Informatics Specialists and Nursing Education: The Need for Collaboration.
the 2005 Twenty-Third Annual International Nursing Computer and Techology
April 15, 2005
Sewell, RN, MSN and Linda Q. Thede, Ph.D, RN, BC
“...the most remarkable feature of this twenty-first century medicine
is that we hold it together with nineteenth-century paperwork. This is
just inexcusable. And it has to change.”
From Tommy Thompson’s
(Thompson, 2004) May 6, 2004 talk at the Health Information Technology
- Driving Forces for Increasing
the Use of Informatics
- The federal government
Information Technology Advisory Committee (PITAC) - In June
2004, a report was made to the President (PITAC, 2004)that emphasized
the need for promoting the electronic health record, clinical
decision support, and computerized provider order entry.
- National Committee
Vital & Health Statistics (NCVHS) is developing strategies
supporting a National Health Information Infrastructure (NHII)(National
Committee Vital Health Statistics, 2001). The objective is to
help health care decision makers and providers and patients
in all settings to access health information.
- Consolidated Health
Informatics (CHI). This is a component of the President’s
Management Agenda. The focus is the adoption of electronic health
messaging and vocabulary interoperability standards for use
in the federal healthcare enterprise (Bradford & Wark, 2004).
- The Institute Of Medicine
(IOM) has made several reports to improve health care that affect
informatics. i. The report Health professions education: A bridge
to quality (Greiner & Knebel, 2003). [Available at http://www.nap.edu/books/0309087236/html/].
the IOM lists the core competencies that they see as being required
of ALL healthcare professionals. There are five overall core competencies
- Provide patient
- Work in interdisciplinary
- Employ evidence-based
- Apply quality improvement
- Utilize informatics
- In the report Crossing
the quality chasm: A new health system for the 21st Century
10 rules are presented. Informatics is applicable in all these
rules(Institute of Medicine, 2001). [See http://www.nap.edu/books/0309072808/html/]
- Forces Supporting the Inclusion
of Nursing Informatics in a Curriculum
- Greiner in Health professions
education: A bridge to quality states that “Without a basic
education in informatics, health professionals are limited in their
ability to make effective use of communication and information technology
in their practice.” (Greiner & Knebel, 2003) p.85.
- In 1997 the Division
of Nursing of the Health Resources and Services Administration -
convened a National Advisory Council on Nurse Education and Practice.
They produced a National Informatics Agenda for Education and Practice.
One of their recommendations was for including core computing and
nursing informatics concepts in nursing curricula (National Advisory
Council on Nurse Education and Practice, 1997). They also identified
eight categories of nursing informatics needs. See the report at
- The American Association
of Colleges of Nursing’s list of core competencies in Information
and Health Care Technologies includes the following skills as necessary
(American Association of Colleges of Nursing, 1998).
- The use of information
and communication technologies to document and evaluate pt care,
advance pt education, and enhance accessibility of care.
- The use of appropriate
technologies in assessing and monitoring clients.
- The ability to
work in interdisciplinary teams to make ethical decisions regarding
the application of technologies and acquisition of data.
- The ability to
adapt the use of technologies to meet pt needs.
- The ability to
teach patients about health care technologies.
- To be able to protect
safety and privacy of patients in relation to the use of health
card and information technologies.
- To be able to use
information technologies to enhance one’s own knowledge
- The American Nurses
Association (ANA) in the Scope and Standards of Nursing Informatics
maintain that all nurses need computer and information literacy
(American Nurses Association, 2001)
- A recent survey (Uttley-Smith,
2004) of nursing administrators from hospitals, home health agencies,
and nursing homes in NC, SC, and TN found that one of the five competencies
wanted by nursing administrator’s was computer skills. Under
that category they list:
- Demonstrates computer
- Is able to access
and retrieve electronic data necessary for patient care
- Uses information
technology to facilitate communications, manage data sets, and
solve patient care problems.
- Difficulties Implementing
Nursing Informatics Education
- a. Some schools still
do not teach informatics. Although we hope this has changed, a 1998
(Carty & Rosenfeld, 1998) survey found that there are many graduates
- are computer illiterate,
or have minimal knowledge that needs remedial teaching by hospitals.
- have little understanding
of how knowledge functions in healthcare thus cannot help nursing
informatics specialists to build systems that serve nursing and
provide information to support and improve nursing care.
- In a recent report Dean
Miller of University of Kansas said “We’re graduating
students today who’re fairly ignorant about the technology that’s
out there.” (Weber, 2004)
- There are an inadequate
number of faculty qualified to teach informatics. McNeil (McNeil et
al., 2003) found that “Faculty who were rated at the ‘novice’
or ‘advanced beginner’ level for teaching information
technology content and using information technology tools are teaching
information literacy skills.” (p341). Compounding the problem,
there is a lack of time for faculty development (Carty & Rosenfeld,
- Too many faculty do not
realize the importance of informatics.
- The informatics information,
if included, is just a course to be taken, passed, but never used
in the rest of the curriculum.
- Information management
is underfinanced (Carty & Rosenfeld, 1998). p 263
- There is a lack of
a clear understanding of informatics as a discipline along with
an overcrowded curriculum (Greiner & Knebel, 2003).
- Lack of easy access
to local informatics experts (Greiner & Knebel, 2003) p 86
is only one part of informatics - the other part is applying informatics
to patient care.
- There is a tendency
to equate informatics with the use of computers to deliver education
(Greiner & Knebel, 2003) rather than to manage information.
- Ways for faculty to educate
themselves about informatics
- Invest in an informatics
book or two.
- Spend an afternoon
every month in the library reading about nursing informatics.
- Take notes and
ask those in the agency where you have clinicals about what
- Dialog with other
faculty members about the importance of informatics.
- Show and explain
to students how informatics can make a difference
- Encourage the use
of an electronic charting program in the skills lab - e.g. ChartSmart.
Students need experience with electronic order entry, order
tracking, reports, and data sharing (Harbeson, 2004)
- Ways to integrate informatics
into the curriculum
- If a separate course,
be sure that the material is integrated into the rest of the curriculum.
- Integrate with various
informatics topics being assigned to various courses.
- Above all, there should
be a carry through in the entire curriculum.
- See if the training
hospital where employees are trained for a system could be made
available to students.
- Current Collaboration Projects
- University of Kansas
partnership with Cerner (Weber, 2004)
- New York University
Medical Center Educational Services Department - established multi-disciplinary
informatics curriculum for all. They offer courses in such areas
as basic computer skills, identification of information resources,
structure of information, development of search strategies in support
of EBP, the identification of qualitative journals and the critical
appraisal of the literature.”(Greiner & Knebel, 2003
- Possible Collaboration Actions
- Faculty actions that
could promote nursing informatics education
- Become acquainted
with the individual responsible for informatics on the unit
where you have students.
- Find out what knowledge
and skills the nursing informatics specialists would like a
beginning nurse to have, a graduate nurse.
- Take any classes
in the hospital where you have students, learn the system, ask
questions, become acquainted with the teacher in those classes.
- Join any local
informatics groups, or attend their meetings. Network!
- Ask a knowledgeable
person to do a guest lecture on how information is used in an
agency. Could be part of a clinical course or informatics course.
(Harbeson, 2004)If there is a user group for a system at the
agency where you do clinicals join it.
- In house nursing informatics
specialists actions that could improve nursing informatics education.
- Seek out any faculty
who have students in your area and offer to provide a guest
lecture. (Harbeson, 2004)
- Talk about how
informatics can add to nursing
- getting aggregate
- Meet with the Dean
or faculty teaching informatics to discuss any differences between
what is being taught and the skills the graduates need. (Harbeson,
- See if your vendor
can provide a demonstration system for the SONs who do clinical
in your agency. (Harbeson, 2004)
- Offer to do an
in-service at a school of nursing for faculty. Arrange for contact
hours to be awarded. Explain the ways that collected data can
be used to improve practice.
- Network with faculty.
- Provide learning
experiences for all students in informatics. Offer one day experiences
with you to students in their clinicals
- Offer to be a preceptor
for a student in their management course (or whatever course
where they shadow a practicing nurse).
- If your agency
won’t let students chart, see if a “Nursing Student”
security position can’t be built that would allow access
to those pieces of the EMR that are appropriate, e.g. vital
signs, intake and output, ACL etc. (Harbeson, 2004)
- Help to develop
a network/system password-naming convention to identify all
students during their clinical periods (Harbeson, 2004).
- Add a “Student
Nurse Notes” section to the EHR (Harbeson, 2004).
- What Informatics Competencies
- See http://www.nurs.utah.edu/informatics/competencies.htm.
This is a Word document of the competencies that are discussed in
the Staggers, Gassert and Curran article in Nursing Research (Staggers,
Gassert, & Curran, 2002).
- Other resources are:
- Ronald, J. &
Skiba, D. (1987). Guidelines for basic computer education in
nursing. NLN Pub No 41-2177. New York: National League for Nursing.
- McNeil, B. J.,
Elfrink, V. L., Bickford, C. J., Pierce, S. T., Beyea, S. C.,
Averill, C., et al. (2003). Nursing information technology knowledge,
skills, and preparation of student nurses, nursing faculty,
and clinicians: a U.S. survey. Journal Nursing Education, 42(8),
- Staggers, N. G.
C. A. C., C. (2001). Informatics Competencies for Nurses at
Four Levels of Practice. Journal of Nursing Education, 40(7),
- Nursing Informatics
Competencies Self - Assessment site. This site has some dead
links, but what is there is valuable. http://www.nursing-informatics.com/
- Other countries are
also struggling with this topic. This site has a discussion paper,
a collection of feedback on key issues, and a power point presentation.
See the Canadian National Nursing Informatics Project.
of Colleges of Nursing. (1998). The essentials of baccalaureate education.
Washington, D.C.: American Association of Colleges of Nursing.
Association. (2001). Scope and standard of nursing informatics practice
(No. 1-55810-166-7). Washington, D.C.: American Nurses Publishing.
A., & Wark, C. (2004). Consolidated health informatics initiative.
Caring., 19(2), 1-3;4.
Carty, B., &
Rosenfeld, P. (1998). From computer technology to information technology:
Findings from a national study of nursing education. CIN: Computers, Informatics,
Nursing, 16(5), 259-265.
Greiner, A. C.,
& Knebel, E. (Eds.). (2003). Health professions education: A bridge
to quality. Washington, D.C.: National Academy Press.
(2004). ANIA news: Informatics professional and the student nurse. CIN:
Computers, Informatics, Nursing, 22(3), 113-114.
Medicine. (2001). Crossing the quality chasm: A new health system for
the 21st Century (2001). Washington, DC: National Academies Press.
McNeil, B. J.,
Elfrink, V. L., Bickford, C. J., Pierce, S. T., Beyea, S. C., Averill,
C., et al. (2003). Nursing information technology knowledge, skills, and
preparation of student nurses, nursing faculty, and clinicians: a U.S.
survey. Journal Nursing Education, 42(8), 341-349.
Council on Nurse Education and Practice. (1997). A national informatics
agenda for nursing education and practice. Washington, D.C.: Health &
Vital Health Statistics. (2001). A strategy for building the National
Health Information Infrastructure: U.S. Department of Health and Human
June). Revolutionizing health care through information technology. Retrieved
April 12, 2005, from http://www.nitrd.gov/pitac/reports/20040721_hit_report.pdf
Gassert, C. A., & Curran, C. (2002). A Delphi study to determine informatics
competencies for nurses at four levels of practice. Nursing Research,
G. (2004, May 6). Health information technology summit. Retrieved June
16, 2004, from http://www.hhs.gov/news/speech/2004/040506.html
Q. (2004). Competencies needed by new baccalaureate graduates. Nursing
Education Perspectives, 25(4), 166-170.
Weber, D. (2004).
Transforming the students nurses experience: A university integrates e-health
technology into the nursing curriculum. Patient Care Staffing Report,