Careers in Nursing 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 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. Two examples are: the American Nursing Informatics Association and the American Medical Informatics Nursing Informatics Working Group. In general, the opportunities described on these sites fall within the following 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 requires 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

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.

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 electronic health records with simulated patients at every stage of the nursing process.
• A partnership within an academic consortium that includes the Cerner Corporation, the University of Kansas, the University of Missouri-Kansas City, and the University of Utah, makes it possible to share simulated patient scenarios and other resources and to leverage each other's progress.

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 (CDC), 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.

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
• needs for information technology
• adequacy of available technologies to meet the needs
• factors associated with successful implementation, and
• 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

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.
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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.
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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.