Is 'Nursing Informatics' really a 'Nursing' specialty?

Specialties Informatics

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  1. Is 'Nursing Informatics' really a 'Nursing' specialty?

    • 37
      Yes
    • 11
      Yes, but I wouldn't bother countering his argument
    • 5
      No
    • 1
      No, but I wouldn't bother countering your argument

13 members have participated

Is 'Nursing Informatics' really a nursing specialty?

The following is a discussion that is taking place right now in one of my classes. We were just discussing competencies for each of our chosen nursing specialties. It somehow led to this conversation which, if the management student's view is right, means that I am doing my MSN in a non-nursing specialty!

Since so many informatics nurses and wannabe informatics nurses frequent this forum, what better place to ask this question than here!

So...

How would you respond to this MSN (Nursing Management) Student (gentleman)?

Dear MSN (Nursing Management) Student,

Very detailed posting that included all the different points.

Every specialty area in nursing has developed competency statements. For example:

Curran, C. R. (2003). Informatics competencies for nurse practitioners. AACN Clinical Issues: Advanced Practice in Acute & Critical Care, 14, 320-330.

Not sure if Informatics is the same/similar to CSM.

APA: Is Stetson a journal article? Need to include specific source. Where is it posted or linked? Electronic source or something else?

- MSN (Nursing Theory) Professor

Dear MSN (Nursing Theory) Professor,

They are not the same. Informatics is a part of Clinical Systems Management by virtue of the fact that in a complex adaptive system of healthcare, computerization, EMRs and hence informatics has come to occupy an increasingly important role.

Stenson (2006) is not a journal article - it is a website that has been cited in the description of this week's discussion forum on the main page of the 'discussion' area.

- MSN (Nursing Informatics) Student

Dear MSN (Nursing Informatics) Student,

At the risk of alienating nurses who work in nursing informatics I want to make an observation related to nursing informatics. Informatics is really not a nursing specialty. Informatics is part of the organizational infrastructure (i.e. IT, MIS). I've worked in IT for major (non-healthcare) corporations for decades prior to becoming an RN. None of these corporations identify informatics as part of their main business. For example, there isn't a stockbroker informatics specialty or is there an accountant informatics specialty yet there is a nursing informatics specialty. Informatics is a specialty unto itself regardless if informatics is used in healthcare, Wall Street or WalMart. Professionals who work in informatics typically have degrees in MIS or computer science and are able to identify and translate business requirements into a working computer application (i.e. EMR, CPOE, EMAR) with the assistance of business professionals (i.e. nurses, physicians). Now that I probably got myself in trouble with everyone who is majoring in nursing informatics (my apology :) ), I have to agree with MSN (Nursing Informatics) Student that informatics is part of clinical systems management, however informatics is a support service to clinical systems management just like other areas of MIS (i.e. networking, hardware.)

- MSN (Nursing Management) Student

Dear MSN (Nursing Management) Student,

Based on this observation, then, would you be able to say educational programs and certifications and research activities towards expanding the knowledge base of 'specialties' like health informatics or medical informatics or bioinformatics or nursing informatics are merely trying to exploit the job market to attract nurses or other healthcare professionals who wish to be involved in the informatics arena?

- MSN (Nursing Informatics) Student

Dear MSN (Nursing Informatics) Student,

I think what is happening is that the healthcare industry embraced informatics within the last 10 years where other industries have built their industry around informatics for decades. The assumption seems to be that informatics is a new field of nursing and therefore programs (i.e. certifications) are established to qualify nurses for this new specialty. Exploitation is probably too harsh of a word. Instead I believe we're seeing an evolutionary step in what has become nursing tradition to be certified in a specialty. Since I'm coming from a non-healthcare industry where I was heavily involved in designing and building computer applications, I'm puzzled why informatics is a nursing specialty. Systems analysts, programmers, project managers have the necessary background to develop and implement EMR, CPOE, EMAR and other healthcare informatics systems. On Wall Street, managers ask the IT department - not a trader - to handle informatics. So why shouldn't the hospital administrator ask the IT department to handle informatics? As the healthcare industry becomes more comfortable with informatics, I think informatics will become a support function as it is in other industries. With that said, I found informatics a fantastic field that can have a dramatic effect on the organization's operations. I'm sure training in nursing informatics will provide the same skill-sets as IT professionals who perform a similar job in non-healthcare industries.

- MSN (Nursing Management) Student

Dear MSN (Nursing Management) Student,

The difference is that nursing informatics encourages the development of IT competencies in addition to the already developed/developing nursing competencies that a nurse possesses.

We have seasoned IT professionals in our department who are not able to understand the end-user's needs even after multiple meetings because they lack the nursing competencies. It is not their fault if they do not understand the nursing workflow and/or the reason for it.

One of the advantages of a nursing informaticist is that he/she can speak/understand nursing lingo as well as IT lingo. They're able to leverage knowledge from both areas of expertise to develop/ troubleshoot/ build/ maintain/ improve a system that is truly beneficial in helping the healthcare provide enhance the quality of patient care.

Have you heard about pharmacy informaticists, laboratory informaticists, and radiology informaticists? I believe the reasoning behind those specializations is also the same / similar.

- MSN (Nursing Informatics) Student

Dear MSN (Nursing Management) Student,

In other industries, there are business analyst and systems analyst. A business analyst compiles business rules from business operations by talking with all stakeholders. The business rules are handed to a systems analyst who translates those rules in a logical flow (pseudo code) that programmers convert into the application. It is common for a person knowledgeable of the business taking on the role of a business analyst for the project and then returns to his normal job once the analysis is completed. Therefore, the nurse informatics specialists would fill the job as the business analyst.

From my IT experience, the problem you describe is an experience problem. An IT person not familiar with the business is learning the business while trying to learn business rules. An IT person who is familiar with the business (i.e. worked on several EMR implementations) would understand the lingo and what the business rules are - and should be. My latter point (i.e. should be) is very important. Not all policies and procedures are followed therefore the business rules presented by the nursing staff to the IT analyst may not be the same as policies and procedures. I recall being that IT person once at a Wall Street firm. A trader showed me rules he followed doing his job. I confirmed that with his boss - and she said "that's not how we do it."

My point is that a nursing informatics specialists is moving from nursing (i.e. caring for patients) into IT, which not a problem. However, I don't think nursing informatics is really a nursing specialty as compared to emergency nursing, critical care nursing, or behavioral health nurse.

- MSN (Nursing Management) Student

Dear MSN (Nursing Management) Student and MSN (Nursing Informatics) Student,

Thanks for your comments. It is interesting that nursing, as a profession, has many specialties and sub-specialties with their own areas of interest, education, and certification. When groups of nurses first started focusing on the use of technology in practice, informatics was born. I believe it was related to the level of technology available at the time. As pointed out, technology has expanded to all areas of work to broadly include complex systems management.

Very interesting discussion on the topic which expands everyone's knowledge and perspective.

- MSN (Nursing Theory) Professor

Would you continue the discussion if you were in my place?

Or would you just let the ignorant wallow in their bliss for the sake of your sanity?

Nursing Informatics is an antiquated term for Health Information Technolgy. HIT encompasses dozens of specialty fields, and 'all' of them are better suited to actual nurses than to lay people that obtain IT or HIT degrees (or certifications, if even that). If nursing weren't so divisive, there wouldn't be such a flurry of new occupations forming all of the time to replace actual nurses with lay people, whether that be ancillary jobs such as MAs, PCTs, PCAs, med techs, etc. or office people operating in practice management, medical billing and coding, insurance, case management, and a million other areas of healthcare. None of these people has the needed knowledge of what the totality of health care involves. And increasingly, these clueless people are in a position to determine what health needs a patient has, and whether or not to pay for it- even if they don't know the difference between a colonoscopy and a brain tumor, without looking it up in their manuals. This is a much larger issue than has been presented.

If nursing weren't so divisive, there wouldn't be such a flurry of new occupations forming all of the time to replace actual nurses with lay people, whether that be ancillary jobs such as MAs, PCTs, PCAs, med techs, etc. or office people operating in practice management, medical billing and coding, insurance, case management, and a million other areas of healthcare. None of these people has the needed knowledge of what the totality of health care involves. And increasingly, these clueless people are in a position to determine what health needs a patient has, and whether or not to pay for it - even if they don't know the difference between a colonoscopy and a brain tumor, without looking it up in their manuals. This is a much larger issue than has been presented.

Ha ha... we'll have a discussion on our hands if someone in your target population takes the bait :)

The purpose of nursing informatics is to assist nurses in using information to provide nursing care (facilitating the use of data to create wisdom). A IT department can create software programs and implement technology into clinical settings, but failure to fully evaluate the nursing work environment is one of the leading causes of failed implementations. A programmer can create a system that is perfect by their standards, but is completely useless by the endusers. Informatics in nursing focuses on the information flow needed to provide nursing care. Nursing informatics is needed to bridge the "techs" with the nurses. "Techs" have no clue what the information needs of nurses are. Just ask any informatics nurse who has had to implement a system that was initially led by only programmers, who waited until the end to ask nurses how they will actually use the system. I have seen a particular implementation be completely unused because it was designed without the nurses workflow in mind.

The purpose of nursing informatics is to assist nurses in using information to provide nursing care (facilitating the use of data to create wisdom). A IT department can create software programs and implement technology into clinical settings, but failure to fully evaluate the nursing work environment is one of the leading causes of failed implementations.

Informatics in nursing focuses on the information flow needed to provide nursing care. Nursing informatics is needed to bridge the "techs" with the nurses.

Just ask any informatics nurse who has had to implement a system that was initially led by only programmers, who waited until the end to ask nurses how they will actually use the system. I have seen a particular implementation be completely unused because it was designed without the nurses workflow in mind.

Regardless of the angle used to argue these points, it is the truth BCRNA, and I can attest to it!

My doctoral dissertation arose out of that question. My conclusion was that Nursing Informatics CAN be nursing if the person approaches the topic from a nursing perspective (nursing philosophy, theory, culture, ethos, etc.). However, it can be Informatics focusing on a nursing situation if the person approaches/views the situation from only an Informatics perspective.

In other words ... it can be either Nursing or Informatics depending on how the person views/considers the situation. Do they use a nursing perspective or an informatics one? That is the key.

That's interesting, llg - I never thought of it that way!

Whether Nursing Informatics is Nursing or not depends on the approach each Informatics Nurse has towards her/his job - is that the gist of your doctoral dissertation thesis statement?

Specializes in Nursing Professional Development.
That's interesting, llg - I never thought of it that way!

Whether Nursing Informatics is Nursing or not depends on the approach each Informatics Nurse has towards her/his job - is that the gist of your doctoral dissertation thesis statement?

Yes. The term "perspective" refers to both the angle that one views a situation from and also the lens through which someone looks. So ... if someone looks at a situation from a nursing perspective (using nursing philosophy, theory, nursing cultural norms, etc.), that person can incorporate informatics knowledge into their nursing practice -- in other words, still be practicing nursing as they are "doing" nursing informatics.

But ... if a person comes from an informatics perspective (informatics philosophy, theory, ethos, etc.) and is simply using an informatics perspective to address a situation that just happens to be nursing (but could be something else) ... then that person is really practicing informatics, not nursing.

It's a continuum. To what extent does the person use a nursing perspective and to what extent do they rely on an informatics perspective? That's the key. I have known people in Nursing Informatics who were/are definitely practicing nursing -- using informatics knowledge/skill while they approached the situation as a nurse. I have known others who were barely nurses -- if they could be called nurses at all -- for whom the fact that this was a nursing situation was just incidental. The situation could have been in any context to them as they did not come from a nursing perspective at all. Nothing about them or their actions reflected nursing.

Yes. The term "perspective" refers to both the angle that one views a situation from and also the lens through which someone looks. So ... if someone looks at a situation from a nursing perspective (using nursing philosophy, theory, nursing cultural norms, etc.), that person can incorporate informatics knowledge into their nursing practice -- in other words, still be practicing nursing as they are "doing" nursing informatics.

Thank you for the response, llg! Perspectives are indeed 'ways of seeing,' and are influenced by background and experience.

Won't all nurses with some clinical experience come from a nursing perspective then?

Have you seen some informatics nurses move on to use some other framework, and then refuse to use a nursing perspective altogether?

Specializes in Nursing Professional Development.
Thank you for the response, llg! Perspectives are indeed 'ways of seeing,' and are influenced by background and experience.

Won't all nurses with some clinical experience come from a nursing perspective then?

Have you seen some informatics nurses move on to use some other framework, and then refuse to use a nursing perspective altogether?

Some nurses "fall in love" with the perspectives of other disciplines as they become deeply involved with them through graduate school, work, peer relationships with people in those other disciplines, etc. For example, some nurses who get MBA's and go into Administration start relating so much to the business side of healthcare that they seem to forget their nursing roots. (Others don't forget their roots, of course.) Similarly, the same thing can happen with Nurse Practitioners, who become so enamored with the "medical model" that they start to "put down" the very nurses they used to work with -- but others don't, of course.

It can happen to anyone who felt the direct-care was "not a good fit for them" and who then got a graduate degree in another field (or in specialty with a lot of content from another discipline.) They feel more comfortable with the content of that other field and start identifying more with that other field than do with the average nurse. Their sense of identity and their perspective become increasingly that of the other field and less and less that of nursing. As I said, it's a continuum of persective and professional identify -- not always clear cut.

Here is a question that helped me think through my dissertation:

Imagine 2 students both getting Master's Degrees. One is an Informatics student who has never been a nurse. The other is getting his/her MSN in Nursing Informatics after having been a nurse for many years -- and who has attended fine nursing schools that provided a strong foundation in nursing theory, research, history, culture, etc.

Both students choose to work on the same project for their Master's thesis. How will those theses differ? Will the perspective of the 2 students be different? Will their approaches? Theoretical foundations? etc. How will the foundations of the 2 students' education and experience influence their projects? Should they be identical or should they be different?

The thesis of the Informatics student should further the development of knowledge in Informatics. The thesis of the Nursing student should further the development of Nursing knowledge. They should be coming from different disciplinary perspectives -- and that should be evident in their projects. Think about how that would show up in their projects.

If Nursing Informatics is going to be a considered a nursing specialty, then they need to be different -- and people getting graduate degrees in Nursing Informatics should know how and why they should be different.

Thanks for the thread. It's been fun for me to re-visit this topic that once consumed so much of my time and attention.

:geek:

If Nursing Informatics is going to be a considered a nursing specialty, then they need to be different -- and people getting graduate degrees in Nursing Informatics should know how and why they should be different.

Thank you llg - I understand your point better now :)

I am not sure if it is considered appropriate, but I'd like to ask you - can I read your dissertation? I may not be able to read it right away - but I'd consider myself privileged to be able to take a look at it.

Let me know :)

Specializes in Nursing Professional Development.

Info(RN)matics: Check your private mail. I'll answer your request there.

llg

That is alot to read. I can tell you from the Army's standpoint, they are starting to move away from placing nurse informaticists in the Dept of Nursing due to the fact that this limits their capabilities. They remain a nursing asset and can't really delve into other arenas such as outpatient clinics and physician workflow, etc. They have become smarter and have begun placing them in the Information Management Dept which opens up their scope to the entire facility. They are becoming CMIO's of their facilities. They tried having CNIO's and then making a physician the CMIO, but it didn't work out because there was too much redundancy. Nurse informaticists no longer work with just nurses, but it's their clinical experience as nurses that give them their unique insight. We can also be MUCH cheaper CMIO's! Think of it as sorta like Nurse Practitioners. They can now do just about anything physicians can do (especially since it's now a Doctoral program!), but are much cheaper to hire! Is NP no longer a nursing specialty now that it's a doctoral program? Not exactly the same, but you catch my drift.

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