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For More Information The American Nursing Informatics Association promotes nursing informatics through networking, education, research and professional activities. The group’s Web site (www.ania.org) lists job opportunities, upcoming meetings and programs, information on membership and a new feature, “cyber-networking,” which offers stories from those in nursing informatics sharing how they entered the specialty. The links to related sites are also helpful. The American Medical Informatics Association’s Nursing Informatics Work Group promotes the advancement of nursing informatics within the larger multidisciplinary context of health informatics. The Web site (www.amia-niwg.org) provides information on education, job descriptions and mentoring. Johns Hopkins University’s School of Nursing recently announced a new Doctor of Nursing Science degree focusing on informatics, as well as outcomes measurement, health care economics and statistical analysis. Offered during the summer, the 50-credit program takes four to five years to complete. Nurses who do so will be poised to take leadership roles in health systems administration, academia and government. For more information, visit the school’s Web site (www.son.jhmi.edu) or contact the Admissions Office at (410) 955-7548. New York University’s master’s degree program in Advanced Education in Nursing Science (www.nyu.edu/education/nursing) includes a concentration in nursing informatics. The school prepares students to assess, design, develop, implement and evaluate clinical computer systems in a variety of patient care settings. The electronic patient record, decision support systems and telecommunications in health care with a specific focus on the implications for nursing are included in the course work. The University of Maryland School of Nursing (www.umbc.edu) will present its tenth annual Summer Institute in Nursing Informatics this July 19-22. Seminars will focus on current information technologies and nursing informatics processes. Participants will be exposed to experts in nursing and health care informatics, as well as software demonstrations and hands-on exploration of computerized management tools. Contact Dr. Carolyn Waltz, Office of Continuing Education, for more information: (410) 706-3180. The Nursing Informatics Program at the University of Utah was initiated by the College of Nursing in 1990. The school notes a continuing demand for nurses to assist with the development of information systems that meet the needs of clinical nursing practice. It is the only graduate program in nursing and health informatics in the country that focuses specifically on clinical informatics. Visit the school’s Web site at www.nurs.utah.edu.

Information, Please...

By Paula Lipp

Face it, it’s a wired world out there. From the ubiquity of cellular phones to the wonder of the Internet, information is flowing faster and farther than ever before—and the world of health care has not escaped the tentacles of technology. Pressure from insurers and policy-makers to increase the efficiency of health care is causing an increasing array of computer systems to be applied within hospitals, doctors’ offices and even community settings to track and manage all manner of data.

For minority nurses interested in a piece of the high-tech career pie, the growing field of nursing informatics may be just the ticket—and one that a rising number of nurses are pursuing with great satisfaction.

On the Job

A 1989 report in Image: The Journal of Nursing Scholarship defined the then-emerging field of nursing informatics as “a combination of computer science, information science and nursing science designed to assist in the management and processing of nursing data, information and knowledge to support the practice of nursing and the delivery of nursing care.”

A component of the broader health care informatics field, nursing informatics has evolved into its own distinct specialty, explains Barbara Carty, Ed.D., clinical associate professor at New York University’s division of nursing and coordinator of the school’s nursing informatics program. “We’re talking about a specific domain—the language of nursing, patient care related to nursing and systems that have specific interventions.”

Consider the transition from paper to electronic patient records and you’ve merely scratched the surface of applications for the nurse informaticist. In theory and in practice, nursing informatics includes:

• hospital integration of information technology;
• the use of computers to educate patients and staff;
• tracking of hospital data to analyze anything from patient outcomes to hospital finances; and
• electronic communications with patients in their homes or medical professionals at other institutions.

“There is so much health care information out there,” Carty explains. “Managing this data is so important for quality care, to prevent duplication and to look at outcomes. Being able to trend and track outcomes is so important because it could tell us the best way to treat patients.”

History will likely look back on these days as nursing informatics’ formative years, given that there is significant ambiguity about the field. “In 1990, I interviewed about 97 specialists in this area,” Carty says. “They were just beginning to define what they did. It ran the gamut—they were managers, clinical information specialists, systems analysts, systems designers. It was a hodgepodge and it still is.”

Although the American Nurses Association began granting certification credentials in informatics as a specialty in 1995, Carty says only three programs in the country focus on the specialty at the graduate level: NYU, the University of Utah and the University of Maryland. She feels strongly that training should be at the graduate level for any nurse seeking to pursue the field. “It’s comparable to advanced practice,” she notes.

Hospitals all around the country have begun to recognize the importance of bringing nurses into this developing arena. Jean Soong, R.N., clinical systems project coordinator at Good Samaritan Hospital in Los Angeles, says that facility has increased its need for systems analysts since six years ago when she was the sole nurse liaison from the clinical realm to enter the computer arena. Now, her department deals with managing an array of data, anything “that is being captured on paper or by the system that relates to patient information,” she explains. “Standardization and uniformity of the information is a big issue.”

Soong was recently involved in recruiting a business systems analyst to the hospital, a job with such responsibilities as preparing and implementing clinical systems for nursing and other medical departments, developing training materials and researching clinical practice related to technology.

The ideal analyst, she says, understands the hospital business and the clinical aspect of practice, and can optimize a computer system to integrate the two. Nurses are uniquely suited to do this, Soong adds: “A clinical practitioner brings an understanding of patient care processes in a hospital environment. Nurses should innately have this understanding from doing patient assessments. Understanding these processes can [enable] automated systems to achieve those same results.”

Involving nurses in the development of information systems also helps the institution secure the support of nurses on the floor. At San Antonio Community Hospital in Upland, Calif., nurses are enthusiastic about the clinical information system that has been in place there since 1984 and that enables them to chart quickly and retrieve the information just as swiftly.

“It’s user-friendly to the nurses here and they do see a benefit from it,” says Angelique Weathersby, R.N., clinical analyst in the hospital’s information systems department.

Stepping Onto the Pathway

How do nurses get into informatics positions? Weathersby has been a critical care nurse for more than 20 years but was still new to nursing when she decided that she might not be able to meet the physical demands of bedside care through her entire career. Still, the thought of leaving the profession did not appeal to her. “I liked nursing and I appreciated the flexibility that I had in being able to work weekends and go to school during the week,” she recalls.

While taking a marketing class, Weathersby encountered a professor who encouraged her to pursue her M.B.A. degree, which she did, receiving her degree in information systems in 1993. Reluctant to give up her nursing practice, she accepted a job with a software company that produced clinical information systems, but believed she would be back at the bedside in a year. As it turned out, “I really liked it,” she says of the high-tech job. “I started in their marketing department, providing sales support, doing [software] demonstrations and traveling around to trade shows.”

Almost four years later, the education bug again bit Weathersby. Her former employer was unable to provide her the time she needed to take classes, so she changed jobs to her current position, which has brought her even closer to the clinical setting. “I’m an analyst for the lab here. I code screens, design pathways and design reports for the lab department,” she says. “I’m learning new skills and I have the flexibility to go back to school and get my Ph.D.”

Weathersby, who is president-elect of the American Nursing Informatics Association, talks about her job enthusiastically, noting that although she is the only woman in her department, she is resolute to attract more nurses to the field. “It is my personal mission to educate other nurses about the field and its opportunities. I am also African American, and that makes me a distinct minority in the field, but it’s an excellent field to get into,” she says. “There’s a lot of opportunity and a lot of potential in it.”

That opportunity became apparent to NYU student Eugene Ragat, R.N., B.S.N., CCRN, in 1995. With more than 15 years experience in critical care nursing, he was introduced to the field by an acquaintance who was studying nursing informatics.

“She gave me an overview of what nursing informatics was all about,” Ragat recalls. “I realized that was what I wanted to do. The problem was that it was only offered [as a graduate course of study] at the University of Maryland. I inquired at NYU again two years later and found out that the university was starting its graduate program in nursing informatics in 1998. I took that opportunity to gather all the requirements that were needed to get in and by the fall of 1998, I found myself in the program.”

It may come as a surprise to hear that Ragat doesn’t consider himself a computer expert. “I didn’t even have a PC before attending school,” he notes. “I taught myself more about computers as soon as I got to my graduate studies—[programs like] MS Word, Excel, Access and PowerPoint. I am now at a point where I am comfortable using these applications.”

When he graduates next year, Ragat plans to pursue a career as a hospital project manager. “I want to help not only the nurses but also all health care professionals and ancillary personnel in facilitating their workflow. I want them to see outcomes that will help them make decisions in their practice,” he says.

Eugene Ragat, RN, BSN, CCRN

Currently working as project coordinator in a level-one trauma center in Manhattan while he completes his graduate studies, Ragat combines his medical experience with his observations of the facility’s business processes and operations. “I firmly believe that as an informaticist, I can make a difference in clinical practice by helping clinicians see outcomes and make decisions at the point of care, thereby improving patient care and reducing cost. I envision that as we move forward with computerization in health care delivery, clinicians will be more apt to use data analysis in practice.”

No statistics seem to be available showing how many African Americans, Hispanics, Asians, Filipinos or Native Americans pursue nursing informatics as a career, but Ragat adds that as a minority, he’s never felt awkward following this path. “I never felt uncomfortable being a minority. When I took the job as informaticist, I was very uncomfortable because I did not have the appropriate skills and knowledge,” he asserts. “But I got support from nursing management and by working closely with my clinical instructors. I then began networking and started to know the appropriate people at work. . .I am more than willing to someday be a mentor to a nurse who wants to be an informaticist, [but] minority or not, if one wants to be a nurse informaticist, there shouldn’t be any problem.”

Not Too Far From the Bedside

Nursing informatics is currently widely used to streamline various data-intensive procedures. Weathersby describes a recent project she completed along with the hospital’s computer programmers, allowing the hospital to retrieve nurses’ notes specific to patient education: “The [Joint Commission on Accreditation of Healthcare Organizations] wants to see that patients are being educated about their diagnoses and their treatments. That information wasn’t as easy to retrieve as it should have been, so we redesigned that pathway to make it easier. We analyzed workflow, designed how the [computer] screen should look and trained the users.”

While not strictly clinical in nature, an application such as this does benefit from program designers who have bedside experience. One of three nurses on the hospital’s five-person medical information systems team, Weathersby says her background in clinical practice enables her to ask qualitative questions and make the medical judgments necessary when automating the often fuzzy realm of health care.

For example, when designing a program to analyze the education of cardiac patients, nurses bring to the table a knowledge of patient assessment criteria: Does the patient have a supportive home environment? Does he have access to medication? What outcomes are the medical staff looking for? “It’s difficult to measure these things,” she says.

San Antonio Community Hospital does not require Weathersby to maintain her clinical expertise, but she attests to the need to do so. “I still work every other weekend in the recovery room to keep my skills up,” she says. “There are new medications that you need to know, new machines, treatment and research. It keeps you current.”

Educators agree that familiarity with patient care helps make a nurse informaticist more effective. “One of the things that we stress is that anybody who comes into [nursing informatics] should come in with a clinical background,” Carty asserts. “Know information flow and patient flow, because you can’t be instrumental in developing systems unless you understand those things.”

Other elements common to the nurse’s job make him or her particularly well suited to this budding specialty. “You have to be able to work with people, be open to change, be articulate, be able to solve problems and be the one with the vision,” Carty adds. “But these are things that nurses do every day.”

“Nursing is inherently involved in the total care of the patient,” Weathersby concurs, “not just the disease, but in social support, access to health care, family support. You bring all of that in when you design these systems.”

Aside from their holistic approach, nurses also acquire particular skills that serve them well in informatics. Because educating users is a big part of the job, a nurse informaticist must be able to explain various aspects of technology to a largely non-technical audience.

“The number of people at different levels who I interact with sometimes is overwhelming,” Ragat admits, “but I have learned to deal with them. I feel comfortable teaching newly hired nurses and even old-timers. I also learned that I needed to have enough patience when interacting, especially teaching those who don’t have computer experience. I have to be very diplomatic in most situations and at the same time be assertive. The bottom line is that communication is a key element for a nurse informaticist.”

Making Progress

Weathersby also thinks that nurses are uniquely suited to move the field beyond its current stage of development. She envisions, for example, greater capabilities for the San Antonio Hospital system. “A lot of things that could be done, like [evaluating] whether patients are getting the best care, are not being addressed yet,” she says. “It’s not yet at the analytical level.”

This may be as expected. “The entire health field is in its infancy, as far as information systems go,” Weathersby notes. “It’s years behind the financial industry, for example. You can go to any ATM anywhere in the country and get money out of your account. Health care is nowhere near that. If you go into a [new] hospital, you answer the same questions all over again.”

One very big issue that health informatics is concerned with is protecting the confidentiality of patient records.

Carty, however, is confident that progress will be made and foresees the day when nursing informaticists move out of the hospital, where most now work. “With the explosion of the Internet, we are seeing informatics spread out in a number of areas. Home health care and community health will be the next expansion,” she predicts. “Nurses will do home visits with laptops and hand-held computers... I can see nurses using e-mail to communicate with patients.” (For an example of informatics at work in the community, see Informatics Project Targets Diabetics.)

“This is a very exciting field for nurses,” Carty sums up. The profession is in a position of empowerment, she says, because nurses can have a hand in the design and implementation of these emerging systems. “Nobody knows the information flow better than nurses. It makes them a natural fit.”

Paula Lipp is editorial manager of Minority Nurse.

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