Ambulatory Informatics Nurses - Translating the Language of Patient Care

AAACN Viewpoint, Sep/Oct 2006 by Lofstrom, Joyce, Sensmeier, Joyce

It's a typical scene in the endocrine clinic: the ambulatory nurse comes into the examining room, takes the patient's vitals, and records the data. But now, this nurse sits down to a laptop computer positioned on the desk in the room. She records any additional new information for this patient, following the procedures of the clinic. She doesn't have to ask about previous history because it is right in front of her as the patient's medical chart comes up on the screen.

But...WHO manages that patient health information and ensures that the electronic medical record or EMR meets the needs of the clinicians staffing this setting? Meet the ambulatory informatics nurse, a skilled practitioner with clinical knowledge and experience who has made the transition from stethoscope to working with specifically designed software and strategic technology to manage patient health information.

As the benefits of information technology (IT) in health care become more evident, ambulatory informatics nurses play a crucial role in the delivery of patient care. Technology represents immediate access to patient information, and through the electronic medical record, all clinicians can track what's happening with patients and with the EMR system itself.

Defining Nursing Informatics

In 1994, the American Nurses Association (ANA) first defined the scope of practice for nursing informatics, and in 2001, ANA defined the specialty of nursing informatics as one that "integrates nursing science, computer science and information science to manage and communicate information, data and knowledge" (ANA, 2001).

In addition, the nursing and nursing informatics literature offers several definitions, citing "nursing informatics":

* Is the vehicle that enables evidence of the effects of nursing interventions to be linked with the outcomes of care in relation to the problems identified for a specific patient or groups of patients (Swan, McGinley, & Lang, 2002).

* Addresses the management and processing of data, information, and knowledge to support nursing practice and the delivery of care (Bakken, Cimino, & Hripcsak, 2004; Delaney, 2001).

* Is 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 (Craves & Corcoran, 1989)

These definitions of nursing informatics demand both attention and understanding based on the job description of a nurse who manages information technology and management systems in health care. Why? Nursing informatics goes beyond the basics of word processing. An ambulatory informatics nurse must be able to develop, access and manage an EMR, often taking on the role of both the data manager and professor, in essence, the nursing professional who must both implement and explain the technology.

"When new clinical IT applications are successful, many stakeholders take credit," said Richard D. Lang, EdD, editor of the Journal of Healthcare information Management in the spring 2006 edition on nursing informatics (Lang, 2006). "Physicians are lauded for their unselfish participation and valuable insight into the process. Administrators are commended for their vision, foresight and leadership in promoting clinical system initiatives. IT staff are rewarded for their technical acumen and long hours of hard work in making the many changes to programs, reports, and screens that ultimately make applications useable in a highly complex, process-driven environment. But whether or not the application is truly successful depends on how well nursing adopts, advocates, and ultimately integrates these initiatives into production."

As a result, the field of informatics has truly introduced a new and effective dynamic, resulting in significantly increased patient care quality, safety, and empowerment. In an ambulatory care setting, information technology helps support the immediacy of care and the caseload of patients. In fact, IT enables every aspect of the nursing process by improving the information flow.

Nursing Informatics - The Profession

Most nursing informaticists arrived at their current position through the traditional nursing path, according to the 2004 Nursing Informatics Survey, conducted by the Healthcare Information and Management Systems Society (HIMSS) and sponsored by Omnicell. In just two years, more degree programs have been created for health informatics in general. To find a list of some of these programs, visit the directory on the HIMSS Web site (www.himss.org/ASP/academicDirectory.asp).

Yet, as evidenced from the data of this nursing informatics Web-based survey, 10% of the total 537 respondents indicated that they hold degrees in nursing informatics; less than 2% were currently pursuing this type of degree. One-third of the respondents had a master's degree in nursing, with 14% holding a master's degree outside of nursing, such as an MBA.

Nursing Informatics - Training