Knowledge Work. As a knowledge worker, every nurse uses data and information. We acquire knowledge, process it, and disseminate what we have learned most of that dissemination occurs informally in our daily communication and work while only a few of us will disseminate knowledge formally through scholarly presentations and publications. And a few primarily the researchers among us will generate new knowledge. This week, we look at the relationship between our roles, competencies, and where we fall in relationship to the foundation of knowledge model. Last week we talked about the potential of HIT to transform healthcare, introduced the topic of knowledge work, and addressed the need for nurses to demonstrate informatics competencies in order to function in today’s technologically rich healthcare delivery system and even to help transform healthcare delivery through technology. Of course, nothing is quite that straightforward or simple. But the realization of healthcare transformation still requires more. This week, we look at current nursing roles, the process of knowledge work, role expectations, competencies, and changes needed to achieve a new healthcare delivery system.
Nurses perform many different tasks and roles such as direct-care provider, patient advocate, educator, and administrator to name a few. But typically, nurses have been in the supporting, nearly invisible role rather than as a full partner in the healthcare delivery process. According to the Institute of Medicine’s (IOM’s) (2012) Future of Nursing: Leading Change, Advancing Health report, nurses can play a major role in realizing the objectives set forth in the 2010 Affordable Care Act, legislation that guaranteed access to healthcare and established incentives to improve coordination of care, but changes are needed in the following areas to enable that role:
- Nurses must practice to the fullest extent of their levels of education and experience.
- Redesign of nursing education to promote a seamless progression for nurses seeking higher levels of education and training.
- Nurses must be full partners with other healthcare professionals in healthcare redesign.
- Better data collection and information structures are needed to inform effective workforce planning and policy.
Stronger roles are more expected today, especially if there are informatics skills and background as nurses further their education, few see themselves as moving into a leadership role, however it is imperative that faculty with this expertise support and help students achieve this potential. This situation requires further attention by educators to help students view leadership as a possibility. When other members of the healthcare team have difficulty perceiving nurses as full partners in the process due in part to both fewer years of education and numerous entry levels into the profession, it is imperative that faculty with expertise support students. But what, if any, relevance does this have for informatics? The changes called for in the Future of Nursing report rely heavily upon the knowledge-work aspect of nursing’s role, which in turn, requires informatics competencies, another recognition needed by educators, administrators, and nurses, themselves. With informatics competencies, those in leadership have raised the bar and expectations as well. Informatics competencies are key to effective knowledge work and advances in nurses as leaders.
Nursing Informatics Roles
NI continues to grow and evolve as it works to create its own knowledge base. NI has its own research agenda that holds interest and benefits for all nurses because NI supports all areas of nursing practice. The National Institute for Nursing Research Strategic Plan addresses the use of informatics and informatics-based solutions to facilitate health, prevent disease, and engage patients in the management of their own care. As NI grows and expands so do NI roles in nursing. According to McGonigle, Mastrian, Kenney, and Androwich (2018, p. 130), nurses may take on numerous roles regarding informatics:
Nursing Informatics Roles
Basic NI Competencies for All Nurses
The assigned reading this week addresses the current state of competency evaluation for informatics and examines potential strategies for the future that can align with recommended models for developing competencies committed to defining the future role of nursing to continuously improve health care. McBride and Tietze (2018, p.558) provided Table 24.1 which outlines levels of NI competencies. Methods to evaluate competencies of these four levels of informatics competencies rely primarily on methods that self-report through survey instrumentation methods. Valid and reliable methods to evaluate informatics competencies measurably and objectively within simulation centers are not currently available. Basic competency recommendations for integration of informatics content into baccalaureate and graduate nursing programs have been addressed by Hunter, McGonigle, and Hebda (2013) and, more recently, by Hill, McGonigle, Hunter, Sipes, and Hebda (2014), who developed a method for self-evaluation of competencies for more advanced informatics competencies, including levels 3 and 4. Yet, methods to objectively evaluate these four levels of nursing informatics competencies in simulation centers that incorporate objective evaluation criteria are lacking.
In 2003, the IOM recommended, “All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice (EBP), quality improvement (QI) approaches, and informatics” (IOM, 2003, p. 121). In 2008, the importance of adopting EHRs in clinical practice and developing competency standards for graduating and practicing nurses was initially identified by the Technology Informatics Guiding Education Reform (TIGER) initiative. The TIGER initiative identified three components for the TIGER nursing informatics competencies model: (a) basic computer competencies, (b) information literacy, and (c) information management. Below are examples of skills associated with the three competencies.
Additionally, collaborators for the TIGER initiative stressed health care providers must be able to determine what information is needed, utilize the appropriate resources to find the information, use valid resources to critique the information, provide evidence-based care based on this information, and evaluate the outcomes of the process. A timeline was established that recommended all graduating nursing students and practicing nurses be able to demonstrate the established competencies by January 2013. Work continues to determine what progress has been made and future forecasts.
The Role of the Advanced Practice Nurse in Adopting Technology and Informatics
The demands of the healthcare delivery system and ensuring that all nurses are adequately prepared with essential skills have implications for APNs. In addition to acquiring requisite profession-specific knowledge, skills, and abilities, all APNs must now demonstrate an acceptable informatics competency. The advanced practice nursing informatics role is an extension of the roles shared by any NI nurse working within interprofessional teams to address patient safety and quality through the deployment of successful HIT implementation. APNs may also play high-level roles in quality improvement, integrating evidence into practice, population health, and policy due to expertise and leadership responsibilities integral to APN scope and practice. Specific roles will be suggested later in this lesson.
The Technology Informatics Guiding Education Reform (TIGER) Initiative
If there are any doubts about what these competencies might be, The Technology Informatics Guiding Education Reform (TIGER) Initiative (2009), compiled and posted a list of competencies on its website that every nurse should display. TIGER first came into being with an invitation-only summit, Evidence and Informatics Transforming Nursing, in 2006, which invited leaders from nursing, government, informatics and technology organizations, and other stakeholders to come together to create a vision to transform nursing to bridge the quality chasm using technology (TIGER, 2013a). TIGER continues its focus on the use of informatics and technology to make healthcare safer, more effective, efficient, patient-centered, timely and equitable by interweaving evidence and technology seamlessly into practice, education and research fostering a learning healthcare system and is a useful resource (The TIGER Initiative, 2013b). The American Association of Colleges of Nursing has also identified informatics competencies expected for each program graduate in their Essentials documents as well as a cross walk document that provides a quick comparison by program level (American Association of Colleges of Nursing, n.d.).
Information and Communication Technologies for Practice and Education
When one thinks about technology and communication, particularly within the workplace, one typically thinks about e-mail; however, there is a growing use of text-message notices and alerts on smartphones and Voice Over Internet Protocol (VoIP) phones, as well as messaging capability that is built into various clinical systems, such as the hospital information system or barcode medication administration system. There is also a growing use of social media to promote healthcare delivery-system services.
The Role of the APN in Promoting and/or Using HIT and Informatics
As mentioned earlier in this lesson, the APN is expected to develop and display a more advanced understanding and mastery of informatics competencies that include the activities listed below.
- Critical review of HIT for benefits (safety, cost effectiveness, improved outcomes) as well as potential problems
- Input into the design, selection, and use of HIT
- Support the integration of HIT and evidence-based practice
- Use data and information to drive decisions
- Role model appropriate/effective HIT use
- Serve as a resource on HIT matters
- Safeguard PHI
- Use electronic communication and systems to communicate effectively and appropriately
- Use HIT for quality improvement activities
- Provide oversight for optimal use of HIT by subordinates
- Use technology to support education
Also important in the elaboration of interprofessional teamwork is information technology and the four IOM core competencies. The key provision of patient-centered care is the goal of interprofessional teamwork and it increasingly relies on technology solutions to enhance patient-clinician communications, planning, and decision making.
The nature of the relationship between the patient and the team of health professionals is central to competency development for interprofessional collaborative practice. Without this kind of centeredness, interprofessional teamwork has little rationale. The other three core competencies, in the context of interprofessional teamwork, identify 21st-century technologies for teamwork communication and coordination (i.e., informatics), rely on the evidence base to inform teamwork processes and team-based care, and highlight the importance of continuous improvement efforts related to teamwork and team-based health care (Interprofessional Collaborative Expert Panel, 2011, p. 14).