Chief Nursing Informatics Officer

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The time is now: The evolving role of the CNIO

Summary After reviewing the clinfowiki article “The CMIO—A New Leader for Health Systems” a review of a research article by Leviss, Kremsdorf and Mohaideen[1] I was curious about similar work on the role of the CNIO. While I found many anecdotal and personal experience articles, I did not find research into the skills and experiences needed to be an effective Chief Nursing Informatics Officer, I was inspired to do a literature review and summary some of the current literature on this topic.

What is a CNIO?

The Chief Nursing Informatics Officer (CNIO) is the executive nurse guiding the procurement, implementation and best use of health information technology systems for an organization or system.[2]Swindle, Carla G and Bradley, Victoria M, “The Newest O in the C Suite: CNIO,” Nurse Leader Vol 8, Issue 3, June 2010, pages 28-30.</ref>

The designation CNIO doesn’t mean that nursing is the only clinical discipline the role is responsible for; rather, it means that the position is filled by a nurse leader with additional preparation as an informaticist.[3] Titles vary; some organizations call this position director of clinical or nursing informatics, vice-president, or similar titles denoting the top executive. This article will use CNIO to denote any top nursing informatics position in healthcare.

Informatics nurses “integrate nursing science with information management and analytical sciences to…manage data, information, knowledge and wisdom into nursing practice”.[4] It's the informatics nurse who brings together knowledge of the clinician's workflow and an understanding of the intersections with information technology systems.[5] “The whole goal of informatics is to improve outcomes.”[6]

CNIOs bring the dimensions of strategic thinking, visionary leadership and understanding of industry trends to the informatics role.[7] Incumbents act as a translator for the rest of the hospital executives, with in-depth understanding of issues and risks in EHR projects.[8]

'Why is this role emerging now?'

The advent of meaningful use clinical quality measures (beginning in 2009 with the HITECH act), created a requirement for many more clinical executives who can span clinical and IT worlds.[9] Healthcare organizations are finding the role of CNIO vital in achieving meaningful use measures, and also in utilizing technology to maximize productivity and quality.[10] Increasingly, CNIOs are responsible for outlining nursing and clinical strategies for information technology in healthcare.[11] “In this era of healthcare payment realignment and evidence-based medicine, key stakeholders say the CNIO position is critical.”[12]

Besides the HITECH act and subsequent explosion in healthcare technology, demands for other technology solutions, especially mobility, interoperability and increasing data requirements are driving need. Growing industry demand for technology solutions adds to the need for informatics nurse leaders “to manage and support staff’s expectations, utilization and adoption of these technologies.”[13]

Traditionally, few nurses have been exposed to health information technology in their educational preparation, but emerging technology and increasing demand has led to a leader who has knowledge of both the clinical and technology sciences.[14] Some nursing schools have added courses designed to provide advanced education in clinical informatics; doing a search for such programs yielded numerous results spread across the country.[15]

Historical perspectives: Florence Nightingale the first CNIO?

The recognition of nurses’ responsibility to gather and document facts is not new. Florence Nightingale is recognized by many as the architect of modern nursing, but not many realize she was a precursor to the modern-day CNIO.[16] Nightingale (1820-1910) advocated for nurses’ responsibility to observe and record, and she accurately collected data on healthcare (during the Crimean War and afterwards in army barracks and hospitals in England), for use in improving outcomes. She used visual representation tools still used today, including the pie chart and the Coxcomb.[17] The American Nurses’ Association designated May 12 – her birthday-- as Nursing Informatics Day, as part of national Nurses Week.[18]

The CNIO’s Time has come

A survey conducted by search firm Witt/Kiefer in 2011 revealed only 12% of respondents with positions of Chief Nursing Informatics Officer, Director of Nursing Informatics, or Director of Clinical Informatics.[19]

In just 5 years since the Witt/Kiefer survey, the role of the CNIO has grown exponentially, and now boasts one of the highest salaries in the healthcare IT industry. The CNIO position has taken on more responsibilities and become an equal to the Chief Medical Informatics Officer (CMIO) role.[20] According to Linda Hodges, vice president and leader of information technology search practice at Witt/Kieffer, the title CMIO was 10 years in the making, and faced barriers in the early years. Similarly, she expects the CNIO title will face obstacles and take time to become widely accepted.[21] Already, over 30% healthcare organizations and systems in America now have a chief nursing/clinical executive position.[22]

Mandatory and voluntary factors are driving the necessity for strong nursing informatics leadership. More and more organizations are realizing the value that a CNIO can bring to improving care coordination, patient safety, and documentation of nursing care.[23] The Healthcare Information and Management Systems Society (HIMSS) 2011 position statement advocates CNIO and similar roles as true partners with the Chief Nursing Officer (CNO) in transforming healthcare through technology.[24]

Primary Skill Sets for the CNIO role

What are healthcare organizations looking for in the role of CNIO? Most want a nursing professional, as nurses use the knowledge and skills of clinical practice to oversee the implementation of evidence-based information systems. Many CNIOs in the industry today started out as clinicians, and have become informaticists through self-education and on-the-job training, often by starting with working on an IT project.[25]

Strong potential candidates will have business backgrounds, or in the increasingly popular field of biomedical informatics.[26] Leadership and financial skills are appreciated; employers want the leadership in these roles to effect change and the financial skills to recognize the budget implications of decisions.[27]

A task force report from the American Medical Informatics Association (AMIA) released on March 16, 2016, included a structure for the education, training and selection of the chief clinical informatics officer. The conclusion of the task force was that the CNIO must complete defined Clinical Informatics and Training education, and supports ongoing certification efforts.[28] A variety of professional organizations offer a clinical informatics certifications, including the American Nurses Association and HIMSS. As mentioned above, the number of colleges and universities offering advanced education, including master’s and PHD’s in nursing informatics is growing quickly.


Similar to the role of chief medical informatics officer (CMIO), the CNIO role is evolving quickly and becoming an increasingly essential role in the successful implementation and optimization of electronic health records and other technology supporting clinicians in healthcare. There is not a clear career track for potential CNIOs, so those considering this role should seek on-the-job technology experience as well as formal education and certification opportunities in preparation. The importance and contributions of this position are just starting to become evident in the literature, but more study is needed about preparation, contributions and the future direction of this developing specialty in healthcare.


  1. Leviss, J., Kremsforf, R., Mohadieen, M.F. (2006). “The CMIO – A new leader for health systems.”,
  2. Kirby, Sharon, Kirby, Sharon B, “Defining the Role of CNIO,” April 14, 2014,
  3. Swindle, Carla G and Bradley, Victoria M, “The Newest O in the C Suite: CNIO,” Nurse Leader Vol 8, Issue 3, June 2010, pages 28-30.
  4. “What is Nursing Informatics?” HIMSS Resource Library,
  5. Kirby, Sharon, “Informatics leadership: The role of the CNIO,” Nursing 2015: April 2015 - Volume 45 - Issue 4 - p 21–22 doi: 10.1097/01.NURSE.0000462394.23939.8e,
  6. Kirby, Sharon B, 2014.
  7. Kirby, Sharon B, 2014.
  8. Swindle, Carla G and Bradley, Victoria M, 2010
  9. Horowitz, Brian T. “’Meaningful Use’ Could Boost Role of CNIO in Health Care,” eweek, Feb 29, 2012,
  10. Hodges, Linda and Wierz, Chris, “The Emerging Role of the Chief Nursing Officer: What is the Current State?” HIMSS 2012 conference presentation,
  11. Horowitz, 2012
  12. Manos, Diana, “CNIO Role on the Rise,” HealthcareITNews, Mar 12, 2012,
  13. Clark, Joan and Mitchell, Mary Beth, “The CNE-CNIO Partnership: Improving Patient Care,” Science Direct, 2013,
  14. Swindle, Carla G and Bradley, Victoria M, 2010
  16. Kirchner RB. Introducing nursing informatics. Nursing. 2014;44(9):22–23.
  17. Rogers, Simon, “Florence Nightingale, datajournalist: information has always been beautiful,” The Guardian datablog, August 13, 2010,
  18. Manos, Diana, “CNIO Role on the Rise,” Healthcare IT News, March 12, 2012,
  19. Hodges and Wierz, 2012
  20. “Top 5 Healthcare IT Jobs for the Rest of 2015,”
  21. Manos, 2012
  22. Herman, Bob, 2014.
  23. Prestigiacomo, Jennifer, “The Rise of the Senior Nurse Informaticist,”, Healthcare Informatics, Jan 23, 2012,
  24. Prestigiacomo, 2012.
  25. Swindle and Bradley, 2010
  26. “Top 5 Healthcare IT Jobs for the Rest of 2015,”
  27. Hodges and Wierz, 2012
  28. Gibson, Lisa, “The Chief Clinical Informatics Officer: New Recommendations from AMIA for Healthcare C-suite Expertise,” PRWeb, April 1, 2016,