What is a Nurse Informatics Specialist

Question:

What is a nurse informatics specialist and what's the difference between that role and the current role of a nurse in our healthcare system today?

Answers from Cheryl Parker:

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 fromhttp://www.himss.org/ASP/ContentRedirector.asp?ContentID=78995

Answers from Karen S. Martin:

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

February 2012