Rethinking Nursing Informatics

I've been doing medical informatics for decades -- four decades, to be exact -- focusing on the sub-specialty of nursing informatics (NI) for the last of those decades. You'd think it would be a mature technology... And you'd be right. But much of the world hasn't figured this out yet. For example, the Bay Area Nursing Informatics Association (BANIA, my local chapter of the American Nursing Informatics Association, ANIA) in which I serve on the Board of Directors, each quarter delivers an educational event to address the question, what is nursing informatics? You wouldn't need to do that for, say, car mechanics. Everyone knows what that is. It's a mature technology. So why, if my contention is correct, must we do so for nursing informatics? My friend and mentor Ann Farrel observes, I hope to overcome your perception that Nursing Informatics (by whatever name) is in its infancy. Nothing could be further from the truth and harmful for [the] profession, unless you think 40+ years olds are babies. The profession wasn't born when you/ANIA nurses entered, you do [the] group a disservice [by] ignoring your fore-mothers and -fathers who in many ways were more skilled and better off professionally than NI nurses today. If NI ignores history, you'll never value or learn from it. She's right. The problems we think we're solving today for the first time are in fact familiar and well-studied and we'd do well to learn from our elders. Indeed, I am an elder. I should know better. Thanks, Ann, for the dose of humility. Even so, I feel compelled -- yet again! -- to explain NI. So what is it, already? One answer may surprise, and one won't. The unsurprising answer is the electronic health/medical record. Nurses use lots of technology but as measured in actual work hours, EHRs/EMRs dominate by far. And are often detested for that reason. I have blogged about this a lot (e.g. Reboot education, NY Tristate Symposium) and have many opinions that I won't repeat here. Perhaps more surprising is the definition of NI as change management, primarily with regard to nursing workflow design. This is the hard part of the NI job, both technically (accurately and usefully describing workflows is hard!) and politically. Engineering change in an organization -- especially one that deals with life and death -- is always fraught. Ok, so I'm an informatics nurse. What does that mean? One thing it doesn't mean is the bedside, and I miss that. Patients are the best part of nursing and informatics nurses don't get to work with patients directly. That's the bad news. The good news? Computers and data offer the potential to improve the quality and efficiency of nursing work, a big part of what informatics nurses strive for. The keyword is, alas, potential. We're not there yet. Computers (and information technology in general) have thus far had an effect on nursing work that is more detrimental than positive. It's not working for us. It's slowing us down, distracting us from our patients. But I have discussed this problem elsewhere (EHR Report Card); let me cease to digress. Conventional definitions of the role of the informatics nurse typically do so in terms of the tools employed, that is information technology. The job description I propose is based more on the role and objectives of the informatics nurse in regard to patients, the organization, its objectives, and sought outcomes. Here's what I say an informatics nurse does: Supports nurses who work at the bedside, enhancing their ability to deliver the highest-possible quality care by designing, implementing and maintaining effective and efficient work processes and the tools to enable them, often but not necessarily technology-based; Manages change; Redesigns workflows; Participates authoritatively in decision-making to advocate for nurses in the setting of policies and budgets in corporations, non-profits, and governments. Go informatics nurses!

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