NURS 6401 week 4 Discussion Essay
Competencies for Nurse Informaticists
Effective use of technology among healthcare professionals is important to the provision of quality patient care. According to the Bureau of Labor Statistics form the largest professional group in the United States’ healthcare field. One of the major roles of nurses in healthcare system is the communication which is facilited by the use of information technology. Nursing informatics facilitate transfer of data among healthcare providers and patients that take place every single day. According to McGonagall and Mastrian (2014) contribute about 37% of electronic health records in the United States. Therefore it is critical for nurses to have good informatics skills to support communication.NURS 6401 week 4 Discussion Essay
As a nurse student, the informatics skills I am developing and validating now will help me to meet the current informatics by expanding my knowledge on electronic healthcare records (EHRs) and technology practice. In addition, the informatics am currently developing will help me in advancement and education to meet the current informatics. One on the most crucial reasons I should focus on developing my informatics skills is the advent of the national EHRs. This electronic system makes it necessary for healthcare professionals to have basic understanding of computer systems to perform their day-to-day duties of patient care and administration. Nurses are expected to know electronic documentation of patient’s care and ensure privacy precautions on the organization’s computer system (Liston & McKinnon, 2017).
Increasingly powerful microprocessors have facilitated the new generation of tablet computers, smart phones and specialized devices which play a significant role in daily patient care (Hübner, et al. 2016). Nurses serve as front-line care providers and expanding informatics skills will help me in field testing new devices as well as their corresponding software applications. With the current informatics skills level I will be in a position to serve as consultant to software developers working on applications for healthcare markets.
As a nurse student, I have ambition in a number of career paths including research, academia, consulting, and management. Good informatics skills ranging from commercial programs to use of industry-specific software. Developing upon and validating informatics to meet current informatics skill levels will help me to pursue my ambition. One of the greatest responsibilities in any knowledge based-profession is transferring that knowledge and skills to the next generation of practitioners (Collins, 2016). The next generation of nurse educators will require a solid background of nursing informatics. Developing nursing informatics skills which meet current nursing informatics skills level will be necessary for guiding the next generation of nurses about the applications of nursing informatics in health care.NURS 6401 week 4 Discussion Essay
Impact of TANIC self-assessment
The TANIC self-assessment changed my impression of my current informatics skills level. The self-assessment promoted my understanding of current nursing informatics skills as crucial for multiple official documentation such as Technology Informatics Guiding Reform (TIGER). The TIGER enables nurses to employ technology to carry out education and research. It can help assist nurses to deliver the highest possible quality of care (Hübner et al. 2016). TIGER-based Assessment of Nursing Informatics Competencies (TANIC) self-assessment added additional information to the significance of education programs across or curriculum. The TANIC self-assessment addressed three competency areas including clinical information management, information literacy, and basic computer skills. With the increasing demand in nursing informatics, the use of computer technology has become universal within the practice and profession of nursing. Therefore, nurses and other healthcare professionals practicing in all settings and domains need to be competent in specific aspects of nursing informatics.
Over the past thirty or so years, various theorists, educators and groups have proposed essential competencies and literacy skills for nurses in practice, research, education and administration. Since the mid 1980’s, some theorists have stressed the need for nursing informatics specialists, now known as informatics or informatists. Specialists develop higher end technological skills and expertise and are most often employed as system coordinators, project managers, agency educators and analysts in all areas of nursing practice.
“The need to adopt a culture in nursing that promotes acceptance and use of information technology has been identified as an important parallel initiative to establishing Nursing Informatics competencies and educational strategies” (Hebert, 1999, p. 6). Strategies for achieving NI competencies in the workplace include in service training, intranet ready modules, access to online resources, and opportunities for continuing education. “Barriers to achieving NI competencies in the workplace include restricted access to training and training systems for nurses and nursing students, few leaders and educators with NI skills, and limited empirical support for the contributions ICT can or will realistically make to nursing and patient outcomes” (p. 6). NURS 6401 week 4 Discussion Essay
Most theorists also emphasize the need for every nurse whether employed in the practice or education setting, to develop a minimum of a “user” level in computer literacy and informatics theory. This site is most useful for the latter – to help individual nurses to assess their level of knowledge and know – how in the realm of nursing informatics.
The first decade of the 21st century provided compelling evidence supporting the need for transformative leadership in healthcare. National and international groundbreaking reports urge nurses and the nursing profession to contribute proactively through leadership roles (Harris and Murphy 2011; Institute of Medicine and Robert Johnson Wood Foundation 2010; Amara et al. 2000; Kirby 2002; Romanow 2002). Specifically, Amara’s (2000) report recommended that eHealth transformational agendas recognize and position nurses as the most qualified to respond to the current changes in our health system. With the intent of eHealth goals to deliver better healthcare that is patient focused, results driven, integrated and sustainable, achieving these goals is critically dependent upon information and information technology. Nursing skill sets continue to align naturally in an environment (i.e., the health system) that is moving towards outpatient care and requires providers to function as teams and assume management roles in facilitating care across the continuum (CNA 2009; Remus 2006; Amara et al. 2000). The authors believe nurses remain most qualified, and well positioned as the largest contributors of healthcare services across all sectors, to support essential clinical transformation efforts through uptake of automated clinical tools (i.e., electronic health/patient records) that will result in new care delivery models.
Recent consultations by the Canadian Nurses Association (2012) advanced this discussion, noting that information must be utilized both as a tool to inform decisions and as an essential element in a preferred future reflecting an informed, effective and sustainable healthcare system. Concurrently, nurse leaders are recognizing that traditional skill sets (i.e., financial, resource management, clinical operations and so on) must be augmented with new skills that enable effective information utilization and management, and support the future-oriented strategic activity inherent in transformational leadership (Meyer et al. 2011). Nurse leaders who equip themselves with new nursing informatics management skills (i.e., information management competency) will be well positioned to reap the benefits that electronic health records (EHRs) offer. Further, those who move their transformative practice agendas forward through successfully leveraging EHRs will make informed, timely decisions that are knowledge driven, creating sustainable healthcare delivery across all nursing settings.NURS 6401 week 4 Discussion Essay
Fostering the Development of Transformational Nurse Leaders
NI competencies: Essential skills for nurse leaders
The Academy of Canadian Executive Nurses (ACEN) (Meyer et al. 2011) suggests that the timing is right and sets the imperative for Canadian nurse leaders to support emerging competencies that will enable health system transformation. Meyer and colleagues (2011: 25) endorse “state of the art communication and information technology savvy” as recommended leadership competencies. They also recognize the value of technology through competency in communication and information technology. However, the authors of this paper propose that this competency, as stated, underestimates the meaning or appreciation of requisite nursing informatics (NI) competencies and does not fully convey the scope or intensity of effort that nurse leaders will need to invest in such competencies. Instead, we recommend explicit articulation of these distinct informatics skills, defining competencies unambiguously with measureable knowledge dimensions and clear outcomes of application supporting avant-garde leadership (Kennedy and Remus 2012b).NURS 6401 week 4 Discussion Essay
NI competencies are not necessarily new. The American Nurses Association in 2001 was one of the first nursing professional bodies to endorse NI through a formal certification program and a published NI scope and standards of practice (ANA 2008).
NI competencies are increasingly recognized as a new essential skill set, enabling contemporary nurse executives to support and advance healthcare system transformation evidenced by a number of nursing and health professional associations that endorse NI and health informatics competencies (ANA 2008; TIGER 2006; COACH 2009; HIMSS 2012). Understanding the distinction between generic health informatics competencies and NI competencies is necessary for all nursing executives to recognize points of alignment, but also the points where nursing is unique and specifically requires a nursing perspective. COACH (2009: 7) defines health informatics as the “intersection of clinical, IM/IT [information management/information technology] and management practices to achieve better health.” Nursing informatics, as a specialty practice within nursing and as a profession-specific specialty of health informatics, is defined by the International Medical Informatics Association (2009: 4) as “integrating nursing, its information and knowledge, and their management with information and communication technologies to promote the health of people, families and communities worldwide.” In Canada, nursing informatics as a practice subspecialty is visible across all clinical nursing specialties, such as cardiology, paediatrics, respiratory, critical and peri-operative care, and more. NI is a foundational skill set regardless of the clinical specialty or role (e.g., executive, educator, researcher, clinical staff) because each of these roles relies on data/information to inform decisions on a daily basis.
COACH (2010: 25) recommends that health informatics leaders must understand “data context, terminology, privacy, data management and quality as well as the transformation of data into information to support decision making across the health care enterprise.” Extrapolating this same breadth of knowledge is essential to nurse leaders, who must integrate these competencies into executive nursing roles to advance clinical information management and ensure the integration of NI competencies in health system reform activities. In doing so, nurses and the broader profession of nursing can improve both quality and continuity of care across the continuum by successfully leveraging information and communication technologies (ICTs), demonstrating evidence-based practices and gaining recognition as sophisticated knowledge workers. Nagle’s 2008 vision challenges nurse leaders to move forward from an era of Luddites and become luminaries, guiding the profession and leading transformational eHealth agendas.NURS 6401 week 4 Discussion Essay
Recent reports, publications and recruitment trends illustrate how leading healthcare organizations are recognizing the value of nursing informatics competencies (Manos 2012; Murphy 2011; Harrington 2011, 2012; Harris and Murphy 2011; Simpson 2011). Catholic Healthcare Initiatives (Alfano et al. 2012), a large US multisite healthcare provider (32 healthcare organizations spanning 19 states), has created a strategic, systemwide chief nursing informatics technology officer role. This role is structured as a dyad with a systemwide chief medical informatics technology officer role and supports six tactical/regional chief nursing informatics officers (CNIOs) partnered with six regional chief medical informatics officers (CMIOs). Linda Hodges (cited in Manos 2012), an executive recruiter, reports that the recruitment of CNIOs is on the rise as a result of academic health science institutions’ and large integrated health systems’ placing value on NI skills and knowledge to facilitate meeting “accountable care organization” (ACO) mandates. Further, Manos (2012) has reported on other health and health-related organizations that are advocating for NI competencies and executive CNIO roles (e.g., Veterans Affairs, IT vendors and policy makers, among others).
Organizations that recruit nursing informatics leadership roles support the integration of NI competencies as an essential specialty role within nursing and healthcare leadership and believe that this contemporary approach will achieve two important goals. First, this approach will help protect healthcare system sustainability through information-informed decisions, and secondly, it supports achievement of the ultimate vision of healthcare – that of knowledge-driven care grounded firmly in outcomes and efficiency (Manos 2012; Currie 2011; Kimmel 2012; Pringle and Nagle 2009; Mays et al. 2008; Nagle 2005). NURS 6401 week 4 Discussion Essay Matney and colleagues’ (2011) investigation into the NI data–information–knowledge–wisdom framework supports the value of distinct NI roles in which nurses link data, information, knowledge and wisdom in meaningful ways. Her work extends the next generation of NI definitional work around NI competencies (Gonçalves et al. 2012; Staggers et al. 2001, 2002). CNIO and/or nursing informatics executive (NIE) roles, although increasingly evident in organizational and regional infrastructures across the United States, are new and not yet widely accepted. Hodges (cited in Manos 2012: 4) suggests the slow uptake and acceptance of both the CNIO title and new role parallel the adoption pattern of CMIO roles, which evolved over a 10-year span. Therefore, Hodges anticipates and suggests that CNIO titles/roles will take time to become accepted and adopted. Dr. Ferdinand Velasco (cited in Manos 2012: 5), a vice-president CMIO, is encouraging his Texas healthcare organization to consider creating a CNIO position now. Velasco suggests that these emerging CNIO roles are “a good indication of the significance in the nursing dimension in the healthcare role and IT.” Further, he emphasizes that effective clinical workflow redesign needed to transform care delivery and meet meaningful use criteria make it imperative that CMIOs and CNIOs work together (Velasco, cited in Manos 2012: 5). Interestingly, Velasco’s endorsement of CNIO roles supports Amara’s (2000) prediction, where nurses and the nursing profession are positioned as the most qualified to respond to the current changes in our health system and meet eHealth transformational agendas. The latter emphasizes the ongoing value – the return on investment (ROI) – placed on nurses and in particular, new nursing informatics leadership roles, such as NIEs or CNIOs.NURS 6401 week 4 Discussion Essay
NI competencies and professional nursing practice
The 2003 Institute of Medicine (IOM) report (IOM 2003) on quality of care featured an extensive examination of the skills required by all healthcare professionals to optimize leadership and clinical excellence in dynamic, information-rich environments. According to the IOM (2003, cited in Dreher and Fitzgerald-Miller 2006: 29), today’s health professional must be able to “(1) provide patient-centered care, (2) work in interdisciplinary teams, (3) employ evidenced-base practice, (4) apply quality improvement and, fundamental to the preceding four, (5) make use of informatics.” For the purposes of this discussion, informatics encompasses the broad knowledge base concerned with all aspects of information literacy, not just computer competence (Saranto and Hovenga 2004; Kerfoot and Simpson 2002). Although a relative latecomer to the skill set of most health professionals, informatics is the most fundamental, owing to its inherent ability to inform and enhance the performance of the other four IOM competencies (Dreher and Fitzgerald-Miller 2006).NURS 6401 week 4 Discussion Essay
Development of NI competencies informs client-centred care, supports interdisciplinary teamwork, provides evidence to support quality improvement and ensures the incorporation of evidence into practice (Dreher and Fitzgerald-Miller 2006). Increasingly, however, NI has gone beyond simply incorporating evidence into practice to enabling the extraction of meaningful data from practice to inform clinical and administrative decisions from bedside to boardroom across the continuum of care. The latter exemplifies lived experiences of nursing informatics competencies or applied nursing informatics in practice settings. Herein lies the critical and essential relationship that integrates nursing informatics with professional practice (Remus 2006). Across Canada, organizations that have adopted the Canadian Health Outcomes for Better Information and Care (C-HOBIC) measures into their documentation standards of practice can demonstrate and experience the initial benefits of knowledge-driven care where meaningful clinical data are informing decisions and reshaping clinical practice and administrative policies. Early C-HOBIC adopters are reporting excellent indicators using their data to facilitate knowledge-driven care (White, 2012). One example includes the Joseph Brant Hospital in Burlington, Ontario, which reports utilizing C-HOBIC data to develop quality resource projects that support evidence-based decisions at the point of care and ultimately influence corporate strategic decisions. A second example is the South Bruce Grey Health Centre – Chesley site in Chesley, Ontario, which reports using C-HOBIC measures every three days on its Restorative Care Unit to monitor patients’ progress in the program.NURS 6401 week 4 Discussion Essay
An examination of why, despite the compelling value and impact on nursing and healthcare, NI competencies are not yet widely adopted by nurse leaders reveals a knowledge gap and perhaps, even more seriously, a lack of recognition of how influential NI is in daily practice. A number of nursing informatics leaders have diverse opinions on this phenomenon, where NI competencies are neither embraced nor well understood by nursing leaders. Nagle (2009) explained that the majority of nurses do not embrace or understand the notion of informatics, or understand its meaning and the relevance to their work. Richards (2001: 8) observed that nursing and nurses appear to be “passively accepting the inevitable saturation of computer technology into all aspects of health care,” both from a computer and information literacy perspective. Barron McBride (2005, 2006) examined clinicians’ perceptions and concluded that informatics was still not considered fundamental to clinical practice but viewed rather as an “add-on.” Pringle and Nagle (2009) explained that historically, nurses have not been “information users” because patient information was not readily available in paper-based practice environments prior to EHR implementations, and recommended continued education to achieve that broad integration of NI competencies into the nursing perspective.NURS 6401 week 4 Discussion Essay Gonçalves and colleagues’ (2012: 130) research on NI competencies provides optimism that adoption is on the horizon and emphasizes that both the current and future nursing workforce must be prepared to perform effectively in “safety-focused, integrated, patient-centred,” technology-enabled and information-rich environments. Although the aforementioned perspectives lend insight into nurse leaders’ indifferences to the essence of NI competencies’ skills and knowledge, research to address this phenomenon is still required. The potential volume of data now being generated by the healthcare system has exploded, in part due to the number of data sources, and the number of solutions that can generate information to inform decisions.
More than ever, nurse executives must be information leaders and guide the nature and scope of information, supporting executive decision-making and innovation. Consequently, NI competencies must be integrated broadly to extend beyond discrete IT implementation activities (work process redesign, clinical systems, EHRs and so on) to all information-dependent nurse executive activities.
Developing NI competencies
The emerging value of nursing informatics competencies is evident not only in healthcare organizations, but also in academia. Richards (2001) argued that academic faculty preparing the nursing workforce are far removed from the realities of practice environments, further exacerbating the challenge of preparing graduates who are able to lead in contemporary environments through innovative change, and promote awareness of and competency in electronic environments.
However, academic and professional institutions in Canada and the United States are increasingly acknowledging the importance of nursing informatics as an essential skill set and are embedding key NI competencies into traditional nursing education curriculums (CASN 2012; RNAO 2011; TIGER 2006). Innovations in traditional academic programming are also emerging to offer future nurse leaders programs that combine traditional nursing education with health informatics programs. Graduates of such programs as the combined master’s program at the University of Victoria emerge with a range of sophisticated informatics skills combining knowledge and skills from both a master’s degree in nursing as well as a master’s degree in health information science (University of Victoria 2012).NURS 6401 week 4 Discussion Essay
Opportunities to build NI competencies are not restricted to formal academia. The United States’ Technology Informatics Guiding Educational Reform (TIGER 2006) initiative developed a national informatics education strategy for its existing nursing workforce. At NI2012 held in Montreal, TIGER launched its new internationalization phase, complete with an international board including representation from Canada, Asia, South America and Europe. Additionally, a range of continuing education opportunities exist in Canada and beyond. Such opportunities include the National Institute on Nursing Informatics (NINI) at the University of Toronto (2012), various “bootcamp” programs affiliated with Canadian universities and professional interest groups such as the Canadian Nursing Informatics Association.NURS 6401 week 4 Discussion Essay