Cheryl Parker responds:

I often hear this question from students who are new to nursing informatics. It's a common paradox: employers require experience, but how do you get experience if no one will hire you? The first thing I recommend is to evaluate your situation and decide what you are willing to do to find that first position. Are you willing to relocate or travel? If so, do you have any restrictions? While you make these decisions, you must also remember that your first NI job will not be your last. New job opportunities will present themselves in years to come and some short-term job difficulties can reap long-term benefits. For example, I have a co-worker who accepted a great position in another state and negotiated a long-distance commuting plan for 12 months until her youngest graduates from high school. After her child graduates she will be able to finalize the family's relocation. Once you know what you are willing to do to get the job, you need to review your skills.

Most nurses have many skills but often we don't translate them into terminology recognized by others i.e. what we call patient management, others call project management. In order to move into informatics, you need be ready to sell all of your skill sets and you may need to rethink how you highlight your experience, education and training to show how it can help you with the new job. The first step is to dust of your resume by reviewing this list of potential interview questions found at http://allnurses.com/nursing-informatics/i-want-get-340772.html and be ready to sell your skill set no matter how limited it is. Be honest but don't be shy either.

It's very likely an informatics nurse will need to use all of the Microsoft Office products - Word, Excel, PowerPoint and Outlook, as well as Access, Visio and Project. I strongly recommend you assess your own skill level in these applications and fill in the knowledge gaps where needed. And I don't mean the ability to type a basic report and create a slide. If you want to see what expert skills are, go to the Microsoft Learning site at http://www.microsoft.com/learning/en/us/certification/mos.aspx#certifications and click on an exam #and then on the Skills Measured tab.

Ask yourself if there are any skills you can upgrade such as using project management software, creating online tutorials, or managing databases. Showing that you have taken the initiative to learn more always helps show you are serious about being a good, proactive employee.

After you identify your strengths and skills, it is time to start sending out your resume. While there are opportunities everywhere, you have to know where to look for them. Investigate healthcare facilities that are at the beginning stages of a big implementation to see if they are willing to train you, but also don't forget about ambulatory clinics, transitional and long-term care organizations. Veterans Affairs (VA) facilities are also good candidates for your job search. Keep a list of possibilities and check their job boards weekly. Remember, in some ways this job search is similar to the one you did right out of nursing school, so you are starting at the beginning again.

As you find job opportunities, apply for anything and everything that is even a remote possibility. I got one of my best jobs from an application I submitted for a part-time hospital bill auditor position. I applied for the job, even though it was not exactly what I was looking for. Although I did not get that position, my resume was sent along to another executive in the company who was looking for a RN with my qualifications. Before too long, I had a great job at Equifax-yes, the credit reporting company-working in the occupational health division. I stayed at this job for five years, until I moved across country and could not telecommute. So just remember to have an open mind and to apply for a wide range of jobs since you never know what might work out.

It's also important to remember that all nursing informatics roles are not only about implementing EMRs. I haven't worked on an EMR implementation in more than five years, so think about other possibilities in the field. I work for a vendor organization; a friend runs a simulation learning center used by hospitals and emergency medical services in her county; and many others work in data analysis for public health, while others teach.

Network, network, network because the best jobs aren't always advertised. Start creating your network both in person and online and attend meetings or conferences when possible. Another way to develop connections is by volunteering your time on committees - this will show your commitment to your new specialty even if you are not working in the field yet. I strongly encourage using LinkedIn to let recruiters know you are interested. Finally, using the HIMSS job boards and alumni services at your school will leave no stone unturned.

Put yourself in the hiring manager's place-what qualities would you want to see besides just experience? Skills such as building an application screen can be taught, but being self-motivated and a self-starter cannot. You must be able to clearly articulate why you would bring value to an organization and be worth the cost of hiring and training.

Lastly, don't get discouraged. It may take a while, but I'm confident you will succeed!

Joyce Sensmeier adds:

Cheryl suggests many good strategies, and I would simply add that you should try to build a case for any informatics or IT experience that you may have, even if it was gained in a volunteer capacity. What informatics or IT projects did you complete in your masters program? Are any of them applicable to the roles or positions that you are seeking? If you can relate these projects to a portion of the position descriptions, it will help build a case for the value that you may bring. Have you volunteered on any informatics related committee, task force or work group? Have you written newsletter articles, published white papers or developed any on-line tools that might inform or support the work of the hiring organization?

When I was being recruited for my current job at HIMSS, I did not have any previous association experience. But one of the things that made me marketable was my experience as a volunteer leader at a regional nursing informatics networking group. I had worked my way up from being a member, to chairing the membership committee, to serving as president. Those experiences were a notable part of my resume, even though they weren't carried out in a paid informatics position. Including those volunteer roles in my resume showed that I could lead an informatics organization to success and that was a definite plus. It also gave me a reference point for my subsequent job duties at HIMSS, and many times I looked back on those volunteer experiences and leveraged the lessons I learned, as well as my network of colleagues and friends.

One other suggestion is to pursue an unpaid internship. That is a great way to gain informatics experience and start to build a network. An internship will also help you to identify the particular informatics role that you may find of interest. Health IT is definitely booming - hospitals and health systems are rapidly implementing both electronic health records and clinical information systems, and informatics nurses are at the forefront of those efforts. Reach out to your professors, colleagues or other contacts and ask them about the projects they or their organizations are working on. Maybe they haven't previously considered having an intern, but your inquiry might spark their interest. Each of us can easily use an extra pair of capable and willing hands!

Finally, be sure to take advantage of social networking tools in your search. Today there are many vehicles available to start a discussion about a particular informatics topic that you are interested in. And that discussion could lead to discovering a new job opportunity. HIMSS has a vibrant nursing informatics community among its members. Post a question in the Nursing Informatics Discussion Forum or join the HIMSS Nursing Informatics Community and participate in its activities. LinkedIn is another great resource for both networking and participating threaded discussions. Once others see your name out there, you will soon be seen as 'in the know' and that alone can lead to future opportunities. In summary, find volunteer opportunities to gain experience, consider an internship, build your network, add confidence and credibility, and you will soon be successful in launching your future informatics career!

Cheryl Parker responds:

That's an excellent question. A registered nurse (RN) may practice in a variety of roles within healthcare organizations regardless if it is government or civilian, inpatient or outpatient. They may also hold non-traditional roles in insurance companies, healthcare device manufacturers, or software application vendors. RNs can practice clinically by providing direct patient care; they can hold management positions; and they can also support clinical nursing and patient care activities, such as the work done by informatics nurses.

There are also a number of different types of nurses in the informatics field. The American Nurses Association's Nursing Informatics: Scope and Standards of Practice (2008) defines an informatics nurse specialist (INS) as an RN who has been "formally prepared at the graduate level in informatics or a related field," and an informatics nurse (IN) as "a generalist who has informatics experience but does not have graduate level education on the subject (p.2)." Informatics nurses of all levels practice at the intersection of technology and clinical practice. The discipline of nursing informatics is a well-established specialty within nursing, which has grown past the point where nurses simply help IT to design electronic medical record (EMR) screens and choose equipment. Now this role is an "integral part of healthcare delivery and a differentiating factor in the selection, implementation, and evaluation of health IT that supports safe, high quality, patient-centric care." (HIMSS, 2011, p. 1) Consider how much technology is now at the point-of-care. From physiologic monitoring and "smart" IV pumps and beds to electronic medical records (EMRs) and barcoded medication administration, technology is everywhere.

Informatics nurses working at a healthcare facility may be involved in evaluating and selecting the technology; determining end-user requirements and customizing functionality; and designing and delivering training. In the early days of nursing informatics, our practice was primarily in hospitals, but now we can work in a variety of healthcare settings. Anywhere clinical nurses are found, informatics nurses can also be found.

I teach nursing informatics in an Masters of Science in Nursing (MSN) program, and the students I teach come from a variety of backgrounds, including correctional facilities, long-term care, rural access hospitals and large academic medical centers–all looking to understand more about informatics. Today, informatics nurses are serving as leaders in policy and standards organizations. For example, is Judy Murphy, RN, FACMI, FHIMSS, FAAN, an informatics nurse was recently appointed the Deputy National Coordinator for Programs & Policy at the Office of the National Coordinator for Health IT at Health and Human Services in Washington, DC.

So what does the "typical" informatics nurse look like? First, all informatics nurses are registered nurses with a clinical background, which is critical to understanding the workflow of clinical nurses as well as the working environment of the various care settings. I have worked as a clinical RN in medical/surgical units, emergency departments, critical care units, home health/hospice and long-term care. In addition, I have held various educational roles including academic, continuing education and clinical educator in healthcare facilities. This wide breath of experience allows me to have a deeper understanding of the complexities and needs of the direct care givers I support with my informatics activities. According to the 2011 HIMSS Informatics Workflow Survey, 46% of the 660 respondents had at least 16 years of direct patient care prior to moving into informatics, and another 20% had more than 11 years of experience. Critical care and medical/surgical experience were the most common background, accounting for 87% of the respondents. However, many informatics nurses have experience in multiple areas, including education and management.

According to this same survey, the majority (68%) of informatics nurses work for hospitals or healthcare systems, 9% work in academic settings and 5% work for either vendors or in consulting. Informatics nurses typically continue to advance their formal education as well, with 56% earning post graduate degrees.

Because our titles and roles vary so greatly depending on our employment situation, the American Nurses Association in the Scope and Standards of Practice has listed the major functional areas for informatics nurses, which include:

• Administration, leadership and management - either directly with clinical informatics departments or in combination with other functional areas such as serving as project managers
• Analysis - using data to synthesize knowledge, inform decision support, and manage outcomes as well as taxonomies
• Compliance and integrity management - helping make sure organizations are meeting all the national laws and standards such as HIPAA, FDA, Joint Commission, etc.
• Consultation - serving both internally or externally as a resource
• Coordination, facilitation, and integration - serving as the translator between end-users and IT experts
• Development - translating user requirements into solutions
• Education and professional development - ranges from teaching the end-user to use a device or application to educating the next generation of nurses and the general public
• Policy development and advocacy - being an advocate for consumers, hospital units, and the institution as a whole; also helping shape policies and standards at the state, national and organizational level
• Research and evaluation - conducting research in a variety of informatics topics that impacts both caregivers and consumers

At the end of the day, however, when anyone asks me if I'm still a nurse, I reply that while I no longer provide one-on-one care to a small group of patients, my work as an informatics nurse impacts much larger aggregates of patients. I am a nurse.

Bibliography

American Nurses Association. (2008). Nursing Informatics: Scope & Standards of Practice. Silver Spring, MD: Nursesbooks.org. HIMSS. (2011, June 17). Position Statement on Transforming Nursing Practice through Technology & Informatics. Chicago, IL. Retrieved from http://www.himss.org/ASP/ContentRedirector.asp?ContentID=78995

Karen S. Martin adds:

Cheryl shared extensive details about the education and roles of informatics nurses and informatics nurse specialists. I would like to add three examples based on real people and situations. The examples have been altered extensively so that you and other readers will not be able to identify the three nurses!

1. Nurse A: Enjoyed working as a staff nurse at a home care agency. She said yes when her administrators asked for a few volunteers to participate in discussions about clinical information systems. She became excited about the possibilities that a system could offer: generate quantitative data to describe practice, communicate more efficiently through standardized documentation, and share computerized information about patients and families quickly. In time, she became the home care agency's primary informatics champion, completed a master's program in informatics, and has a job title created for her IT position.
2. Nurse B: Has worked in an acute care specialty clinic for some time. He became frustrated when his patients received in-patient, out-patient, and specialty clinic care: he felt that he spent too much time trying to give and receive information, and that the information was not sufficiently concise, meaningful, or patient-centric. After their health system's accreditation visit did not go well, he volunteered to represent his clinic on an informatics committee. He recently enrolled in an informatics course, and enjoys it. He plans to become ANA-certified in informatics.
3. Nurse C: While working at a public health department as a staff nurse and then a manager, she developed extensive IT interest and skills. Recently, she accepted a position with a software company. She is working with a team of nurses, other health care professionals, programmers, and systems engineers who are responsible for the upgrades on the very software she was using at her health department.

What are the commonalities in the three examples? The nurses had strong clinical experience prior to becoming involved in informatics, were self-motivated, communicated well with others, took career risks, and enjoy their work. They exemplify Benner's novice to expert continuum. Benner published extensively, but her first book is a classic (1984).

You, I, and all nurses and health care professionals are novices when we graduate from our basic programs. Each of us has the potential to advance along that continuum by learning from professional, personal, and educational experiences. I hope you will consider informatics as a specialty AND enjoy it!

Bibliography

Benner P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park, CA: Addison-Wesley

Dana Alexander responds:

There has and continues to be many challenges for nursing informaticists, however, the environment is changing and today there is a greater understanding and recognition of the importance of nursing informatics. Historically, defining informatics and nursing informatics was a challenge; the field is relatively young as compared to other roles and industries. An exciting aspect that I (and many others) have had is the opportunity to pioneer roles and define scope and responsibilities of those roles. The challenge has been gaining understanding from individuals in both IT and the profession of nursing. However, today informatics and nursing informaticists are more readily understood. And while the field continues to evolve and define itself, the industry at large is recognizing the importance of nursing informatics as HCIT continues to be a focal point to achieve the goals of the National Quality Strategy and in support of US healthcare transformation.

Challenges have also included defining nursing informatics as an extension of nursing practice, defining the nursing informatics competencies required for every nurse and those specialized competencies required for nursing informaticists. Within nursing informatics, there are many roles which may require specialized competencies as well. Another challenge has been defining the nursing informatics infrastructure within an organization to support nursing and patient care, and subsequently how to integrate nursing informatics as an aspect of the professional practice model. Great strides have been made in these areas and continue to evolve. As the degree of HIT implementation increases the nursing informatics infrastructure and roles need to evolve to optimize the changing care delivery model and strategies of the organization.

Moving forward into the future, I strongly believe that career opportunities in nursing informatics will be very strong and will exceed opportunity levels as compared to other industries and fields. I consider nursing informatics to be a “sweet spot” for growth. While there is much work yet to be done to achieve meaningful use and implementing EHRs there will be significant growth in clinical business intelligence and analytics creating a further demand for nursing informatics. Organizations will need a well-tuned analytics strategy to manage patients to achieve accountable care and goals of the National Quality Strategy.

As we drive toward accountable care, we can expect the financial/reimbursement models of today to change to support new care delivery models that will better leverage the inter-professional care delivery team. There will be a greater demand for nurses in roles outside of the hospital setting into the community and home. New technologies will be needed to reach, connect and engage the patient and caregivers. The U.S. Healthcare IT market spend is expected to grow at 22+ % annually from 2012 -2014. Additionally, as future technologies continue to emerge to support and connect the patient and family through remote health management, nurses will have a key role in managing and monitoring these patients from settings outside of the hospital. That said nursing informaticists are needed to support the development, design, usability and implementation of these emerging technologies.

In addition to the growing demand for nursing informaticists in practice and education settings, nursing informaticists that have a research focus to support evidenced based practice and the evolving care delivery models are needed as well. These are a few areas where I foresee continued opportunities for a career in nursing informatics. It is our responsibility as nurses and nursing informaticists to innovate, create and define the roles that are necessary to support the transformation of U.S. Healthcare. The opportunities are abundant and needs only to be seized.

Willa Fields adds:

I made my way into informatics from the field of quality/performance improvement. Informatics was a natural progression from my interest in using computerized data to answer clinical questions. I accepted a position with a clinical information system software vendor to help them and their clients maximize the use of data in the system. I found that working for a vendor was quite different from a hospital. First off, I realized the engineers and programmers had an acronym language I was totally unfamiliar with. With the help of the internet, I soon mastered this new language. Then I realized the engineers and programmers did not understand hospital operations, nursing, or patient care; I needed to be specific in my requests and speak their language, not mine. It was also important to establish nursing’s credibility and the clinical voice. We all had the same goal in mind: to establish a safe, user friendly system that would improve care, so it was important to communicate nursing and patient data needs in a way the engineers and programmers could understand.

The challenges faced by nurses in health IT may not be that different today. Every discipline has its own language, and the nurse informaticist needs to know both the clinical and IT language to bridge nursing and software development and design.

Recent research has demonstrated that health IT is demonstrating positive results, although dissatisfaction among some clinicians remains a problem and is a barrier to achieving the potential of health IT (Buntin, Burke, Hoaglin, & Blumenthal, 2011). Nurse informaticists play a key role in improving clinician satisfaction by helping design better systems, educating clinicians on effective and safe use, and bringing forward solutions to maintain and improve existing systems. The demand for nurse informaticists will continue to increase, especially with the number of organizations implementing complex clinical systems as a result of the HITECH Act.

Many organizations are hiring nurse informaticists and Chief Nursing Informatics Officers. Now is an exciting time for health IT - as nurses, we are making contributions by helping to design better systems and ensuring clinicians are well equipped to effectively and safely use health IT to improve care. I completely agree with Dana, “The opportunities are abundant and needs only to be seized.”

Reference: Buntin, M., Burke, M., Hoaglin, M., & Blumenthal, D. (2011). The benefits of health information technology: A review of the recent literature shows predominiately positive results. Health Affairs, 30(3), 464-471.

Brenda Herrmann responds:

Like most questions about what is essential exposure for a Healthcare Informaticist, the answer begins with "it depends what you want to do."  As a project manager, my initial response would be, “Take advantage of every project management experience or class you can get your hands on!”  However, after a bit more consideration, I’d say expose yourself to as many different things in school as you can.  Pragmatically speaking, taking a project management course may make sense, but college provides unique opportunities to explore and experiment in ways you will never have in “real life”. 

For example, if you plan to go into research, the project management class may not be as beneficial as others like Advanced Information Retrieval or Data Mining.  After graduation, you can always take a week long dedicated project management course at a conference (like the week before the Summer Institute in Nursing Informatics at the University of Maryland), and it will be as comprehensive as a semester-long course in school. 

If your plan is to focus on systems implementation or to work for a vendor, the project management certification is highly valued.  Ironically though, you have to have several years of project management experience before you can sit for the certification exam.  project management, as important as it may be, is something you can pick up down the road.  Ultimately, the academic discipline of project management is quite different from the real-world skill of managing a project.  It's unlikely that a one-semester course will significantly improve your standing as a potential employee.

Before leaving the friendly confines of academia, if you have an opportunity to intern with a company that looks promising as an employer, jump on it.  It’s kind of like working as a nursing tech while in nursing school.  The real world experience is worth far more than the classroom or clinical practicum you get in school.  Now, that is easier said than done.  Vendors and consulting firms are just beginning to realize the desperate need for clinical informaticists in helping healthcare to meet all the government mandates and to provide systems that are clinician and patient friendly!  I think this is where our real challenge is today in informatics – linking the clinical informaticists with the vendors in a useful way.  Wouldn’t it be fun to have a student intern “clearing house” that hooked up students with their desired work areas and employers with future leaders?

By the way, as a student you can join many organizations for a greatly reduced fee.  You should join as many as you can afford, and take advantage of going to conferences as a student volunteer.  HIMSS should be at the top of your list if you are interested in vendor or consulting jobs, and AMIA if you are interested in academia or research.  The Alliance for Nursing Informatics is the NI group that links both of them, and is strong on public policy comment.  ANIA-CARING is a must for every NI student – very inexpensive, and the networking is phenomenal!  Good luck!

Jeanette Polaschek adds:

I agree with the advice that Brenda has outlined in her response.  The answer to your question very much depends on your planned career goals.  Having said that, project management is a skill that lends itself well to learning in a real-world environment. The basics of project management are actually planted as you developed your skills as a clinical staff nurse.  The patient is your project - you have deadlines to meet (times when treatments and medications are due), you have resources to assist (ancillary staff, physicians) and you are responsible for the overall management of the project (while that patient is assigned to you during your shift).  As nurses working at the bedside we learn to prioritize our work, pay close attention to detail and be diligent in follow-up and documentation.  All of the skills make up the essential toolset of a good project manager.

In terms of what classes to take while in school, as Brenda has said, it again depends on your career goals.  Do you want to develop your technical skills – perhaps become involved in actual systems installation or administration?  Or maybe work for a vendor as a solution architect or developer.  If that is the case, then learn a programming language and take some basic courses in design and system architecture. These types of classes will provide an education on how software is developed and fundamental components of a range of system environments.

If you are interested in sales or marketing, then you should look for classes that cover the fundamentals of business, market research, competitive strategy and statistics.  All of these topics have a much broader perspective that will take you outside the world of health care but the concepts are important and very much applicable to the current health care market.

For the more pure informaticist perspective, classes on decision support, probability theory and knowledge bases would definitely be of interest.  This is an exciting area and the opportunities for careers in this area are growing as most health care organizations are finally at a point where the basic information systems are in place.  Now that the registration system, ancillary services and other essentials are in place the focus is shifting to the more interesting applications where information integration, clinical decision support and analytics will play a key role.

Good luck with your education and career!