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.)
© 2017 IMIA and IOS Press. This article is published online with Open Access by IOS Press and distributed under the terms Evolving Role of the Nursing Informatics
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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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