As I reflect on what a culture of safety means for me as an informatics nurse and what my role in a safety culture might be, it occurs to me that informatics nurses are the clinicians responsible for making sure that the health IT systems used by nurses contribute to, rather than detract from, nursing care. Specifically, informatics nurses work to assure health IT is:
- Coordinated – Informatics nurses work to reduce clinical documentation burden, expressed by many nurses as a contributing factor affecting their ability to provide safe care and limiting their time at the bedside. By examining documentation elements to determine what information is necessary and meaningful, eliminating redundancy, and advocating for interoperability, informatics nurses coordinate documentation that meets the needs of the nurse and informs the healthcare team.
- Useable – Workflow analysis and health IT optimization help IT systems better conform to the unique context that is nursing. Informatics nurses possess the skills to understand and diagram how nurses accomplish patient care so that health IT may be optimized within nursing workflow.
- Supportive of Learning – Better structured data facilitates decision support and data sharing across settings. Informatics nurses work at local and national levels to make sure that commonly used tools, such as fall and skin assessment scales and definitions of what “normal” means in a nursing assessment, are included in standard terminologies. Facility-based informatics nurses incorporate these tools and parameters into their specific health IT systems.
- Transparent – Nursing care must be visible to the healthcare team and to the patient. Informatics nurses work to make it easier to illustrate nursing’s unique contribution to patient outcomes.
- Unobtrusive – The health IT devices and workstations used by nurses must not get in the way of our relationships with our patients. Informatics nurses are informed on current technology and options for documentation and monitoring.
- Relational – Informatics nurses suggest and deploy strategies that assist with communication and care transitions among nurses, other members of the healthcare team, and patients. Such communication becomes even more important, as we seek to understand not just how our patients improve after they leave the hospital, but also, what keeps them healthy.
- Evaluative – With implementation of health IT systems, the informatics nurses constantly evaluate their use. Are there elements of the system for which nurses develop workarounds? How might a system better meet user expectations? Is there additional training required? Can health IT systems be queried to meet quality reporting requirements?
Contemporary health IT systems are tools nurses can use to demonstrate they are meeting the four goals identified by the ANA in its definition of a safety culture:
1) openness and mutual trust when discussing safety concerns,
2) assuring appropriate resources, such as staffing and skill-mix,
3) a learning environment where the healthcare team learns from errors and proactively corrects systemic deficiencies, and
4) transparency and accountability. (http://www.nursingworld.org/CreatingSafetyofCulture).
Informatics nurses have a responsibility to our profession to make sure health IT tools are able to accomplish all four safety culture goals. Informatics nurses, a culture of safety DOES begin with us!