer a master's degree either in informatics or, commonly, a master's degree in nursing administration with an emphasis on nursing informatics.
Continuing education for informatics nurses is available through two universities that offer informatics conferences. The University of Maryland, Baltimore, and Rutgers, the State University of New Jersey, offer these programs. The Weekend Immersion in Nursing Informatics⁵ was created as an intensive weekend to learn about informatics concepts. It is offered at various locations in the United States and Canada. The content parallels topics that are needed to understand the field of nursing or health care informatics - theories related to nursing informatics, human factors, information/database management, computer technology, systems analysis and design, systems implementation and support, system testing and evaluation, and professional practice trends and issues.
Resources
Job titles vary for the informatics nurse. There are more than 50 titles in use by informatics nurses. Many of them are iterations of systems analyst, clinical analyst or implementation specialist. No national surveys have been conducted, but estimates of salary range from $35,000 per year to well over $100,000. Salary depends upon the organizational setting, amount of travel required, the purview of responsibilities, location and job requirements. The job outlook for the informatics nurse is very favorable as many organizations are seeking to use technology to solve documentation issues and reduce errors.
Although little research has been done specifically in nursing informatics, there is a body of nursing informatics literature available in books, articles and conference proceedings. Nurses can travel outside the bounds of informatics nursing and study clinical or health care informatics. Clinical informatics is a broader term than nursing informatics, that considers all clinical areas such as radiology, pharmacy and respiratory therapy. There are national, regional and local informatics groups that support education and networking.⁶ One major group is CARING, which has more than 575 members in 45 states and 10 countries.⁷
Nursing informatics can be a rewarding career path for those nurses with a solid background of clinical experience coupled with a desire to utilize technology to improve the health of populations, communities, families and individuals.