Winter 2024 Issue

Informatics: Evolving Nurse Informaticist Skill Sets
By Elizabeth S. Goar
For The Record
Vol. 36 No. 1 P. 10

While it’s been around in some form since computers were first introduced into health care, nursing informatics wasn’t formally recognized by the American Nurses Association as a nursing specialty until 1992. Since then, it’s evolved into a role that blends nursing science with technology, utilizing informatics processes to analyze data and support informed decision-making, according to Cait Obenauf, MBA, HIMSS clinical informatics program manager.

Nurse informaticists, she says, support the establishment of a strategic vision for nursing technology. They approach how technology can be leveraged to enhance nursing practices, contribute to a health care organization’s overall objectives, drive major IT initiatives for nurses, and serve on or provide dedicated teams to support clinical applications. They also collaborate with organizational partners, applying system design life cycle processes to improve health care services in line with best practices and standards.

“Their commitment to continuous learning and adherence to professional and regulatory standards make them key contributors to the convergence of nursing and technology in health care,” Obenauf says.

An Evolving Profession
Nursing informatics evolves in tandem with health care and information technology. Where they were once tasked primarily with transitioning to EMR systems and ensuring data could be leveraged for quality improvement, the nursing informatics role has now expanded to include everything from data analytics, population health, public health, and education to workflow and system optimization, security, and even software integration.

An important catalyst for change in the nursing informatics profession is the massive volume of data that flows into health care organizations daily—how to utilize it and how to get it in front of clinicians in real time to support clinical decision-making, according to Lisa Stephenson, chief nursing informatics officer at Houston Methodist.

“It’s now even gone beyond that to [encompass identifying] how to harness all this data that’s out there from multiple different systems. We’re also talking about … how, based on that data, we can provide more predictive tools using AI [artificial intelligence] and how we can automate things for clinicians to make their job easier as far as documentation,” she says. “We are looking at ways to really innovate … with AI and to really understand data more [and how] all the other technology coming to the market can interplay and really benefit clinicians.”

Rebecca Freeman, PhD, RN, FAAN, FNAP, vice president for health informatics at the University of Vermont Health Network and member of the HIMSS Nursing Informatics Community, notes that the direction nursing informatics has taken over the years varies based on practice setting.

For example, in large health systems that have moved past the implementation and immediate postimplementation phases, informaticists are now “more focused on the refinement of optimization, technology selection, education, and/or governance. For the health systems still gearing up for an enterprise EHR implementation, you may still find informaticists working hard to gather appropriate stakeholders and make decisions about the training, support, and design of the new system,” she says.

The maturity of the nursing practice model itself has also influenced the work of nurse informaticists, particularly with the rise in affiliations and mergers and acquisitions. “It is frequently the case that the EHR is the only standard amongst many different approaches to practice. Nurse informaticists can serve a critical role in those governance frameworks, too—supporting the efforts to align practice with expertise on how to best design systems that support nursing best practices for optimal patient outcomes,” Freeman says.

Nursing Informatics by the Numbers
The HIMSS triannual 2022 Nursing Informatics Workforce Survey sheds some additional light on the evolution of the profession as a whole. The role itself has changed in several diverse ways over the past few years. For example, while the title of nursing informatics specialist (17%) remains the most common, clinical informatics specialist (12%) is edging closer, which is not necessarily a positive, according to Tammy Kwiatkoski, MBA, senior director of information operations and implementation at HIMSS.

“While this might reflect their broader role in informatics and collaboration between health care providers and departments, it dilutes the focus of importance on nursing informatics and the specialized training and skills they bring to their organizations. A clinical informatics specialist may not necessarily hold a nursing degree; however, nursing informatics specialists uniquely contribute a vital and essential nursing perspective to their roles,” she says.

The survey also found that reporting structures are shifting, with nurse informaticists reporting most often to information systems/technology (34%), informatics (33%), and nursing (30%). This “shows the importance of the role in cross-departmental collaboration and influence as both a nurse and informaticist. However, there are some concerns on the ability to communicate effectively to the appropriate leadership specifically connecting to the nurse role,” Kwiatkoski says.

The HIMSS survey also revealed the top responsibilities of a nurse informaticist, including systems implementation (41%), system optimization/utilization (35%), project management (30%), systems development (29%), and quality initiatives/reporting (26%).

Opportunities Abound
The evolution and expansion of the nursing informatics profession brings with it a multitude of opportunities. In academia, there’s an increased demand for professors, educators, and instructors. Health care organizations—which employed 60% of respondents according to the HIMSS survey—need nurse informaticists to design, implement, and maintain nursing informatics solutions within the hospital or within a government or public health agency.

Nurse informaticists also play an essential role in vendor organizations, where they focus on ensuring technology products and solutions represent the clinical users’ perspective and meet their workflow needs. There are also opportunities in professional associations and advocacy groups as well as with consulting firms.

Kathleen Morouse, DNP, RN, NI-BC, CCRN-K, the 2023 president of the American Nursing Informatics Association, urges nurse informaticists seeking to optimize opportunities to look beyond traditional titles. Instead, she advises, look for clinical informaticist, analyst, computer informatics, consumer informatics, health informatics, public health informatics, educational health informatics, or research in nursing informatics.

“Informatics nursing skills transfer and fit nicely into quality positions such as quality assurance or quality improvement. Specializing in security and project management are other informatics specialties,” she says.

Desired Skill Sets
To maximize opportunities, nursing informatics professionals should possess a portfolio of skill sets that have evolved with both demand and responsibilities. In particular, today’s nurse informaticists must understand the pros, cons, and potential pitfalls of technological advances like AI to ensure they are used in an appropriate and ethical manner.

It’s about “being able to understand the big picture and seeing things from a larger lens. … Everybody gets pulled in by the nice shiny thing, so it’s important for an informaticist to be able to see that big picture, to see how things integrate. To not be pulled from one direction to another by the technology but by [whether] they fit together in a way that makes sense and really best utilizes the tools within the workflow for the nurse. It’s having that fundamental understanding of clinician needs merged with how technology can benefit them,” Stephenson says.

Successful nurse informaticists must also be able to communicate with leadership about what is needed for a well-rounded technology portfolio that avoids duplicative functionality, does not overwhelm users, and is cost-effective. They should also be problem solvers who are willing to dig deep for solutions.

“Part of that is being a good listener and having that ‘big picture’ mindset to be able to see how things fit together,” Stephenson says, adding that good nurse informaticists will also be “very adaptable and agile, especially with the push for innovation. You need to be able to quickly think through processes and potential impacts of implementations and be able to adapt if things aren’t going correctly.”

The American Nursing Informatics Association’s current secretary, Denise Tyler, DNP, MSN, MBA, RN-BC, identifies desirable characteristics as “critical thinking and analysis as they look at clinical workflows. [Nurse informaticists are] detail oriented and organized due to project management needs [and have] excellent organization skills and communication skills,”

Further, where “years ago, new informatics nurses were not experienced beyond being a super user and basic computer skills,” today’s must be proficient with a range of software, including Word, Excel, PowerPoint, Teams and, in some cases, Visio, and project management applications, as well as data-based skills, and data analytics, she says. They should also possess excellent skills in project management, customer service, and oral, written, and electronic communication.

Obenauf also lists experience with systems development life cycle-related projects, IT competence, and the ability to collect, analyze, and present data at various audience levels as among skills they see most often in job descriptions. Other desired skills include the following:

• the ability to work on several complex issues simultaneously;
• strong critical and analytical thinking skills, which can be used practically to strategize and prioritize in collaboration with business and operational partners;
• the ability to develop business case materials to support strategic priorities; and
• professionalism and an ability to manage stressful situations in a manner conducive to finding resolution.

“The skill sets have evolved over time due to advancements in technology and changes in health care delivery,” Obenauf says. “As technology becomes more integral to health care, nurse informaticists must adapt by acquiring new technical skills and expanding their knowledge of health care systems. The emphasis on soft skills, like communication and leadership, remains constant as they are fundamental to effective collaboration and implementation of technology in health care settings.”

Advances in health care and IT have elevated the role of nurse informaticists and with it the necessary skill sets to succeed. For the right individual, it remains a career with limitless opportunities across the health care spectrum.

“It’s so important to be passionate about what you do because, like any role, especially in nursing, it can be challenging. You have to understand your greater purpose and how you are impacting clinicians and ultimately the patients,” Stephenson says. You have “to be passionate about it to really drive your focus and maintain that [right] kind of skill level and you need to keep up with what’s going on in the world. It’s a profession where you must continue learning—just like in bedside nursing. It’s [a role] that takes careful consideration and a strong passion.”

— Elizabeth S. Goar is a freelance health care writer based in Wisconsin.