Chapter 8

Nursing Informatics Roles,

Competencies and Skills
 Objectives
• Provide an overview of nursing informatics
historical development.

• Explore the concept of nurses as knowledge

workers.

• Discuss the evolving roles and competencies

of nursing informatics practice.
 Key Terms Defined
• Advocate/Policy Developer –A nurse informatics
specialist who is key to developing the infrastructure
of health policy. Policy development on a local,
national, and international level is an integral part of
this role.
• Certification - Validates that a nurse possesses
certain skills and knowledge or is competent to
complete a task; competence and skill level
determined by or based on an external review,
assessment, examination or education.
 Key Terms Defined
• Cognitive Activity - any process or task
(activity) that involves the capacity to think,
reason, imagine and learn.
• Consultant - A person hired to provide their
expert advice, opinions, and
recommendations based on their area of
expertise.
 Key Terms Defined
• Continuous Learner - Gleans lessons or learns
from success as well as failures; constantly
searches for information to add to their
knowledge base.
• Core Sciences - Nursing, computer, and
information sciences are considered core
sciences for nursing informatics (NI); some
believe, including the editors of this text, that
cognitive science should also be included in the
core sciences.
 Key Terms Defined
• Data - Raw fact; lacks meaning.
• Data Gatherer - Direct procurement of raw facts (data);
raw fact (data) collector.
• Decision support - A single recommendation or series of
recommendations implying next steps based on care
protocols; the computer reminders and alerts to improve
the diagnosis and care of a patient including screening for
correct drug selection and dosing, medication interactions
with other medications, preventive health reminders in
areas such as vaccinations, health risk screening and
detection and clinical guidelines for patient disease
treatment (IOM, 2003).
 Key Terms Defined
• Educator - Sage, leader and/or guide who
assists in the process or practice of learning.
• Entrepreneur -One who assumes the risks of
beginning an enterprise or business and
accepts responsibility for organizing and
managing the organization.
 Key Terms Defined
• Industrial Age - Late 18th and early 19th centuries
when there were major changes in manufacturing,
farming and transportation, inventions and
innovations led these changes.
• Informatics - A specialty that integrates the specialty's
science, computer science, and information science to
manage and communicate data, information,
knowledge and wisdom in a specialty's practice;
Nursing informatics facilitates the integration of data,
information, and knowledge to support patients,
nurses, and other providers in their decision-making in
all roles and settings. (cont’d)
 Key Terms Defined
• Informatics - (cont’d) This support is accomplished
through the use of information structures, information
processes, and information technology; “a specialty
that integrates nursing science, computer science, and
information science to manage and communicate data,
information, and knowledge” (Staggers & Thompson,
2002, p. 260); synthesis of nursing science, information
science, computer science and cognitive science to
facilitate the management of healthcare data for the
improvement of patient care and advancement of the
nursing profession.
 Key Terms Defined
• Informatics Innovator - Process of making
enhancements or improvements; creative,
novel and inventive solutions in the
informatics specialty.
• Informatics Nurse Specialist (INS) - An RN
with formal, graduate education in the field of
informatics or a related field and is considered
a specialist in the field of nursing informatics.
 Key Terms Defined
• Information - Data that are interpreted,
organized, or structured; data that is
processed using knowledge or data made
functional through the application of
knowledge.
• Information Age - At the end of the 20th
century, information was easily accessible
using computers, networkds and Internet.
 Key Terms Defined
• Information User - The person who accesses and
makes use of information made available to
her/him.
• Informatique - French term that refers to the
computer milieu.
• Interdisciplinary Knowledge Team - A team
composed of members of various disciplines in a
health care organization who each contribute
their unique knowledge to the team in problem-
solving or management situations.
 Key Terms Defined
• Knowledge - The awareness and understanding of a set of
information and ways that information can be made useful
to support a specific task or arrive at a decision; abounds
with others’ thoughts and information; information that is
synthesized so that relationships are identified and
formalized; understanding that comes through a process of
interaction or experience with world around us ; info that
has judgment applied to it or meaning extracted from it;
processed information that helps to clarify or explain some
portion of our environment or world that we can use as a
basis for action or upon which we can act; internal process
of thinking or cognition; external process of testing, senses,
observation, interacting.
 Key Terms Defined
• Knowledge Builder - Nurses will transition from
knowledge users to knowledge builders when they
examine clinical data and trends across groups of
patients. These trends are interpreted and compared
to current scientific data to determine if this data
would improve the nursing knowledge domain. An
example of the transition to knowledge builder would
be an observation of patients’, diagnosed with chronic
high blood pressure, medication compliance rates over
a specified time period and then comparing these rates
to evidenced based literature to determine if this
information would improve the nursing knowledge-
base (Snyder-Halpern, et al.).
 Key Terms Defined
• Knowledge User - Individuals or groups who benefit
from valuable, viable knowledge.
• Knowledge Worker - Work with information and
generate information and knowledge as a product.
• Medical Informatics - A specialty that integrates
medical science, computer science, cognitive science
and information science to manage and communicate
data, information, knowledge and wisdom in medical
practice; collected informational technologies which
affect the medical decisions made regarding patient
care (Hannah, Ball, & Edwards, 2006).
 Key Terms Defined
• Nursing Informatics Competencies - Abilities
to perform NI tasks.
• Product Developer - Designs, creates and
builds a product, for example, a computer
program, network and/or system; user that
employs productivity software to create a
product.
 Key Terms Defined
• Project Manager - Responsible for the success
of a project by managing the planning and
enactment of the project.
• Researcher - Conducts research or
investigates phenomena.
• Technologist - Person skilled in the use of
technology.
 Key Terms Defined
• TIGER Initiative - They were called the
Technology Informatics Guiding Education
Reform or TIGER Team. This group
determined that “utilizing informatics” was a
core competency for all healthcare workers.
They also determined that many nurses lack IT
skills which limit their ability to access
evidenced based information that could be
incorporated into their daily practice. (cont’d)
 Key Terms Defined
• TIGER Initiative – (cont’d) This group is currently
working on a plan to incorporate informatics
courses into all levels of nursing education and
then they will look at how to get the information
out to practicing nurses who are not currently
enrolled in an academic program (TIGER
Initiative, 2007). Many of the items identified as
lacking in both nursing students and practicing
nurses are items that Staggers, et al. (2002)
determined to be NI competencies.
 Introduction
• Nurses have historically gathered and
interpreted data.
• Nurses are able to access information quickly
and easily.
• Accessing the information via the internet or
the electronic health record (EHR) allows the
nurse to provide the best possible patient
care.
 Introduction
• Nursing recognized early on that computers
would change healthcare and became actively
involved in shaping how computers were used
in healthcare.
• The American Nurses Association (ANA) first
recognized Nursing Informatics (NI) as a
specialty in 1992 (Saba & McCormick, 2006;
American Nurses Association [ANA], 2001).
 What is Nursing Informatics?
• The term informatics was derived from the
French term informatique, which means to
refer to the computer milieu (Saba, 2001).
• The Health Information and Management
Systems Society (HIMSS) defines informatics
as “the discipline concerned with the study of
information and manipulation of information
via computer-based tools” (2006, p. 44).
 What is Nursing Informatics?
• Graves and Corcoran define NI as a
“combination of computer science,
information science and nursing science
designed to assist in the management and
processing of nursing data, information and
knowledge to support the practice of nursing
and the delivery of nursing care” (p.227).
 What is Nursing Informatics?
• The ANA points out that even though NI is
based on science, it is an applied science and
not a basic science.
• Graves and Corcoran (1989) and the ANA
(2001) both believe that data, information,
and knowledge are key components of NI
practice.
 What is Nursing Informatics?
• Data, information, knowledge, and the core
sciences, when combined, represent the
foundation of NI practice.
 History
• Healthcare began to use computers in the
1950’s.
• Computers, in this era, were typically used in
the business office (Saba & McCormick, 2006).
• In the 1970’s, nursing began to realize the
importance of computers to the nursing
profession and became involved in the design,
purchase, and implementation of information
systems (Saba & McCormick).
 History
• In the 1980’s, medical and nursing informatics
specialties emerged.
• 1995 saw the first certification exam for NI
(Saba & McCormick).
• The post-2000 era saw an unprecedented
explosion in the number and sophistication of
both computer hardware and software.
 History
• Telemedicine became possible and was
recognized as a specialty in the late 1990’s
(Saba & McCormick).

• NI has experienced rapid growth in the last 40

years which does not appear to be slowing.
The Nurse as a Knowledge Worker
• It has been established that nurses use data
and information.
• This information is then converted to
knowledge.
• The nurse then acts upon this knowledge by
initiating a plan of care, updating an existing
one or maintaining status quo.
The Nurse as a Knowledge Worker
• Knowledge can be defined as “the distillation
of information that has been collected,
classified, organized, integrated, abstracted,
and value added” (HIMSS, 2006, p. 49).
• A worker is “one that works especially at
manual or industrial labor or with a particular
material” (Merriam-Webster, 2007).
The Nurse as a Knowledge Worker
• Drucker (1994) describes a knowledge worker
as one who has advanced formal education
and is able to apply theoretical and analytical
knowledge.
• The knowledge worker must be a continuous
learner and a specialist in a field.
 Knowledge Worker Concept
• Many industrial workers are finding it more and
more difficult to obtain jobs as they do not have
the educational base or mind set required of
knowledge workers (Drucker).
• The technologist is no longer trained on the job
as were the industrial workers which can cause
significant problems for the industrial worker
who does not have the education required to
transition to a knowledge worker position
(Drucker; Sorrels-Jones & Weaver, 1999a).
 Knowledge Worker Concept
• Knowledge workers are innovators and the
work they produce is the foundation for
organizational sustainability and growth.
• Knowledge workers are most efficient when
they are working in a multi-disciplinary team.
• Leadership will shift and change as the team
tackles different parts of the project, with the
topic expert taking the lead.
 Knowledge Worker Concept
• A well-functioning team will consistently
outperform an individual (Sorrells-Jones &
Weaver, 1999b).
• A key impediment to an effective team is a
lack of understanding between team
members as well as a lack of respect for each
other’s knowledge and experience (Sorrells-
Jones & Weaver, 1999a).
 Knowledge Worker Concept
• Companies that employ knowledge workers
have had to change their management
structure to support the knowledge workers.
• Loyalty is no longer purchased with a
paycheck but is earned by giving the
knowledge workers the ability to use their
knowledge effectively and innovatively
(Drucker, 1992).
 Knowledge Workers and Healthcare
• Healthcare needs to begin making the
transition from the Industrial Age to the
Information Age.
• Healthcare can begin this transition by
adopting a new philosophy that recognizes
that employees are mature, self-reliant,
independent-thinking adults who function as
partners in carrying out the work of the
organization.
 Knowledge Workers and Healthcare
• Management needs to understand and
support the knowledge work and non-
knowledge work that is performed daily in
healthcare.
• Organizations must switch from measuring
the number of tasks completed to measuring
the outcomes obtained by knowledge workers
(Sorrells-Jones & Weaver, 1999b).
 Nurses as Knowledge Workers
• Nursing entails a significant amount of
knowledge and non-knowledge work.
• Knowledge work would include such things as
interpreting trends in labs and symptoms.
• Non-knowledge work would include such
items as calling the lab to check on lab results
or making beds.
 Nurses as Knowledge Workers
• Nurses rely on their extensive clinical
information and specialized knowledge in
order to implement and evaluate the
processes and outcomes related to patient
care.
• Nurses are data gatherers by nature.
• Nurses collect and record objective clinical
data on a daily basis (Snyder-Halpern, et al.,
2001).
 Nurses as Knowledge Workers
• Nurses will transition from knowledge users to
knowledge builders when they examine
clinical data and trends across groups of
patients.
• The data gatherer requires a system that will
capture and store data accurately and reliably
and allow the data to be readily accessed.
 Nurses as Knowledge Workers
• The information-user role requires a system
that can transform clinical data into a format
that allows for easy recognition of patterns
and trends.
• The knowledge-user role is the least
supported role and many systems are
currently looking at ways to support the
nurses in this role.
 Nurses as Knowledge Workers
• The knowledge-builder role is typically seen in
conjunction with the nurse researcher role
and quality management roles.

• The knowledge needs of nurses will continue

to improve as the systems improve.
 Nursing Challenges
• In order for nurses to be treated as a
knowledge workers, nurses must first be
recognized as knowledge workers (Snyder-
Halpern, et al., 2001).
• Nursing still has a long way to go before being
accepted as an equal participant in the
interdisciplinary knowledge team.
 The Nurses Knowledge Needs
• Computers, technology, and the informatics
fields are assisting healthcare workers in dealing
with this information explosion.
• Nurses deal with a vast amount of information
and knowledge every day which they use to care
for their patients.
• Nurses rely on their own knowledge but there
are times when this is not adequate and they
must access information in order to provide safe
patient care.
 The Nurses Knowledge Needs
• Decision support systems (DSSs) may be
incorporated into the EHR.
• One challenge, that healthcare is currently
facing, is the vast differences in computer
literacy and information management skills
that healthcare workers possess (McNeil,
Elfrink, Beyea, Pierce, & Bickford, 2006).
 The Nurses Knowledge Needs
• Staggers, Gassert, & Curran (2002) conducted
a Delphi Study to validate the placement of
the competencies into the correct skill level.
• Of the 305 original competencies identified,
281 achieved an 80% approval rating for both
importance as a competency and for
placement in the correct practice level.
Nursing Informatics Specialty Practice
• NI is an established and ever evolving
profession which began when computers
were introduced into healthcare (Belanger,
2006).
• Nursing has been involved in the purchase,
design, and implementation of Information
Systems (IS) since the 1970’s (Saba &
McCormick, 2006).
Nursing Informatics Specialty Practice
• Nursing is involved heavily in the design of
educational materials for practicing nurses,
student nurses, other healthcare workers, and
patients.
• Computers have revolutionized the way
patients access information as well as
revolutionized the educational process (Saba).
Nursing Informatics Specialty Practice
• NI is important to nursing and healthcare as it
focuses on representing nursing data,
information, and knowledge.
• NI has become a viable and essential nursing
specialty with the introduction of computers
and the electronic health record (EHR) to
healthcare.
Nursing Informatics Specialty Practice
• Nurses who enter this field may have done so
by accident because they were comfortable
working with computers and their co-workers
used them as a resource for computer related
questions.
• Assisting nurses to incorporate this new
technology into their daily workflow is one of
many challenges that the nurse informatics
specialist (NIS) may tackle.
Nursing Informatics Specialty Practice
• One position that nurses do quite well in is the
role of the project manager which is a result of
their ability to manage multiple complex
situations at one time (HIMSS Nursing
Informatics Awareness Task Force).
• The first two graduate NI programs were
introduced at the University of Maryland and the
University of Utah in 1989.
• The first doctoral program was offered in 1991 at
the University of Maryland (Duke University
School of Nursing, 2007).
Nursing Informatics Specialty Practice
• Local colleges and universities should be
researched to see which may have added
informatics programs.
• NI is a nursing specialty that does not focus on
direct patient care but instead focuses on how
to improve patient care and safety as well as
improving the workflow and work processes of
nurses and other healthcare workers utilizing
technology.
Nursing Informatics Specialty Practice
• Continuing education allows the NIS to
improve a process or workflow within the
hospital or to change the way a system
upgrade is rolled out.
 Thought Provoking Questions
Hospital C is looking to implement an EHR. It
has been suggested that a NIS be hired. This
position does not involve direct patient care
and the administration is struggling with how
to justify the position. How can this position
be justified?
 Thought Provoking Questions
This chapter discusses the fact that nurses
are knowledge workers. How does nursing
move from measuring the tasks completed to
measuring the final outcome of the patient?