CONSULT PRN

Nursing Informatics JULIA STOCKER SCHNEIDER, PhD, RN

Q: I have heard of a nursing specialty called “nursing informatics.” Can you explain what this is about? Nursing informatics refers to a specialty “that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice” (American Nurses Association [ANA], 2008, p. 1). The practice of nursing informatics involves making information available to support patients, nurses, and other healthcare providers in decision making. In 2008, there were 8,100 nurse informaticists working in the United States (Health Resources and Services Administration, 2010). Demand has grown markedly in the last several years, primarily driven by the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, which has stimulated electronic health record (EHR) use (Furukawa et al., 2012). In 2013, the U.S. Department of Health and Human Services (HHS) reported that 80% of hospitals and more than 50% of physician and other providers were adopting the use of EHRs (HHS, 2013). Other factors contributing to the rising demand for nurse informaticists include the advances in technology and increasing pressure for health organizations to deliver

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higher quality care while reducing the costs of care. Nurse informaticists work in hospitals, health systems, and other settings including software vendor organizations. Additional education and training is required to master the necessary skills. Specialty competencies for informatics nurses include advanced computer literacy, information literacy (including information retrieval knowledge and skills), and professional leadership with a focus on management to ensure safe and ethical use of informatics

• system development: customizing or updating vendor systems and developing or updating homegrown systems; • clinical analytics: discovering and communicating meaningful patterns of clinical data for performance monitoring, compliance and integrity management, quality improvement, decision support, and population health management; • quality initiatives/reporting: problem solving, system evaluation, and quality improvement;

Nursing informatics refers to a specialty “that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice.” (ANA, 2008). As the field advances, more nurse informaticists are seeking a master’s degree or higher and many are also seeking specialty certification, to distinguish competency as a nurse informaticist (Health Information and Management Systems Society, 2014). The functions of nurse informaticists include the following: • system implementation: preparing users and providing training and support; • systems optimization/use: applying technology applications to maximize value for the stakeholder and organization;

• informatics education: serving as a resource to healthcare providers, patients, families, administrators, and information technology staff regarding nursing informatics principles, processes, skills, and competencies; • liaison/communicator: coordination, bridging communication between the technical and clinical arenas, user requirements and technology solutions, and project vision and work process realities; and • regulatory initiatives: compliance, transparency, and reporting related to regulatory programs involving

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Address for correspondence: Julia Stocker Schneider, PhD, RN, 4001 W McNichols Rd., Detroit, MI 48221-3038 (stockeju@ udmercy.edu).

Nurse informaticists in hospital and ambulatory settings are focused on developing, implementing, or optimizing nursing clinical documentation, electronic health records, and computerized provider order entry. health information technology (ANA, 2008; HIMSS, 2014). Although home healthcare agencies have not yet been included in the meaningful use incentive program contained in the HITECH Act, information management and communication needs are present. Nurse informaticists in hospital and ambulatory settings are focused on developing, implementing, or optimizing nursing clinical documentation, EHRs, and computerized provider order entry (HIMSS, 2014). Home healthcare organizations also need technology

REFERENCES

to support information needs and provide decision support in community practice. Through improved EHR adoption in all care settings combined with enhanced interoperability across systems, better healthcare outcomes can be achieved. Nurse informaticists in all settings, including home care, are crucial players in the achievement of these goals.

Julia Stocker Schneider, PhD, RN, is an Associate Professor, McAuley School of Nursing, University of Detroit Mercy, Detroit, Michigan. The author declares no conflicts of interest.

BOOK REVIEW

The Good Nurse: A True Story of Medicine, Madness, and Murder Graeber, C. (2013).

New York, NY: Twelve. 307 pages. When you read The Good Nurse by Charles Graeber you will wonder how registered nurse Charlie Cullen managed to get hired at hospital after hospital, despite serious misgivings at every point along the way in his career as a critical care nurse. Although he was never successful for any length of time as he bounced from job to job, he was never reported to the state board of nursing. It appears that his superiors at all of the hospitals, happy to be rid of him, did nothing to prevent him from wreaking havoc on the next hospital. The description of Graeber by a nurse coworker as an “odd duck” is an understatement. He was a serial killer, who preyed on the most vulnerable, elderly, and critically ill inten-

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DOI: 10.1097/NHH.0000000000000124

American Nurses Association. (2008). Nursing Informatics: Scope and Standards of Practice. Silver Spring, MD: Nursebooks.org. Furukawa, M. F., Vibbert, D., & Swain, M. (2012, May). Hitech and health IT jobs: Evidence from online job postings. ONC Data Brief, 2. Retrieved from http://www .healthit.gov/sites/default/files/pdf/0512_ ONCDataBrief2_JobPostings.pdf Health Information and Management Systems Society (2014). HIMSS 2014 Nursing Informatics Workforce Survey (pp. 1–30). Chicago, IL: Author. Retrieved from http://himss.files.cms-plus.com/ FileDownloads/2014-Nursing-Informatics-Survey-Full-Results.pdf Health Resources and Services Administration (2010). The Registered Nurse Population: Finding From the 2008 National Sample Survey of Registered Nurses. Washington, DC. Retrieved from http:// bhpr.hrsa.gov/healthworkforce/rnsurveys/rnsurveyfinal.pdf U.S. Department of Health and Human Services. (2013, May 22). Doctors and hospitals’ use of health IT more than doubles since 2012 (press release). Retrieved from http://www.hhs.gov/news/ press/2013pres/05/20130522a.html

sive care patients, killing as many as 400 of them with insulin-spiked intravenous fluids or intramuscular digoxin. He was an alcoholic, and prone to overdosing on whatever handful of pills he could find, especially when he was spurned by women who, after initial interest, grew uncomfortable with his weird antics. You will wonder how he ever managed to get away with it. It is disheartening that so many of his superiors looked the other way, protecting the hospitals’ reputations over the lives of patients. This is a somewhat uncomfortable book to read, but it is an important one. Healthcare providers who read this may find themselves more alert to odd behavior and stories that do not add up and perhaps will be more insistent that action be taken. After reading this book, I can assure you that you will be reluctant to leave the bedside of your hospitalized loved ones. —Contributed by Maureen Anthony, PhD, RN The author declares no conflicts of interest. DOI: 10.1097/NHH.0000000000000132

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