Are you the tech-savvy nurse on the unit? Do your colleagues seek you out with questions about the quirks of your electronic health record (EHR)? If so, consider turning that know-how into a career in nursing informatics.
A background at the bedside is critical for a successful nursing informatics role. “There’s typically some kind of clinical experience involved before jumping into an informatics role,” said Christy St. John, MSN, RN, NI-BC, CPHQ, president of the American Nursing Informatics Association (ANIA), in an interview. “To come straight from your studies into informatics is fairly rare.”
A combination of clinical nursing experience and education in informatics is essential, according to Melinda L. Jenkins, PhD, FNP, associate professor and director, nursing informatics specialty, Rutgers School of Nursing. Experience with patient care in the clinical setting is essential to the nursing informatics role because this role is the connection between the clinical setting and the technology piece of healthcare, says Lori Martone-Roberts, DNP, RN, CHSE, director of simulation and professor of the practice of nursing, Wheaton College.
Although training and hands-on experience with technology is important, Michael Mickan, chief nursing informatics officer at Memorial Hermann Health System, looks for experience using the tools on hand and a natural curiosity that leads to self-teaching. He feels that a nurse with that kind of informal experience is usually more successful as a nurse informaticist than those who wait to be formally trained before exploring a new technology.
Range of Skills
You’ll need to bring many skills to a nursing informatics role. Mickan outlines a variety of abilities:
Communications: Nurse informaticists must be able to provide “translation” of patient care, and clinician needs to technology partners as well as technology concepts and requirements to clinical users and communicate with various disciplines.
Problem-solving: Informaticists must be able to identify the real problem with astute observation and critical thinking encompassing people, processes, and technology.
Change management: Nurse informaticists must understand change management strategies and be comfortable facilitating, guiding, and managing change.
Project management: Often, a nurse informaticist facilitates collaboration between clinical and technology partners to solve problems and support the optimal use of technology. To do this effectively, proficiency in project management is a must.
Data analytics: Nurse informaticists must have a solid grasp of the data that validates the problems to be solved and provides the baseline for measuring progress.
Day-to-Day Projects
What kind of work will you do on a daily basis? An example, notes Martone-Roberts, could be to evaluate workflows or improve usability and streamline processes, leading to improved functioning and efficient data capture.
She notes that nurses in the nursing informatics role will work with EHRs in various ways, including managing information and troubleshooting issues when healthcare professionals use the system. Other projects involve training, validating, and reporting data and ensuring the collected data is useful.
She suggests that one example of a project could involve using chatbots to keep a patient engaged and decrease re-hospitalization. Similarly, Mickan outlines workflow analysis and optimization projects, working with clinical decision support systems and EHR implementation and optimization.
Growing Field
When it comes to future demand for nursing informaticists, “I see it as a growing sector,” says St. John.
“I think sometimes it’s a matter of being a little bit more broad in the way we think about nursing informatics,” she notes. Instead of simply searching for the term on a job site, a job search can be more about “opening my eyes to things that might include AI, analyst, or health informatics roles. I think nurse informatics roles will be more in demand in the bigger picture of health technology.”
Education and Certification
According to Martone-Roberts, you’ll need an RN and BSN to serve in a nursing informatics role. Also, she says, a nurse with a master’s degree in healthcare informatics, nursing informatics, or data management will be better positioned to succeed.
Although one of the more technical roles in nursing, nursing informatics still has patient care as the end goal. “At the end of the day, what we’re after is better outcomes for the populations that we’re serving, whether that’s in the inpatient setting, whether that’s in an ambulatory setting, whether that’s in our communities,” says St. John.
Nurse burnout continues to hinder the healthcare system across care settings. Hospital margins are thinning, and allocating resources to nurse retention and engagement is imperative to offset the cost of losing nurses. The average cost of turnover for one bedside RN is $52,350 – which can add up to expenses between $6.6M-$10.5M, according to a recent retention and staffing report stating “each percent change in RN turnover will cost/save the average hospital an additional $380,600/year.” In skilled nursing facilities, regulated staffing levels will likely impact quality care scores and reimbursements in the future. Staffing and reducing turnover are top of mind for healthcare leaders everywhere, even more so as they continue to look ahead to 2024.
Overcoming Nurse Burnout
While the industry challenge of nurse burnout is clear, the right approach to ease nurses’ burden is harder to decipher. Staffing leaders must balance competing priorities, such as investing in expensive agency labor versus racking up internal hours and offering nurses more flexibility to choose the best shifts while ensuring every shift is filled.
Three themes are among the top strategies to address nurse burnout: improving communication, increasing flexibility, and supplementing staff.
1. Improving Communication Between Nurses and Managers
Many organizations need help in traditional staffing workflows, tediously tracking multiple spreadsheets or using one-by-one phone calls or text messages to make scheduling adjustments and fill last-minute openings. This approach is not just time-consuming; it’s disruptive, siloed, and does not take advantage of widely accepted and expected technology.
With healthcare workforce software to deploy one-to-many communications, nurse leaders can post shifts, set rules for shift selection, and relay scheduling needs quickly – for example, by implementing a first-come, first-served open shift approach or shift bidding based on seniority or other factors. This respects nurses’ time and frees up time for nurse leaders to focus on their team’s growth and development, supporting operations, and improving patient care.
2. Giving Nurses More Flexibility
More shifts are not the answer to nurse burnout – but more scheduling options could be. With real-time scheduling available at their fingertips, nurses have the necessary flexibility. More choice empowers them to select schedule changes that best fit their work-life balance. It gives nurses the freedom to trade shifts or take on open shifts and makes them feel like they have control over their schedule, motivating them to do their best work.
Greater scheduling flexibility can reduce the likelihood of no-shows or call-outs and reengage nurses in their work, preventing turnover. Meanwhile, nurse leaders can ensure these individual choices are made with commitment rules in mind by defining scheduling rules that make their staffing software work with their team’s unique needs.
3. Supplementing Staff with Agency Nurses
For some healthcare leaders, agency staff can be an expensive response to reducing burnout and attrition. However, it could be the more affordable option in the long run. Compared to the cost of losing a nurse and the time it takes to hire a new nurse, the investment in supplemental agency staff could greatly outweigh the costs of staff turnover. If managed well, agency staff becomes an extension of the team – used as needed, but not the immediate response to every open shift.
At the core of all these decisions is data and using available technology. Schedulers must have confidence in who is doing what, when it’s happening, and where it’s taking place. Clear, at-a-glance staffing data differentiates between taking a one-size-fits-all approach and making appropriate staffing adjustments based on an organization’s most significant contributors to burnout and resignations.
Accessible staffing data revenue objectives and organizational goals empower healthcare leaders to take a holistic approach. They can weigh their options and resources from a united front and choose investments to target specific challenges while understanding the impact this may have on another aspect of the organization.
Smarter Planning Leads to Reduced Stress, Higher Satisfaction
While there are many options to address nurse burnout, one thing is clear: better staffing management is necessary. In fact, 57% of nurses planning to leave the workforce would reconsider returning to their position if their workplace implemented a more flexible approach to scheduling and shift management.
With data and a smart workforce management solution, staffing leaders can make thoughtful, more informed choices that fluctuate seamlessly with day-to-day, real-time scheduling needs. Nurses can impact their schedule and sign up for shifts that give them the best work-life balance through technology customized for their practice. Managers can refocus their time to make strategic staffing decisions. And ultimately, patients get high-quality, uninterrupted care.
Throughout history, new technologies have always sparked legitimate fears that some jobs will be radically changed or eliminated due to innovation. The telegraph, the telephone, the tractor, the steam engine, the internet, robotics, artificial intelligence — each of these developments has brought some form of change in the job market, the viability of particular professions and skills, and how things get done.
When it comes to nurses and the nursing profession, innovative technologies might give us pause to consider what nurses do, how they perform specific tasks, and if the profession might stand to lose something.
While medication-dispensing robots, telemetry, electronic fetal monitoring, artificial intelligence, and other technological advances have altered our work as nurses, fears that robots will replace us and send nurses into the historical career dustbin are likely unfounded. New opportunities are being created as nurses embrace emerging technologies and become educated and trained in valuable 21st-century skills.
The Human Touch
Nurses are the most trusted profession in the United States because they touch patients literally and figuratively daily. The trust between nurses and their patients is born mainly from the human-to-human interactions that make nursing a compelling combination of an art and a science.
No matter how efficient a robot may be in doling out medications and how powerful artificial intelligence and machine learning may become, the absolute humanity of nursing care would be impossible to replace with a machine entirely.
The physical assessment of a newborn, the expression of empathy, and the practice of hospice nursing are just three areas that come to mind where the human side of nursing care is so utterly crucial. While an immersive virtual or mixed reality application could be utilized to educate a patient about dialysis or provide basic diabetic teaching, no application can take the place of a nurse sitting on the edge of a patient’s bed, holding their hand, and providing emotionally intelligent supportive counseling as the patient mentally prepares for surgery.
The human side of nursing is the art that maintains the sacredness of the nurse-patient bond. Nursing may be partially driven by plans of care developed within the parameters of the nursing process, but where the rubber hits the road is where person-to-person interaction informs the patient experience and the nurse’s calling.
Nursing Embracing Technology
Rather than considering how technological advances might cause nurses to be replaced by machines, the more likely new reality is that of nurses embracing technology in the interest of their careers.
Nursing informatics has opened new career paths for nurses interested in computers, data management, and analytics. Nurses who master their facilities’ electronic medical records can make themselves invaluable as super users capable of training other nurses and staff in using an EMR.
Nurses pursuing master’s and doctoral degrees in informatics can pursue previously closed opportunities, including positions such as Chief Nursing Informatics Officer (CNIO). For nurses who can find such opportunities, companies creating new bedside technologies and digital interfaces will need skilled clinicians who can act as consultants on testing devices and applications that have yet to be ready for prime time.
The Robots Won’t Be Replacing You
Although science fiction could tell an entirely different story, the reality is that we won’t be seeing autonomous robot nurses speeding from room to room, providing hands-on patient care without ever needing a break for dinner or the bathroom, at least not anytime soon.
Rather than considering how the robots may be coming for your nursing job, perhaps it’s best to focus on how you can embrace them and leverage these new developments to the advantage of your nursing career.
Don’t worry — the robots won’t be rolling into town next week to staff the ICU. But if you’re a nurse wondering how the tech revolution could revolutionize your nursing career, there’s much to learn and new opportunities just around the corner.
Virtual nurses may work from behind computer screens, but their impact is felt throughout healthcare as their expertise is increasingly integrated into patient care and nursing workflows.
Since the invention of the telephone in the modern digital age, healthcare providers have used telecommunication tools to bring clinical expertise and care to wherever patients need them. Regardless of the technology, nurses play essential roles throughout telemedicine, usually conveying or using insights or information.
Simply put, virtual nursing is the practice of nursing using telecommunication and telehealth tools and technologies.
Initially focused on increasing access to care in rural and remote areas and responding to the aftermath of natural disasters, telehealth, and virtual nurses have become part of the care provided to thousands of patients across the globe every day. They now support clinical teams throughout the patient care continuum to help ease the overwhelming demands and address serious healthcare issues.
During the COVID-19 pandemic, many care providers considered how telehealth tools could be used in innovative ways in the care of patients. The United States Government Accountability Office reported a 15-fold increase over the prepandemic level in telehealth use among Medicaid beneficiaries. Numbers skyrocketed from 2.1 million in the year before the pandemic to 32.5 million from March 2020 to February 2021.
Teresa Rincon, PhD, RN, FCCM, is a pioneer in virtual nursing. In 2003, she was one of the first nurses to practice from behind a camera as part of a teleICU. Today, she is an assistant professor at UMass Chan Medical School and its Tan Chingfen Graduate School of Nursing in Worcester, Massachusetts, and a senior telehealth consultant with Blue Cirrus Consulting, Greenville, South Carolina. She recently served as editor for a symposium of articles on virtual nursing for AACN Advanced Critical Care, a journal published by the American Association of Critical-Care Nurses (AACN).
When Rincon became a virtual nurse, there were fewer than 1,000 teleICU beds in the United States. Over 20 years, that number has grown 20x, with an estimated one in eight ICU patients now monitored remotely.
“The level of technology acceptance has created opportunities to apply the virtual nursing model to ‘virtually’ anywhere,” she said. “The ability to leverage clinical expertise across and despite geographical boundaries is an efficient and cost-effective way to ensure safe, timely, and effective care in critical situations and routine care delivery.”
Immediate Access to Clinical Support
Virtual nurses regularly assist with tasks that do not require physical proximity to the patient, such as patient-family education, completing admission and discharge tasks, and participating in two-person verification processes.
During a patient assessment, a remote nurse and an on-site nurse can efficiently work in tandem, with one managing tasks that require physical proximity to the patient and the other completing tasks such as clinical documentation, patient-family education, and expert nurse surveillance.
Virtual nurses provide an additional layer of clinical support to nurses at the bedside. At the push of a button, bedside clinicians have immediate access to additional nursing support.
This ease of access gives bedside nurses peace of mind, knowing that an experienced fellow nurse is not only assisting in monitoring for changes in a patient’s status but is available to collaborate and assist with care at a moment’s notice.
Virtual nurses serve as valuable mentors to novice nurses as they develop into competent and confident clinicians. They also may support travel or agency nurses to help bridge knowledge gaps caused by a lack of familiarity with specific facilities and policies. In addition, peer-to-peer collaboration can help on-site colleagues feel more supported.
Lisa-Mae Williams, PhD, RN, CCRN, is the chief nursing officer at Intercept Telehealth, Weston, Florida.
“In addition to caring for patients, virtual nurses are helping to address the experience gap by providing an extra layer of support and expertise to the on-site team,” Williams said. “Knowledge and expertise are precious commodities, especially when caring for critically ill patients.”
Beyond the ICU
Virtual nurses and tele-critical care (TCC) programs have become more pervasive, thanks to technological advances, modalities expansions, and the number of patients served.
“We’ve seen significant growth in the number of tele-critical care services, as they expand beyond traditional critical care areas, including to emergency departments, medical-surgical units, and even home-care settings,” said Fiona Winterbottom, DNP, MSN, APRN, ACNS-BC, ACHPN, CCRN, clinical nurse specialist, at Ochsner Health in New Orleans. Advances in technology have led to increased use of mobile carts, which bring the expertise of intensivists and TCC nurses wherever they may be needed. In the emergency department, they can proactively manage patients waiting for hospital admission, providing earlier access to interventions and improving outcomes.
Remote clinicians can also support rapid response teams to help stabilize a patient with a deteriorating condition. The patient can often remain in their current unit and avoid transfer to an ICU. An added benefit is that the mobile cart can stay in the patient’s room, allowing the virtual nurse to continue monitoring them for a defined period.
There are also opportunities to create an observation space in the emergency department where patients who need short-term care for diabetic ketoacidosis, drug/alcohol overdose, allergic reactions, and other issues can get the expert care they need without being admitted to another unit.
Beyond the hospital, wearable devices and monitoring kits that link to an on-call automated system and a mobile app can help patients self-manage at home with a medical support system.
Unlimited Options
Ryan Morcrette, BSN, RN, CEN, is the director of virtual care and clinical communications at St. Luke’s University Health Network in Pennsylvania and New Jersey. “The concept of virtual nursing will continue to mature along with the technology to support it, and we’re going to look back and wonder how we ever provided healthcare without this asset,” Morcrette said. “It will become second nature for patients, bedside nurses, and other clinicians.”
“As we look to the future, we have to think about how to harness the knowledge and skills we need to improve the care we provide to patients. We need innovative solutions to manage the impacts of the global nurse staffing shortages successfully,” Rincon said. “Thanks to telehealth technologies, an expert can be located anywhere in the world and connect with someone who needs their assistance.”
