Nursing informatics rev 2019

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Nursing informatics is a specialty that "integrates nursing science with multiple information and analytical sciences to identify, define, manage and communicate data, information, knowledge, and wisdom in nursing practice" [1]. Nursing informaticist typically have a strong nursing background in addition to the informatics training and therefore can facilitate the implementation of user friendly and practical solutions to staf [2]. Based on the 2017 HIMSS survey, 40% of participants reported system implementation was a responsibility followed by other areas, including quality initiatives and project management [3].

History

A 2009 HIMSS survey on the impact of informatics nurses shows that nursing informatics is involved in a variety of roles related to information technology. This includes workflow analysis, education, HIT implementation and support. On a 1-7 point scale, with 7 being the highest, survey respondents rated the value of nursing informatics an average 6.29 This value is seen in patient safety, workflow, facilitating user acceptance and change management. (2)

In the last few years, hospitals have been shifting their focus from operations to outcomes. This shift translates into reimbursement. Leveraging information technology (IT) will facilitate this process. IT can be used in the collection of data to determine which quality outcomes an organization should emphasize. Nursing informaticists play a role in the collection and interpretation of this data. (3)

With the focus of the American Recovery and Reinvestment Act on electronic health records and financial incentive, the role of nursing informatics is becoming more important. Meaningful use criteria must be met by 2015 in order to receive full reimbursement. Nursing informaticists can help organizations achieve this goal. Their knowledge on the integration of evidence-based knowledge and information systems that promote patient safety and quality outcomes is essential to meet meaningful use. (4)

With the advent of the full implementation of the Affordable Care Act in 2014, an estimated 30 million new patients will be insured and demand care. The 3 million nurses currently practicing in the U.S. are expected to provide better quality, safer care to a larger number of people in a health care environment that is rapidly changing. The proficient use of technology is thought to facilitate the fulfillment of this enormous challenge.

American Nursing Informatics Association (ANIA)

ANIA is an organziation involving roughly 3000 informaticists in nursing and other fields. Based on the website:

ANIA Mission: To advance nursing informatics through education, research, and practice in all roles and settings.

ANIA Vision: To be the organization of choice to advance nursing informatics.

Originally, ANIA was founded in 1982 by Capital Area Roundtable on Informatics in Nursing (CARING). This undertaking started as a forum for nurses striving to advance automated healthcare systems [4].

ANIA was formed in 1992 as a means for "networking, education, and information resources" to facilitate the role of nurses in informatics [4]. Starting in 2005, ANIA and CARING initiated a merger and held their first official joint conference in 2007. These groups officially merged in 2010.

Information regarding members, joining the organization, goals, and conferences can be found on the ANIA fact sheet.

Alliance for Nursing Informatics

The Alliance for Nursing Informatics (ANI) is a group of organizations that represent more than 20,000 nursing informaticists. ANI is cosponsored by two other large informatics entities, AMIA and HIMSS. ALI "advances nursing informatics leadership, practice, education, policy and research through a unified voice of nursing informatics organizations. We transform health and healthcare through nursing informatics and innovation" [8].

Technology Informatics Guiding Education Reform (TIGER)

The Technology Informatics Guiding Education Reform (TIGER) Initiative was formed in response to the 2004 creation of the Office of the National Coordinator (ONC) for Health Information Technology [5]. A summit with nursing stakeholders took place in 2006 to ensure the nursing workforce were capable of using IT to improve the delivery of care [6] [nursing]. The TIGER Informatics Competncies Collaboritive (TICC) formed in 2010 and later released the document Informatics Competencies for Every Practicing Nurse: Recommendations from the TIGER Collaborative [7]. The complete list of competencies can be found in the following document.

As of September 22, 2014, TIGER joined HIMSS and adopted a more interprofessional and interdisciplinary approach [7]. This transition has facilitated international collaboration -- an in-depth review of its current state can be found in the document here.

Nursing Informatics Education

Although the nursing informatics specialty has several complex competency requirements, in order to function in the increasingly complex healthcare environments, all nurses are expected to: have basic computer competencies, be information literate, and have information management skills [1]. Basic computer competency includes the understanding of basic information and computer technology and vocabulary (e.g. PDAs, CPU, memory, software, etc.), the proficiency in using computers, managing files, and common software programs, and the ability to produce presentations and browse the web. Information literacy on the other hand, refers to the ability to determine the nature and the extent of the information needed, to be able to access and use the information proficiently, and to evaluate it critically. Finally, information management refers to the data-information-knowledge continuum. It is the ability to collect data, process them, and transform them into knowledge that can be used to improve clinical outcomes.


Nursing Informatics Education: Past

The first curriculum in health care informatics appeared in 1977 at State University of New York at Buffalo, after that other universities joined and today there are several graduate certificate and master’s programs across the country and a few Nursing Informatics doctoral programs. [1]

Nursing Informatics Education: Present

In 2008 the National League of Nursing (NLN) published the results of a survey of deans and faculty across the nation. It found informatics content to be lacking and to be seriously misunderstood. Computer literacy and information literacy were usually equated to informatics training [2]. Among the respondents who claimed to teach informatics, the most commonly cite examples of how it was implemented in the curriculum was via assignments that require computer competency and taught information literacy. Online teaching was thought to be synonymous with informatics education. Nevertheless, informatics content related to privacy, security and confidentiality was frequently offered, and the use of handheld computers and software was increasingly being used in clinical teaching. According to the NLN survey, only 30% of schools have a terminal program objective that addresses informatics and that same proportion offer specific content in informatics. Fewer offer specific courses in the subject. The most commonly cited reasons for not including informatics content was that there was no room in the curriculum, that faculty lacked preparation, and that informatics was viewed as a low priority.

Nursing Certification and Renewal Process

Nurses interested in pursuing a career in Nursing Informatics can obtain an official certification. This consists of meeting criteria to sit for a board examination that is maintained through the American Nursing Credentialing Center (ANCC). Upon successful completion of the examination, nurses gain the title of an RN-BC. Eligibility for this exam includes the following:

Eligibility

  • Hold a current, active RN license in a state or territory of the United States or hold the professional, legally recognized equivalent in another country.
  • Hold a bachelor's or higher degree in nursing or a bachelor's degree in a relevant field.
  • Have practiced the equivalent of 2 years full-time as a registered nurse.
  • Have completed 30 hours of continuing education in informatics nursing within the last 3 years.
  • Meet one of the following practice hour requirements:
    1. Have practiced a minimum of 2,000 hours in informatics nursing within the last 3 years;
    2. or

    3. Have practiced a minimum of 1,000 hours in informatics nursing in the last 3 years and completed a minimum of 12 semester hours of academic credit in informatics courses that are part of a graduate-level informatics nursing program;
    4. or

    5. Have completed a graduate program in informatics nursing containing a minimum of 200 hours of faculty-supervised practicum in informatics nursing.

Nurses who are certified in Informatics are required to renew their license every 5 years.This process can be found on the ANCC website under renewals.

The Future of Nursing Informatics Education

Given the overwhelming evidence that nurses require informatics training and the paucity of this content in curricula, the American Association of Colleges of Nursing (AACN) and the NLN incorporated the new competencies suggested by the 2003 IOM Report. These nursing schools accrediting bodies made modification to their requirements in 2008 to reflect the value and urgency of this change. The AACN Essentials of Baccalaureate Education [3] element IV is titled Information Management and Application, and recognizes that “knowledge and skills in information management and patient care technology are critical in the delivery of quality patient care” (p. 3), and therefore must be incorporated in nursing baccalaureate curricula.

The NLN position statement declared that “it is imperative that graduates of today’s nursing programs know how to interact with these important [informatics] tools to ensure safe and quality care” [4]. The NLN set goals for itself and made recommendations for nursing program administrators and for nursing faculty. It pledged to continue to develop the nursing informatics competencies, to disseminate them with exemplars, and to seek funding for nursing faculty education. Deans of nursing programs were encouraged to create opportunities for faculty to develop the skills and knowledge necessary to teach nursing informatics, to provide the planning and the resources to create the infrastructure necessary for such curricula to blossom. Faculty were asked to acquire informatics training, to take leadership at the local level and champion curricular changed that incorporate informatics, to integrate nursing language and terminology in the curricula, and to collaborate with clinical agencies to create opportunities for students to use informatics tools.

Meanwhile, the TIGER Initiative organized collaborate teams of experts and created several reports that provide an action plan based on best practices in nine areas. Three areas were related to the development of the workforce [5]. They focused on the informatics competencies nurses should have to practice effectively, the education and training faculty should have to teach informatics effectively, and the skills the leadership should have to transform the nursing education curriculum. The competencies suggested were discussed earlier in this manuscript and they include: basic computer competency, information literacy, and information management. Faculty were encouraged to offer informatics theory, research and practice throughout the curriculum. However, due to lack of faculty training in informatics, the TIGER Initiative encourages organizational leaders to create trainings and offer resources for nursing faculty to be able to teach informatics and create nursing informatics programs, develop a local task force to examine and integrate informatics content in the curriculum, encourage federal financial support and collaborations with industry and service organizations. In addition to a relevant curriculum and well-trained faculty, the TIGER reports suggest that nursing informatics curriculum or programs also need effective and knowledgeable leadership. Although chief nurse executives and deans were found to be proficient in most areas, they should also continue to have opportunities to evaluate the interaction between nursing practices, workflow, policies and procedures, and system implementation.


References

  1. American Nurses Association. (2015). Scope and Standards of Practice: Nursing Informatics. Silver Spring, MD. American Nurses Association.
  2. Retrieved from https://www.allnursingschools.com/nursing-informatics/job-description/#targetText=Nursing%20Informatics%3A%20Using%20Data%20to,of%20data%20and%20technical%20systems.&targetText=Some%20common%20titles%20in%20nursing,Nurse%20informaticist. Accessed October 14, 2019.
  3. HIMSS 2017 Nursing Informatics Workforce Survey. (2017). Available at: https://www.himss.org/sites/himssorg/files/2017-nursing-informatics-workforce-full-report.pdf 2017 HIMSS survey.
  4. Retrieved from: https://www.ania.org/about-us. Accessed 10/19/2019.
  5. Technology Informatics Guiding Education Reform – TIGER* An International Recommendation Framework of Core Competencies in Health Informatics for Nurses. (2018).
  6. Retrieved from: http://www.tigersummit.com/Competencies_New_B949.html. Accessed 10-19-2019.
  7. Retrieved from: https://www.himss.org/library/evolution-tiger-competencies-and-informatics-resources. Accessed 10-19-2019.
  8. Murphy, J. (2010, August). The journey to meaningful use of electronic health records. Nursing Economics, 28, 283-286.
  9. Sensmeier, J. (2009, September). The latest? A shift from operations to outcomes. Nursing Management, 2-9.
  10. Sensmeier, J. (2010, January/February). Alliance for nursing informatics statement to the Robert Wood Johnson foundation initiative on the future of nursing: Acute care, focusing on the areas of technology, October 19, 2009. CIN: Computers, Informatics, Nursing, 63-67.
  11. Englebardt, S. P., & Nelson, R. (2002). Health care informatics: An interdisciplinary approach. St. Louis: Mosby.

Submitted by: Kathy Gaines, Michelle Tellez, and Matthew Cain (2019).
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