If you have read my previous post, you would be correct in assuming that I just recently came back to work. Yes, back to my nursing work. But, no, not the kind of nursing work you may be thinking about. You see, I am a nurse informaticist. What is that you say? Please allow me to explain.

Nursing Informatics: What is That?

I asked the same question when I started this job a year ago. Most, if not all, of us are familiar with the typical nursing specialties. We may have heard of intensive care unit (ICU) nursing, Medical-Surgical nursing, Pediatric nursing, Rehabilitation nursing, Behavioral Health nursing, and I am just talking about a few of the inpatient hospital nursing specialties.

Nursing informatics is defined by the American Nurses Association as a specialty that integrates nursing science with multiple information and analytical sciences to identify, define, manage and communicate data, information, knowledge and wisdom in nursing practice.

Most clinicians refer to those working in the nursing or clinical informatics field as information technology (IT) nurses. They typically bridge the gap between the clinical and the IT aspects of nursing. In simpler terms, nurse informaticists advocate for the appropriate use of IT tools and devices to help with the efficiency of the clinical workflow. If frontline nurses help patients and clients, informatics nurses help other nurses, and clinicians for that matter, work smarter, not harder!

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The Healthcare and IT Merger

Work smarter and not harder? Everyone wants that. The question is: how can that be accomplished?

Experienced nurses know our workflow like the back of our hands. For someone like me who has been in the organization for more than 10 years, knowing the policy and procedures of our practice is second nature. It is for this reason that we are able to advocate for the most appropriate and beneficial innovation and tools. As such, we become the conduit or the translators of clinical language into health innovation.

Healthcare and technology have always been intertwined. However, it has not been as much pronounced as it has been in the last decade or so. I still remember documenting in the patients’ paper charts like it was just yesterday. Now, during downtimes, nurses would rather wait for the electronic health record (EHR) system to come back up. Long story short, it is hard to fill out the kilometric paper flowsheets.

With that being said, IT or innovation is not only limited to the EHR or the use of computers. EHR is just one of the tools that we use in the clinical areas to provide quality, safe, and person-centered care. With the explosion of clinical tools that are available for use, we tend to forget that a thermometer or a sphygmomanometer are forms of innovation as well. Maybe, they are not as novel as our cardiac monitors that can be virtually observed from an e-ICU these days. Nevertheless, that doesn’t diminish their respective importance.

How Did I Become a Nurse Informaticist?

Let me preface this paragraph with a simple truth: I am not tech-savvy at all! And I thought, for the longest time, that being an informatics nurse requires one to be technologically adept with the latest IT tools. Therefore, I contented myself with being just our unit’s superuser during EHR upgrades or the introduction of new applications.

Working in the Pediatric field, I would always be vocal during the educational sessions that we need specialized training. Advocating for specialty-based training, I would always get feedback that we just have to adapt the tool to the specific needs of our patient population. It irritated me to no end when colleagues from the adult world consider our pediatric patients as smaller versions of the adults that they take care of.

When I was given the opportunity to pursue graduate studies, that was my main goal. I figured that an advanced degree will provide me with the much-needed training to back up my proposal. Slowly, I found my voice to present appropriate tools for my itty-bitty babies in the Neonatal Intensive Care Unit (NICU). Case and point? My mentor and I were able to facilitate the interoperability between the breast milk scanning system and the EHR. Interoperability basically means “allowing two or more systems to talk to each other.” 

One example that I can distinctly remember about interoperability was when we were able to retrieve a tourist’s EHR from her native United Kingdom to be reviewed by local doctors. For those of us who utilize our respective patient portals, that, too, is interoperability exemplified. The labs and diagnostic imaging may use a different application than the doctors use to enter notes. Yet, we are able to review them all within the same platform.

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What Does An Informaticist Do?

I think the more appropriate question to ask is:

Informaticists, what don’t they do?

When I was a bedside nurse, regardless of how busy the shift was, I have established consequential routines. The shift always started with a report from the outgoing nurse followed by the introduction of myself to the patients’ parents. Then, my true workflow started: checking vital signs, assessing babies from head to toe, bathing and weighing them, hanging the total parenteral nutrition, or feeding them orally…you get the gist. Even during times that I may have to prioritize something else (e.g. taking care of a baby with low blood sugar level), I would always revert back to my routine.

In contrast, I don’t have such a thing in informatics. It vaguely resembles an emergency department (ED). Like in the ED, I have to triage what are the priority issues and address them first. We will have meetings, collaborate with end users who may have issues, and figure out the best resources to resolve those concerns. We round in the hospital to provide at the elbow support for clinicians. On some days, we also teach incoming nurses and doctors how to use our EHR.

Most frontline nurses don’t take care of only one patient. Iinformaticists also just don’t work on one issue at a time. That is the reason why being an experienced nurse counts a lot. Critical thinking skills and prioritization come with years and years of practice. They are necessary when working in the field of informatics.

What is a Typical Day Like?

Last Friday, for example, I was already working on two issues at the start of the day. One issue was a doctor’s inability to delete a note written in error a few weeks ago. The other issue was the patient’s EHR still stated that he had an infection he already tested negative for. Because the second issue concerned a current patient, I had to prioritize that. I contacted the nurse leader, infection control manager, and the analyst on what could be done to remove that flag. Upon confirming that the lab result proved the absence of infection, the alert was removed from the patient’s EHR.

While still figuring out the resolution for the first issue, another nurse manager reached out to me for a different issue. A patient in her unit missed two anticoagulant doses because the nurses did not see the order. I researched the circumstances regarding the concern. I accessed the patient’s electronic record, took screenshots, and created a job aid in order to prevent that from happening again.

Towards the end of the day, I had a virtual meeting with an assistant nurse manager to review with her how to run a Covid report I shared earlier. She had to disseminate that information with her staff. She wanted to ensure that she knew how to do it properly. I also emailed her a tip sheet to use as a reference.

If you are already overwhelmed reading this, let me tell you about our Covid 19 Project…Nah, you don’t have time to really decipher all the work my colleagues and our informatics system leaders put into it. And it still remains to be a work in progress!

Settling In on the Responsibilities

As you can tell, there is no rhyme or rhythm in what I do in this role. Some days, I miss my routines as a frontline nurse. However, my adventurous nature as a neophyte informaticist welcomes the excitement each day brings.

Aside from extensively using my critical thinking and prioritization skills, I relish the ability to collaborate with colleagues I wouldn’t have met had I not taken this job. In a nutshell, my world expanded exponentially when I became a nurse informaticist. In as much as I love my fellow nurses in my previous unit, I am no longer confined within the safe walls of our Maternal and Child Department. Rather, I have broken ground into this new and exciting venture, albeit one step at a time.

What about you? If given the same opportunity presented to me, would you have taken the leap? Are you willing to leave your comfort zone behind even if you don’t know what awaits you on the other side? Please share your thoughts below. I would love to hear them.