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Just over a decade ago, the term nursing informat-ics might have drawn blank stares. Since then,this burgeoning field has become an essential ele-ment of healthcare delivery. In the last decadealone, there’s been a significant increase in the

demand for nurses whose knowledge of nursing and spe-cialization in informatics contributes to nursing practice,leadership, education, and research throughout the UnitedStates and other countries.

What, then, is nursing informatics? The definitionadopted by the International Medical Informatics Associa-tion’s Interest Group on Nursing Informatics is “the inte-gration of nursing, its information, and information man-agement with information processing and communicationtechnology, to support the health of people worldwide.”1

Knowledge explosionThe introduction of robust and sophisticated clinical in-formation systems has prompted significant transfor-mation in healthcare, along with increased attention topatient safety and outcomes. In addition, there’s beenincreasing pressure for healthcare systems to improveefficiency while standardizing and streamlining organi-zational processes and maintaining care quality. This“knowledge explosion” strains clinicians to learn andintegrate information systems into their already de-manding daily practice.

There are many reasons why this transformation istaking place. Catalysts includefederal initiatives that encouragenationwide adoption of electronichealth records (EHRs) and reportssuch as the Institute of Medicine’sthat claim clinical informationsystems improve processes andultimately save patient lives.

One estimate is that nurses spend as little as 15% oftheir time on direct patient care, but 50% on documen-tation. A welcome outcome expected of the many infor-mation technology (IT) initiatives is revitalization andredefinition of the role of nurses and nursing practice.2

The movement toward evidence-based practice driveshome the need for nurses to have the necessary infor-mation for decision making at the point of care.

Evidence-based clinical practice involves integratingthe best available evidence with clinical judgment,client values, and consideration of available resources.3

An expertly designed clinical information system canserve as the integrator that supports clinical judgmentand client values with proven outcomes and up-to-dateevidence-based practice.

When evidence-based practice is coded to an appropri-ate taxonomy system, computerized nursing documenta-tion allows nurses to realign and track the care process,focusing on improving outcomes by implementing ap-propriate nursing care for identified problems. The re-sult? Improved patient safety and care delivery throughdecision support. Another measurable outcome from evi-dence-based care is the ability to demonstrate the valueof nursing to the overall health and well-being of patientsand families.

Interest in implementing clinical information systemsseems to have escalated since President Bush, in 2004,called for the widespread use of EHRs within 10 years.

In response to the President’smandate, the Office of the Na-tional Coordinator for Health In-formation Technology was cre-ated. Experts cite numerous bene-fits of EHR usage, but the drivingforce appears to be improved carequality and greater efficiency.

Appointed by the Healthcare Information and Man-agement Systems Society (HIMSS), task forcemembers include Karen Carroll, RN,BC, PhD; AliciaBradford, RN,BC, MS; Melissa Foster, RN,BC,CPHIMS, FHIMSS; Jim Cato, RN, CPEHR, CRNA,MHS, MSN; and Josette Jones, RN,BC, PhD. Youcan contact the task force at informatics@himss.org.

This growing specialtyhas the potential tochange your daily

practice for the better.By HIMSS Nursing Informatics Awareness

Task Force

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Specific rolesNursing has been carving out a spe-cialty over the years, and nurseshave been informally practicing asinformaticists since the early 1960s.4

Many nursing informatics (NI) spe-cialists unofficially adopted the rolewhen they were selected to be thenurse member of a hospital infor-mation system team. Often thesenurses were already seen as the“techy” or “go-to” nurses—andwere in the right place as a systemwas being implemented. They hada knack for making the systemwork for their unit or area. After thesystem was implemented, the nurseremained in the role.

Information technology depart-ments, as well as nursing depart-ments, have learned the value of theinvolvement and project manage-ment skills provided by a clinicallyknowledgeable nurse. In their every-

day clinical practice, nurses workwith patients and families to coordi-nate multiple services and impactpatient care. These skills translatewell into implementing complex sys-tems to patient care: Nurses makegreat project managers.

In acute care and long-term-careorganizations, as well as industry orvendor companies, nurse informati-cists have held such diverse titles asNI specialist, clinical analyst, clini-cal project manager, and NI man-ager. Some of these roles “live” inthe IT department; others report tothe chief nurse officer and have aclose working relationship with theIT department and the educationstaff. Nursing informatics positionsare also seen in practice as seniormanagers holding titles such asclinical IT directors, chief informa-tion officers, and chief nurse offi-cers. The Nursing Informatics

Working Group of the AmericanMedical Informatics Associationmaintains a repository of NI roledescriptions at http://www.amia.org/mbrcenter/wg/ni/roles.asp.

The job responsibilities can be var-ied and encompass project manage-ment, health information systemmanagement, writing requests forproposals or returns on investments,developing educational programs,evaluating work process flows, writ-ing policies, aiding in the design andcontent of an organization’s intranet,and making recommendations tochief nurse officers/chief executiveofficers on a preferred clinical systemfor nursing.

Nurse informaticists ensure thatnursing is represented in decisionsthat impact clinical systems in thepractice setting. As the largestgroup of healthcare professionals,nurses are the largest group of clini-

cal users. Nurse informaticists en-sure that any system meets theneeds and fits the work flow ofnurses. Their ability to liaison be-tween nursing and IT allows themto prevent many costly errors:© in system selection (choosing asystem that doesn’t fit with thenurse’s work flow)© in design (ensuring that the designof screens works for nurses andmeets documentation standards)© in education (confirming that ed-ucation addresses what nurses needto know to use a system)© during implementation (selectinga suitable work flow for nurses)© postimplementation (focusing onsystem maintenance, optimiza-tion—with input from clinical nurseusers—research and data informa-tion, and knowledge management).

Outside hospitals and nursinghomes, the roles for NI positions also

offer a wide array of opportunities.Nurses can work for vendors doingclinical system design, implementa-tion, customer training, testing, andsales. Or they can target education,research, and professional standarddevelopment, working to standard-ize nursing languages and represen-tation to the national and interna-tional informatics committees.

Educational programs In 1992, the American Nurses Asso-ciation (ANA) officially establishedthe role of the informatics nursespecialist, shortly after which theybegan offering the first credential-ing exam in 1995. Although thisrecognition of NI is fairly newamong the nursing specialty prac-tices, skilled information manage-ment has always been a cornerstoneof successful nursing practice.Nurses spend a significant portion

of their time collecting and translat-ing data for consumption by otherproviders, patients, and families. Ascomputers increasingly become atool for repositing healthcare infor-mation, it’s imperative that allnurses have computer competen-cies, just as they would with anyother healthcare instrument.

The ANA’s Scope and Standardsof Nursing Informatics Practice(2001) identifies three progressivelevels of NI competencies: the be-ginning nurse, experienced nurse,and informatics nurse specialist.5 Asthe specialty of NI has becomemore defined, nurses have soughtout more learning opportunitiesand have benefited from the emer-gence of more formal NI educationprograms. Until the last decade,there were few formal NI programs.It’s even more recent that informat-ics theories and competencies have

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Informatic theories and competencies have started being incorporated into basic nursing associate degree and baccalaureate curriculums.

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started being incorporated intobasic nursing associate degree andbaccalaureate curriculums. Not sur-prisingly, many practicing nurse in-formaticists received their “formal”training on the job, typically as anecessity of their institution’s sys-tems implementation.

As we transform the healthcareindustry to this IT-enabled age, it’svital to incorporate basic computerskills and NI competencies into alllevels of professional nursing edu-cation programs. For a comprehen-sive list of programs for nursing,medical, and health informatics,visit http://www.amia.org/informatics/acad&training/.6,7

Certification for NIThe American Nursing CredentialingCenter (ANCC) began administeringan informatics nurse certification

exam in November 1995. The examtopics cover areas of basic IT, infor-mation and knowledge management,system development, human factorsand NI models, theories, and profes-sional practice.8 The ANCC Web sitedetails the nursing candidate’s quali-fications for the informatics nursecertification exam as:© a baccalaureate or higher© an active RN license, with at least2 years of professional practice© practice of at least 2,000 hours ofNI within the last 3 yearsor© 12 hours of graduate work and1,000 hours of NI practiceor© completion of a graduate pro-gram in NI that included at least200 hours of clinical practicum© completion of 30 continuing-education contact hours in specialty

area within the last 3 years for thosewho haven’t completed a graduateinformatics program.9

Those RNs, with a baccalaureateor higher degree in the field of nurs-ing, who successfully pass the certifi-cation exam are recognized as“board certified” with the initials“RN,BC.” For RNs with baccalaure-ate or higher degree in a nonnursingfield, their certification is recognizedas “certified” with an “RN,C.”

Enhancing practiceAs the healthcare industry contin-ues to move toward utilization of ITtools to shape healthcare decisionsand delivery, it’s essential thatknowledgeable nurse informaticistswork with other nursing specialtiesto ensure the discipline of nursingis enhanced by new technologies.The goal of nursing is to have these

technologies enable and enhancenursing to care for patients andfamilies. In this pursuit, nurses needto be prepared to interface withother healthcare professionals usinghealth IT, while also assisting theirpatients to use IT for wellness anddisease management. NM

REFERENCES1. Special Interest Group Nursing Informatics of

International Medical Informatics Association1998. Available at: http://www.imia.org/ni/index.html. Accessed March 4, 2006.

2. Mills ME. A growing role in system devel-opment. In: Ball MJ, Waver C, Kiel J, eds.Healthcare Information Management Sys-tems. New York, NY: Springer-Verlag;2004:320-331.

3. DiCenso A, Callum N. Implementing evidence-based nursing: some misconceptions. EvidBased Nurs. 1998;1(1):38-40.

4. Saba V. Nursing informatics: yesterday,today and tomorrow. Int Nurs Rev.2001;48:177-187.

5. American Nurses Association. Scope

and Standards of Nursing Informatics Prac-tice. Washington, DC: American NursesPublishing; 2001.

6. HIMSS News. Nursing informatics groupsform alliance through HIMSS and AMIA toprovide unified structure. Available at:http://www.himss.org/asp/ContentRedirector.asp?ContentID=57813. Ac-cessed January 30, 2006.

7. American Medical Informatics Association.AMIA 10x10 program. Available at:http://www.amia.org/10x10/. AccessedJanuary 30, 2006.

8. American Nurse Credentialing Center. Infor-matics nurse certification exam. Availableat: http://www.nursingworld.org/ancc/certification/certs/informatics.html. Ac-cessed January 30, 2006.

9. HIMSS. CPHIMS certification. Available at:http://www.himss.org/ASP/certification_cphims.asp. Accessed January 30, 2006.

ABOUT THE AUTHORSThe HIMSS Nursing Informatics AwarenessTask Force works to support the practiceand discipline of nursing by increasingawareness of informatics in nursingcommunities.

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