Evolving Role of the Nursing Informatics

The scope of nursing informatics practice has been evolving over the

course of the last 5 decades, expanding to address the needs of health care

organizations and in response to the evolution of technology. In parallel, the

educational preparation of nursing informatics specialists has become more

formalized and shaped by the requisite competencies of the role. In this chapter,

the authors describe the evolution of nursing informatics roles, scope and focus of

practice, and anticipated role responsibilities and opportunities for the future. Evolving Role of the Nursing Informatics

Further, implications and considerations for the future are presented.

Keywords. Nursing informatics specialist, role function, connected health, data

science, big data, personalized medicine, clinical intelligence, virtual care

1. Introduction

By 2018, 22 million households will use virtual care solutions, up from less than a

million in 2013. Average (healthcare) visits among these adopter households will

increase from 2 per year in 2013 to 6 per year in 2018, which include both acute care

and preventive follow-up services in a variety of care settings—at home, at retail kiosk

or at work. [1] Evolving Role of the Nursing Informatics

Nursing informatics roles have taken many forms in focus and function over the

last decades; suffice it to say that they have not been consistently described or defined

in terms of scope of practice. At the time of this writing it is clear that role of nursing

informatics specialists will continue to evolve at an increasingly rapid rate in the

coming years. The unfolding of new health care paradigms will bring greater

connectivity between care providers and patients, include a wide array of emerging

technologies and an increasing emphasis on data analytics will make the integration of

informatics competencies into every area of nursing an imperative. Evolving Role of the Nursing Informatics

2. Brief history of roles of the past and present

The earliest and most common types of informatics work assumed by nurses has

included: oversight of organizational workload measurement systems, project

leadership, systems educator, and nursing unit or departmental information technology

resource. In many instances, these roles were enacted on the basis of a specific

identified organizational need and were often secondments to the Information

Technology Department. It was not unusual for these roles to have the designation of

Forecasting Informatics Competencies for Nurses in the Future of Connected Health J. Murphy et al. (Eds.)

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“IT nurse” [2]. As role responsibilities and job titles have been widely varied, so have

the qualifications for each. The need for more specificity and consistency in nursing

informatics roles has been recognized for several years [3, 4, 5].

The advent of formal education programs for nurses interested in specializing in

informatics has occurred in conjunction with increasing sophistication in the use of

information and communication technologies (ICT) in clinical practice settings. Today,

nurses have the option to pursue specialization and credentials at a variety of levels

including graduate specialization and specialty certification. Advanced credentials and

certification (e.g., Certified Professional in Healthcare Information and Management

Systems – CPHIMS) have afforded nurses the opportunity to achieve credibility and

legitimacy regarding the specialty informatics knowledge and skills they bring to bear

in nursing practice and academia and healthcare in general [6]. This credibility has

been recognized with the development of executive level positions such as the “Chief

Nursing Informatics Officer” (CNIO) in some countries. The position of the “Chief

Medical Informatics Officer” (CMIO) is much more prevalent and deemed essential in

medium and large health care organizations while the C-level nursing counterpart

remains less common. Several authors [7-11] have described the role and competencies

for these senior informatics positions, yet the valuing of these positions remains limited

among health care provider organizations. Evolving Role of the Nursing Informatics

In addition to the evolution of formalized training programs for nurses interested in

informatics, the specialty of nursing informatics has continued to evolve and has

become recognized in local jurisdictions, nationally and internationally. Groups of like-

minded nurses have organized into special interest groups affiliated with larger

interdisciplinary organizations (e.g., International Medical Informatics Association –

Special Interest Group on Nursing Informatics (IMIA-NI-SIG)). Organizations such as

the Canadian Nursing Informatics Association (CNIA), the American Nursing

Informatics Association (ANIA), the Nursing Informatics Working Group of the

European Federation for Medical Informatics (EFMI-NURSIE) are examples of forums

for nurses to network, collaborate and profile their work in informatics. The existence

of these specialty organizations has served to further legitimize the work of nurse

informaticians and provided a venue for advancing regional, national and international

efforts in nursing informatics. Through conferences, meetings and the offering of

educational sessions, virtually and face to face, these networks of nurse informaticists

have collectively advanced the practice and science of nursing informatics. A case in

point is the International Nursing Informatics Congress and post-conference, now held

bi-annually and hosted by countries across the globe. Outputs of these meetings include

publications such as this one; benefitting nursing informatics specialists and the nursing

profession worldwide. Evolving Role of the Nursing Informatics

At the time of this writing, we find nursing informatics specialists in virtually

every clinical practice setting. The roles and focus of their work endeavors are wide

and varied. The titles of “informatics nurse”, “nurse informatician”, and “nursing

informatics specialist” are but a few of the titles applied to nurses working in the field.

Many of the roles of the past and present have been more extensively described

elsewhere [2,12]. For the purpose of this chapter, the authors use the title of nursing

informatics specialist to provide illustrations of the potential focus of these roles

current and future. Evolving Role of the Nursing Informatics

Roles to date have largely focused on supporting acquisition, implementation and

evaluation of clinical information systems in health care organizations. As noted by

McLane and Turley [4], “informaticians are prepared to influence, contribute to, and

mold the realization of an organization’s vision for knowledge management” (p.30).

L.M. Nagle et al. / Evolving Role of the Nursing Informatics Specialist 213 Evolving Role of the Nursing Informatics

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Nurses have been in pivotal roles at every step of the systems life cycle and

instrumental in the success of deployments at every level of an organization. From the

provision of executive oversight, project management, systems education and training,

and analytics, nurses in clinical settings have become core to organizations’

information management infrastructure and support. Evolving Role of the Nursing Informatics

In addition to health care provider organizations, nursing informatics specialists

can be found in the employ of technology vendors, retail outlets, and consulting firms

while many others have created their own entrepreneurial enterprise. Over the last few

decades, technology vendors, hardware and software, have come to appreciate the

invaluable contribution of nurses to the development, sales and deployment of their

solutions. Throughout the world, nurses are also engaged in academic pursuits to

advance the knowledge base of nursing informatics through the conduct of research.

Efforts are underway in many countries to advance the adoption and integration of

entry-to-practice informatics competencies into undergraduate nursing programs.

Notwithstanding some of the ongoing gaps in the provision of informatics content in

undergraduate nursing education, many courses and programs have been taught in a

variety of post-secondary education institutions over several years by nursing

informatics specialists. In fact it is not unusual for many nurses to develop an interest

in informatics through a single course and subsequently pursue further studies and

employment opportunities. Evolving Role of the Nursing Informatics

Since the early 90’s many graduate level courses and degrees, certificate and

certification programs have been developed and offered world-wide. Nurses have

pursued these opportunities recognizing the necessity of informatics knowledge and

skills now and particularly into the future, as they face an increasingly connected world

of digital healthcare. To a large extent, the core competencies of the nursing

informatics specialist have become essential for all nurses and expectations of the

specialist role will continue to evolve even further. Evolving Role of the Nursing Informatics

3. Emerging roles for nursing informatics specialists

The healthcare sector continues to evolve in the application and use of technologies to

support the delivery of care. Factors including: a) rising health care expenditures, b) the

increasing incidence of chronic disease, c) the ubiquity of technology, d) an aging

demographic, e) personalized medicine, f) mobile and virtual healthcare delivery, g) the

emergence of consumer informatics, h) genomics, i) big data science, and connected

health are and will continue informing the evolution of nursing informatics roles.

One of the main challenges we have to cope with is the difference in growth rate

that is exponential for the new technology and knowledge yet is still linear for

changing human behavior, learning, organizations, legislation, ethics, etc, A linear

growth rate is mostly represented by a function in a form like y(x) = ax+b. An

exponential growth rate is mostly represented by a function in a form like f(x) = kax.

For example: In an exponential world where the information is doubling every year, 5

exponential years would equal to 25 or 32 linear years which has a massive impact on

the management of professional knowledge. In reality, we estimate that knowledge

development in healthcare, which has doubled every century until 1900, is now

estimated to double every 18 months. And the pace is getting faster. This means that

when nurses finish their education, the knowledge they gained might be already

outdated. The traditional way of developing procedures, protocols and care pathways,

sometimes requiring a year to develop, are outdated when they are finalized and are

L.M. Nagle et al. / Evolving Role of the Nursing Informatics Specialist214 Evolving Role of the Nursing Informatics

insufficient to guide future practice. The only way forward is to integrate and embed

the new knowledge in electronic patient records using algorithms and decision support

systems so that practice remains aligned with new knowledge and insights. The impact

might be that best practices can change very quickly and what is viewed as best

practice before your holiday leave might be different upon your return to work. Making

the connection between these different dimensions of time will be a key-role of the

evolving role of the NI specialist Evolving Role of the Nursing Informatics

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