Careers in Nursing Informatics

Eun-Shim Nahm, PhD, RN, FAAN, Associate Professor
Arpad Kelemen, PhD, Associate Professor
Mary Regan, PhD, RN, MS, Assistant Professor
Charlotte Seckman, PhD, RN-BC, Assistant Professor
Nancy Staggers, PhD, RN, FAAN, Professor
Marisa Wilson, DNSc, MHSc, RN, Assistant Professor

Have you ever considered a career in nursing informatics? Do you even know what nursing informatics is?

Let us tell you about some of the exciting opportunities that are crying out for nurses with an aptitude for information technology.

The American Nurses Association (ANA) says that nursing informatics “integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice."¹ Registered nurses who enter this field via on-the-job training or continuing education are called informatics nurses. Nurses who earn a master's or doctoral degree or pursue a post-master's (non-degree) option in nursing informatics or a related field such as biomedical or health informatics or information management are called informatics nurse specialists.¹ All are helping to usher in a transformation of health care by providing essential information to students, educators, clinicians, consumers, administrators, scientists, and policy makers when over and where ever they need it. Here are some examples:

Clinical informatics

Most informatics nurses and informatics nurse specialists take jobs that draw directly on their clinical backgrounds, as well as their organizational skills and informatics knowledge. Although there is overlap between the types of roles, nurses in applied/professional positions focus more on technical aspects of development and evaluation of systems. Nurses in expert/liaison roles focus more on needs assessment, system selection or marketing, education, and implementation.² In either type of position, informatics nurses and specialists are uniquely qualified to bridge the gap between the clinical world and the of Information Technology (IT) world.

In a health care organization, nurses will typically fill applied/professional positions in the IT department or expert/liaison positions in the nursing department. Nurses hold similar roles in corporations that develop and sell health care information technology and in consulting firms that assist health care organizations in selecting, implementing, and evaluating health care information technology.

A number of websites list job descriptions for clinical informatics nurses and specialists. The examples are: American Nursing Informatics Association and the American Medical Informatics Nursing Informatics Working Group are just two. In general, the opportunities described on these sites fall within the two categories:

Applied/Professional Job Titles

• Systems Analyst
• Support Analyst
• Systems Administrator
• IT Training Manager
• Project Manager
• Project Leader
• Chief Information Officer

Expert/Liaison Job Titles:

• Super User
• Trainer/Educator
• Informatics Coordinator
• Chief Nursing Informatics Officer
• Information Technology Nursing Advocate

Each of these jobs require stat nursing experience, relevant training, and increasing levels of informatics experience.

Whatever role nurses take in clinical informatics, they stand to make significant contributions to patient outcomes and staff satisfaction. Informatics nurses and specialists have the potential to improve patient care, make the value of nursing visible, reduce the burden of paperwork, and improve communications within an interdisciplinary team.³

Consumer Health Informatics

In the 20th century, the focus of health care informatics shifted from supporting business processes like billing and registration to supporting health care professionals in decision making, education, and other professional activities⁴. In the 21st century, informatics is expanding rapidly to deliver information resources to consumers via the Internet and other electronic media.^{5, 6} With the current emphasis on health promotion, disease prevention, self-management, and patient-centered care, the role of patients and their family members as collaborators has become vital.^{7, 8}

Nurses working in consumer health informatics focus on:

• assessing consumers' needs for health information and treatments
• conducting research on how to meet consumers' needs for health information and self-management of health and illness, and
• integrating consumers' preferences into information systems⁶

Informatics nurses and specialists work to develop and improve systems for:

• Telemedicine—delivering care at a distance, such as answering questions and providing advice via secure messaging
• Telehealth—promoting health through interactive educational materials or self-management systems for tracking one's own health behaviors and progress toward goals
• Telemonitoring—delivering patient data such as blood sugar or daily weights to a clinician for treatment decisions.^9-12

Because one of nursing's central missions is to help patients and families live as well as they can with the health issues they face, consumer health informatics is a natural fit for nurses.

Educational Health Informatics

Just as consumers are increasingly learning from the Internet and other electronic media, students in nursing and other health care professions are benefiting from online and Web-enhanced courses, as well as from the integration of health care information technologies into their clinical courses. Informatics nurses and specialists who focus on education may develop, select, implement, and evaluate learning resources for consumers or for health care professionals.¹³

For example, to make Web-based courses more “real” and interactive, faculty members at the University of South Florida provided synchronous, online lectures and virtual break-out rooms for student work on group projects. Students reported that these innovations facilitated their learning and made their online courses more satisfying ¹⁴. At Texas Tech University, Web-based RN-to-BSN students benefited from collaboration and mutual assistance through the establishment of online student learning communities.¹⁵ The University of Massachusetts College of Nursing and Health Sciences let students and faculty members borrow personal digital assistants from the library to gain access to up-to-date reference materials in clinical settings.¹⁶ At the University of Maryland School of Nursing, informatics faculty members and clinical faculty members are collaborating in revising clinical courses to integrate the use of the electronic health record with simulated patients at every stage the nursing process. Partnership within an academic consortium that includes the Cerner Corporation, University of Kansas, University of Missouri-Kansas City, and University of Utah and with a major vendor of health care information technology, makes it possible to share simulated patient scenarios and other resources and to leverage one each other 's progress.

Public Health Informatics

Nurse clinicians and scientists practicing in public health and epidemiology focus on obtaining, synthesizing, and providing access to information and knowledge related to community and population health for consumers, for other health care workers, and for policymakers. The fledgling field of Public Health Informatics (PHI) addresses the information needs of policymakers and public health professionals by applying informatics principles at the community and population levels.¹⁷

The Centers for Disease Control and Prevention (STET) as well as state and local health departments, have identified several areas of PHI focus:

1. Developing a Public Health Information Network (PHIN) to share information among state and local public health organizations
2. Developing an information exchange service for public health providers at the regional level
3. Improving biosurveillance programs by rapidly sharing information about health threats such as disease outbreaks and injurious medication side effects
4. Improving collection, distribution, and security of vital statistics¹⁸

In addition, PHI specialists work on such projects as immunization registries, public health surveillance systems, and domestic violence research and intervention.¹⁷

Informatics nurses and specialists in PHI are most likely to work for a government agency such as the CDC or a health department, possibly having to write their own job descriptions for pioneering roles. Many prospective employers will require a master's degree in informatics (or a related field) and related work experience. Professional organizations supporting PHI include the American Medical Informatics Association and the Public Health Informatics Institute.

Research in Nursing Informatics

The ANA sees research as an important function of the informatics nurse specialist.¹ Using systematic, scientific methods to collect and analyze data, the INS can gradually build knowledge that applies across settings and applications. In the course of a system life cycle, the INS will assess:

• the readiness of an organization for new technology
• the needs for information technology
• the adequacy of available technologies to meet the needs
• the factors associated with successful implementation, and
• the impact of the technology on workflow and organizational dynamics.

In consumer health informatics, where most programs focus on health promotion and disease prevention and management, the INS can study the impact of the informatics intervention on health practices and outcomes.^19-21 Nurses with the Doctor of Nursing Practice degree will develop and use informatics tools to obtain and apply evidence to improve patient care. Nurses with academic doctoral degrees (PhD, DNSc) are developing standards for representing data, information, and knowledge in information systems, developing methods of decision support for nurses, developing and investigating new technologies to support nursing processes, and advancing knowledge about how nurses use and communicate data, information, and knowledge. In the face of the nursing shortage, this research enables “a rebalancing of the human and technological resources deployed to support patient care”.²²

Getting Started

Career opportunities in nursing informatics are as varied as nursing itself. Although many nurses have come into informatics through on-the-job training or continuing education, the increasing complexity of the field and the demanding performance standards of today's workplace make formal education increasingly necessary. There is broad and growing consensus that all nurses need to be educated about the basics of informatics to support their clinical, educational, or administrative practice. To practice nursing informatics at an expert level, nurses need to study informatics at the master's or doctoral level. Master's education is increasingly available through online programs at respected universities. Doctoral education usually requires on-campus study.

As expert practitioners, informatics nurses and specialists provide new tools that help clinicians to practice, educators to teach, students to learn, researchers to investigate, policymakers to deliberate, and consumers to manage their own health. In all these ways, Informatics Nurses and Specialists pursue a fundamental nursing goal,“to improve the health of populations, communities, families, and individuals by optimizing information management and communication.”¹

Reference List

1. American Nurses Association. Scope and standards of nursing informatics practice (Draft submitted for public comment 2007 April 2). Silver Spring, MD: American Nurses Association; 2007.
2. Hersh W. Who are the informaticians? What we know and should know. Journal of the American Informatics Association, 2006;13:166-170.
3. Thede LQ. Informatics nurse specialist: a specialty in two disciplines. Informatics and nursing opportunities and challenges. Philadelphia: Lippincott Williams & Wilkins. 199;2003
4. Greenes RA, Shortliffe EH. Medical informatics: An emerging academic discipline and institutional priority. The Journal of the American Medical Association. 1990;263(8):049-1137.
5. Brennan PF, Starren JB. Consumer Health Informatics and Telehealth. In: Shortliffe EH, ed. Biomedical Informatics: Computer Applications in Health Care and Biomedicine. 3rd ed. New York: Springer; 2006:511-536.
6. Eysenbach G. Consumer health informatics. BMJ. 2000;320(7251):1713-1716.
7. Committee on Quality of Health Care in America, Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001.
8. US Department of Health and Human Services. Healthy People 2010. Washington, DC: U.S. Department Health and Human Services; 2000.
9. Brennan PF. The ComputerLink projects: a decade of experience. Studies in Health Technology & Informatics. 1997;46:521-526.
10. Maheu M, Whitten P, Allen A. E-health, Telehealth, and Telemedicine. San Francisco: CA: Jossey-Bass; 2001.
11. Effertz G. Telemedicine 101: Using a business case for telehealth - a model for persuading decision makers. Telemedicine Information Exchange. April 18, 2005.
12. Damush TM, Perkins SM, Mikesky AE, Roberts M, O'Dea J. Motivational Factors Influencing Older Adults Diagnosed With Knee Osteoarthritis to Join and Maintain an Exercise Program. Journal of Aging & Physical Activity. Vol 13: Human Kinetics Publishers, Inc.; 2005:45.
13. Nahm E-S, Resnick B, and Covington B. Development of theory-based, online health learning modules for older adults: Lessons learned. CIN: Computers, Informatics, Nursing, 2006. 24:5;261-268.
14. Little BB, Passmore D, and Schullo S. Using synchronous software in Web-based nursing courses. CIN: Computers, Informatics, Nursing, 2006;24:6:317-325.
15. Tilley DS, Boswell C, Cannon S. Developing and establishing online student learning communities. CIN: Computers, Informatics, Nursing, 2006; 24:3;144-149
16. Scollin P, Callahan J, Mehta A, Garcia E. The PDA as a reference tool: Libraries' roles in enhancing nursing education. CIN: Computers, Informatics, Nursing, 2006; 24: 4;208-213.
17. McNabb SJN, Koo D, Pinner R, Seligman J. Informatics and Public Health at CDC. Atlanta, GA: Centers for Disease Control and Prevention; 2006 Dec 22. Report No.: 55 (Sup 02).
18. Association of State and Territorial Health Officials. Public Health Informatics Workforce Issue Report. Washington, DC: Association of State and Territorial Health Officials; 2006 Jun.
19. Schneider NM. Managing congestive heart failure using home telehealth. Home health care Nurse. Oct 2004;22(10):719-722.
20. Brookes L. SPAN-CHF II: Specialized Primary and Networked Care in Heart Failure II. WebMD. Available at: http://www.medscape.com/viewarticle/514121 Accessed 2005, October 20.
21. Brennan PF, Moore SM, Bjornsdottir G, Jones J, Visovsky C, Rogers M. HeartCare: an Internet-based information and support system for patient home recovery after coronary artery bypass graft (CABG) surgery. Journal of Advanced Nursing. Sep 2001;35(5):699-708.
22. McDaniel AM, Delaney CW. Training scientists in the nursing informatics research agenda. Nursing Outlook March/April 2007; 55(2):115-116.

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