Goals and Objectives
The focus of IMIA-NI is to foster collaboration among nurses and others who are interested in Nursing Informatics to facilitate development in the field. We aim to share knowledge, experience and ideas with nurses and healthcare providers worldwide about the practice of Nursing Informatics and the benefits of enhanced information management.
Specific Objectives
Explore the scope of Nursing Informatics and its implication for health policy and information handling activities associated with evidence based nursing practice, nursing management, nursing research, nursing education, standards and patient (or client) decision making and the various relationships with other health care informatics entities.
Identify priorities or gaps and make recommendations for future developments in Nursing Informatics
Support the development of Nursing Informatics in member countries and promote Nursing Informatics worldwide.
Promote linkages and collaborative activities with national and international nursing and healthcare informatics groups and nursing and health care organisations globally.
Provide, promote and support informatics meetings, conferences, and electronic communication forums to enable opportunities for the sharing of ideas, developments and knowledge.
To participate in IMIA working groups and special interest groups to present a nursing perspective.
Develop recommendations, guidelines, tools and courses related to Nursing Informatics.
Encourage the publication and dissemination of research and development materials in the field of Nursing Informatics
To support and work with patients, families, communities and societies to adopt and manage informatics approaches to healthcare.
Ensure the group is more visible by providing up to date information on the web site enabling external groups e.g. WHO, ICN to access as required.
In 1992, the American Nurses Association (ANA) recognized the specialty of nursing informatics, publishing The Scope of Practice for Nursing Informatics [11] and The Standards of Practice for Nursing Informatics [12]. These were subsequently revised into a single publication in 2008 to reflect the scope and standards of practice and professional performance for the informatics nurse specialist [13]. See Table 12.2 for the overarching dimensions of the ANA nurse informatics specialist standards for practice and professional performance.
Table 12.2
Informatics nurse specialist standards of practice and professional performance
Standards of Practice |
1. Assessment |
2. Problem and issues identification |
3. Outcomes identification |
4. Planning |
5. Implementation |
5a. Co-ordination of activities |
5b. Health teaching and health promotion and education |
5c. Consultation |
6. Evaluation |
Standards of Professional Performance |
7. Education |
8. Professional practice evaluation |
9. Quality of practice |
10. Collegiality |
11. Collaboration |
12. Ethics |
13. Research |
14. Resource utilization |
15. Advocacy |
16. Leadership |
In the late 1980’s, Canadian nurses working in informatics were initially organized as the Nursing Informatics – Special Interest Group (SIG) of the Canadian Organization for the Advancement of Computers in Health (COACH). Disbanded in 2001, this group was reconstituted in 2002 as an independent corporate entity, the Canadian Nursing Informatics Association (CNIA). A year later, the CNIA was granted Affiliate Group status with the Canadian Nurses Association (CNA), formally recognizing the specialty within the Canadian nursing community. Shortly thereafter, the CNIA became the COACH nominee to the represent Canadian nurses on the IMIA NI-SIG. During the last decade, although CNIA members have been invited to participate in international initiatives, they have been most active in the development of national health data standards, core informatics competencies for basic nursing curricula, resources for nurse educators and formal education and certification programs in Canada.
Although beyond the scope of this chapter, nurses working in informatics have continued to organize worldwide and are convening regularly to network and address shared issues and challenges at national and international meetings and conferences. IMIA member and non-member countries are invited to participate in a number of scientific meetings (e.g., Medinfo, International Nursing Informatics Congress, European Federation for Medical Informatics), which take place every 2–3 years in a variety of locales. In the early days, these forums were commonly the venue by which a majority of nurses obtained the foundations of their training and education in informatics. This is likely still the case for nurses from countries in which other informatics learning options are non-existent.
Specialty Preparation and Certification
In conjunction with the recognition of nursing informatics as a specialty, numerous college and university based programs were launched in the early 90’s, offering individuals an opportunity to obtain a wide variety of certificates, diplomas and undergraduate and graduate degrees. Existing programs are varied in their focus, duration and completion credential but are intended to provide nurses and others with the specialized knowledge and skills needed to become effective informaticians. Over the last 10 years, many online program offerings have also been developed further extending the reach of continuing education opportunities. The American Medical Informatics Association (AMIA) maintains a comprehensive inventory of US and internationally based informatics program and course offerings on their website [14]. Similarly, the Canadian health informatics association, COACH, maintains a listing of educational opportunities targeting individuals with technical and/or clinical backgrounds [15]. In addition to these education offerings, there are now a number of professional journals that have a specific focus on issues of practice and research in nursing informatics including: (a) CIN: Computers, Informatics, Nursing and (b) the Online Journal of Nursing Informatics. Although the publication of nurse informaticians’ work is not limited to these journals, they do offer nurses opportunities to publish their experiences and learnings from practice, education and research with a nursing audience in mind.
In addition to formal programs of study, those with health informatics expertise may realise a nationally recognized professional designation upon successful completion of national certification examinations. Among these is the Health Information Management Systems Society (HIMSS) designation of Certified Professional in Healthcare Information and Management Systems [16, 17]. A Canadian variation, CPHIMS-CA, on this credential is also offered for interested individuals with clinical or technology backgrounds. Upon successful completion of the certification exam, individuals receive a credential signifying that they have the health informatics “skills, knowledge and abilities to perform safely and effectively in a broad range of practice settings” [15]. While the ANA has afforded nurses the option of securing a Board certification in nursing informatics for several years now [18] this type of nursing specific professional certification is not widely available to nurses in other countries. In addition to nursing and informatics education credentials, many nurses have also completed a course of study and exam to achieve a Project Management Professional® (PMP) certification in response to the demand for project leadership skills within healthcare settings.
With the establishment of nursing informatics organizations and the creation of opportunities to complete formal informatics education offerings, informatics has achieved recognition as a specialty within nursing [5, 7, 17, 19–21]. Nonetheless many nurses remain unaware of the potential opportunities in the field and often encounter these by chance rather than design. Until core informatics competencies become integrated into the curricula of all entry level nursing programs, informatics may not even be on the radar as a specialty option for a majority of nurses. Increasing awareness and knowledge of informatics within the broader nursing community continues to be a key area of focus for many nursing informatics specialty groups.
Current Nursing Informatics Workforce
According to McLane and Turley [7], “informaticians are prepared to influence, contribute to, and mold the realization of an organization’s vision for knowledge management” (p. 30). Today many individuals throughout North America, including nurses, have attained credentials that denote their knowledge, expertise and experience in the field of health informatics. Over the years, many nurses have moved into senior executive positions including the role of Chief Information Officer; some of the challenges for nurses in this role have been described previously [22]. Roles for nurses have actually evolved to the extent that executive positions with the designation of CNIO have been established in some health care organizations. Nevertheless public advocacy for more positions of this ilk continues [20, 23–25]. It is most common to find nurses specializing in the field of informatics referred to as informaticists, informaticians, informatics nurse specialists and/or clinical informatics specialists, sometimes but not always, denoting that they have advanced training or a credential in informatics. However, despite the emergence of informatics specific educational offerings and positions, many nurses do not have formalized training and often find themselves in informatics roles for which they are ill-prepared. And as was found in a recent HIMSS survey, a majority of nurse informaticians continue to derive their knowledge and experience through on-the-job training [17]. Some additional findings from this survey are provided to provide the reader with a sense of the current context of nurses’ work in informatics at least within North America albeit primarily within the United States.
Work Location and Reporting
Of the 660 survey participants, 48 % reported working in a hospital, 20 % working in the corporate offices of a healthcare system, 9 % in an academic setting and 5 % for a consulting firm or vendor, with the remainder working in a variety of other settings. Most of the respondents (52 %) indicated that they report to an information systems department, reflecting an increase (2 %) from the previous survey in 2007. Those individuals reporting to a nursing department dropped from 38 to 32 % in the same time period with a slight shift in reporting to administration. Sixty-one percent indicated that they had no direct or indirect staff reports suggesting that a majority do not have management positions [17].
Years of Experience, Credentials, and Titles
Forty-nine percent reported years of informatics experience as 7 or more and 56 % reported being in their current position for more than 3 years. While 20 % reported being currently enrolled in an informatics program (bachelors, certificate, masters/PhD), another 40 % reported receiving a formal credential in 2011. A majority (58 %) reported that they did not have any type of informatics certification (e.g., ANCC, CPHIMS) [16, 18], but 56 % indicated their intent to obtain one in the future. When asked about their job titles, 20 % indicated that they have a title of nursing informatics specialist and 10 % are referred to as clinical specialists. The title of nursing informatics specialist was more common than previously reported and 37 % indicated that their title clearly denoted the informatics nature of their work [17].
Position Responsibilities
The respondents’ top three areas of job responsibility were reported in the following areas (shown by top eight areas identified):
Systems implementation (57 %)
Systems development (53 %)
Quality initiative (31 %)
Informatics education (23 %)
Liaison (23 %)
Strategic planning (16 %)
Nursing education (11 %)
Operations (10 %)
Systems implementation and development activities included: user preparation, training, support and system customization or updating. Ranked third, the focus on quality improvement activities including: problem-solving, issues of patient safety and system evaluation, reflecting a promising 10 % increase when compared to the previous survey in 2007 [17]. The applications reported to be the most often the focus of the respondents’ development and implementation activities included the following (shown by top nine areas identified):
Nursing clinical documentation (77 %)
Electronic Medical Record/Electronic Health Record (62 %)
Computerized Provider Order Entry (CPOE) (60 %)
Clinical Information Systems (58 %)
Non-nursing Clinical Documentation (56 %)
Electronic Medication Administration Record (48 %)
Bar Coded Medication Management (41 %)
Point-of-care Decision Support (33 %)
Quality Improvement/Risk (30 %)
Respondents reported that they also had the most experience with these applications and systems. These findings are not surprising in light of the current investments and emphasis on clinical information system deployments throughout the United States and beyond. In particular, the focus on clinical documentation and CPOE reflects the current state of EHR maturity within a majority of health care organizations throughout North America. The survey respondents were found to be least likely involved in activities associated with utilization review, voice communications, practice management, and remote monitoring [17]. Since only 4 % of the respondents came from outside of the United States, it is difficult to generalize the findings of the HIMSS 2011 nursing informatics workforce survey to other countries. However, the results do offer some interesting insights into the evolution of nursing informatics within a developed nation, especially one in which it has been recognized as a specialty for more than two decades.
Nurse informaticians can be found working within health care organizations, leading and participating in ICT initiatives. Others have secured roles working in government and legislative bodies, advancing standards, policy and strategic initiatives. In academic settings, nurses are advancing informatics education and research and informing innovations in teaching and learning. And still others have been recruited by ICT software and hardware developers and suppliers to bring their expertise to bear on the evolution of technology solutions to support clinical care delivery. The evolution of nurse informatician roles has occurred as a direct result of the need to converge nursing expertise with the knowledge of informatics to better inform systems design, implementation, education, and evaluation. Nurses knowledge and skills have been acknowledged as integral to the effective implementation of ICT as well as effective information and knowledge management [5, 7, 8].
Domains of Nurse Informatician Work
Informatics roles in practice settings have been widely varied in their scope and function but have largely focused on components of the system lifecycle (e.g., design, implementation, training, and evaluation). Hersh [6] underscored the ill-defined relationship between the practice of informaticians and job titles. A recent publication by McLane and Turley [7] offers perspectives on the keys areas in which the nurse informatician can play a role within healthcare organizations. They also highlight the intricacy and complexity of the knowledge and skills required by organizations endeavouring to deliver on an ICT agenda that will lead to safer, more effective care and also support clinical practice.
Although there continues to be a lack of clarity and consistency in defining the roles and responsibilities of nurses in informatics, the following discussion provides a broad categorization of major domains of informatics practice. Table 12.3 provides a synthesis of the seven domains of work and common areas of work focus within each (Audio 12.1, 12.2, 12.3, and 12.4):
Table 12.3
Domains and areas of focus for nurse informaticians
Domain | Areas of focus |
|---|---|
Leadership | Strategy |
Strategic planning | |
Change leadership | |
Consultation | |
Advocacy | |
Political action | |
Health policy | |
Customer relations | |
ICT life cycle management | Systems analyses |
Workflow | |
Process improvement | |
Usability | |
Ergonomics | |
Socio-cultural | |
Functional specification | |
Acquisition | |
Application design | |
Data representation | |
Terminology | |
Standards development | |
Interoperability/integration | |
Implementation | |
Change management | |
Education | |
Competency assessment | |
Training & education | |
Evaluation | |
Formative | |
Summative | |
Systems support | |
Health system use | Data analytics |
Aggregate reporting
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