Nursing Outlook
Volume 55, Issue 4 , Pages 210-211, July 2007

Informatics competencies for nursing leaders

  • Bonnie L. Westra, RN, PhD

      Affiliations

    • Corresponding Author InformationReprint requests: Bonnie L. Westra, RN, PhD, Assistant Professor and Robert Wood Johnson Executive Nurse Fellow, University of Minnesota School of Nursing, 5-160 Weaver Densford Hall, 306 Harvard St SE, Minneapolis, MN 55455.
    • Bonnie L. Westra, RN, PhD, is Assistant Professor and Robert Wood Johnson Executive Nurse Fellow, University of Minnesota School of Nursing, Minneapolis, MN.
    • ,
  • Connie White Delaney, PhD, RN, FAAN, FACMI

      Affiliations

    • Connie White Delaney, PhD, RN, FAAN, FACMI, is Dean and Professor, School of Nursing, University of Minnesota, Minneapolis, MN.

Article Outline

 

There is currently a series of events occurring to form the “perfect storm” in the electronic health care environment; each event by itself does not create a crisis, but when occurring simultaneously they create significant turbulence. This series includes the escalating health care budget, with consumers and employers crying amass about their costs for health care; the unveiling of waste in health care through redundant tests, unnecessary treatments, and ineffective administrative processing of information; latent dissemination of research to improve practice; and, last but certainly not least information about the potential harm to and premature death of patients. Nursing leaders are in the eye of the storm—the question is: Are they prepared to fully lead in this changing environment?

Technology has rapidly evolved and can provide solutions to navigate the turbulent waters. One example is the 2004 Executive Order, which called for electronic health records (EHRs) for all Americans by 2014. This initiative has served to bring the health care and technology communities together to begin to address the barriers to creating an electronic health environment. A concern, however, is that nursing leaders may not be adequately prepared to lead change in this technological revolution that has profound implications for nursing practice. Nursing leaders must be competent in informatics, based on their role within the organization.1 Management’s role is pivotal in organizational transformation with EHRs.2, 3 However, informatics competencies for nursing leaders are ill defined, leaving them in a quandary about what they should pursue to be effective. To address this need, a Delphi study was conducted to determine the informatics competencies appropriate for nursing leaders to help identify strategies for improving leadership in the electronic world of health care.

The varied responsibility of nursing leaders, which includes nurse managers through nurse executives, provides a challenge in defining informatics competencies that are role appropriate. In addition, nurse leaders work in a variety of settings from small through large health care organizations, providing acute through community-based care. Although there are several sources for defining informatics competencies, none have focused specifically on how the role of the nursing leader may differ from the front-line user or the nursing informatician.4, 5, 6, 7, 8 These are the questions asked of a group of nursing leaders, informaticians, and researchers in a Delphi study to define informatics competencies for nursing leaders.

•Should nursing leaders be expected to be proficient users of an EHR?

•Should they know how to build screens in an EHR?

•Should they be required to abstract data from a data warehouse?

The authors synthesized multiple competencies from review of the literature, comparing these with responsibilities for nursing leaders. The framework of Staggers et al8 was used to group competencies into computer skills, informatics knowledge, and informatics skills. During the three rounds of the Delphi survey process, participants raised a number of interesting questions:

1.How do you define a nursing leader—do you include clinical nurse specialists or other advanced practice roles?

2.There is a vast difference between the nursing executive and the front-line nurse manager—how can you include both in defining informatics competencies?

3.There is an assumption that nursing informaticians report to nursing, which often is not the case—what is the effect of the reporting relationship on the informatics competencies required by nursing leaders?

4.Informatics is highly interprofessional—how does this influence informatics competencies for nursing leaders?

5.Nursing leaders do not “do”; they lead—therefore, what areas of knowledge and skill are really required?

After a three-round Delphi Survey, nursing informatics competencies have been identified for future evaluation with nursing leaders. The three major concepts are computer skills, informatics knowledge, and informatics competency. Within these broad concepts are more specific categories and items. For instance, computer skills include such categories as use of basic software applications, electronic communication, and patient-related computer applications. Informatics knowledge includes categories such as management concepts associated with informatics, knowledge of data issues, and knowledge of information system concepts. Last, example categories of informatics skills include defining of system requirements and selection of information systems, financial skills applied to information systems, and implementation and management skills for information systems.

The questions now are “Who cares?” and “What’s next?” In fact, there are efforts underway statewide and nationally to support nursing leaders in the effective and efficient use of technology for better and safer patient care. On a state level, the University of Minnesota School of Nursing and the Minnesota Organization of Leaders in Nursing (MOLN) just completed a survey on nursing leaders’ competencies in informatics, and they are establishing an action plan based on priorities from this survey. The next step is to expand this work with additional organizations such as the Local Public Health Association. On a national level, the TIGER Initiative (Technology Informatics Guiding Educational Reform) conducted a summit of key stakeholders—including nursing leaders from practice, education, governmental organizations, and informatics organizations—to collaborate on improving the use of technology for better and safer patient care.9 This summit will be replicated on a state level through collaboration of the University of Minnesota School of Nursing, MOLN, and MINING (the Minnesota Nursing Informatics Group) to collaborate on the educational support that makes a difference in practice for staff nurses and nursing leaders. If nursing leaders are to fulfill the American Organization of Nurse Executives’ vision of “shaping the future of healthcare through innovative nursing leadership,”1 they must be competent in informatics, and this work is a first step toward achieving that vision.

Back to Article Outline

References 

  1. AONE. AONE nurse executive competencies. Nurs Leader. 2005;3(1):15–21
  2. Glaser J. Management’s role in IT project failures. Healthc Financ Manage. 2004;58(10):90–92
  3. Knecht K, Simpson RL, Weaver CA. Clinical transformation and nursing executive leadership. In:  Weaver CA,  Delaney CW,  Weber P, et al. editor. Nursing and Informatics for the 21st Century: An International Look at Practice, Trends and the Future. Chicago, IL: HIMSS; 2006;p. 57–66
  4. Association of Colleges & Research Libraries. Information literacy competency standards for higher education (2000). Available at: http://www.ala.org/ala/acrl/acrlstandards/informationliteracycompetency.htm#ildef. Retrieved May 16, 2007.
  5. Curran CR. Informatics competencies for nurse practitioners. AACN Clin Iss Adv Pract Acute Crit Care. 2003;14(3):320–330
  6. Kaminski J. Nursing informatics competencies: self-assessment (2000). Available at: http://www.nursing-informatics.com/niassess/competencies.html. Retrieved May 16, 2007.
  7. O’Carroll PW, Public Health Informatics Competencies Working Group. Informatics competencies for public health professionals (2002). Available at: http://www.nwcphp.org/docs/phi/comps/phic_web.pdf. Retrieved May 16, 2007.
  8. Staggers N, Gassert CA, Curran C. A Delphi study to determine informatics competencies for nurses at four levels of practice. Nurs Res. 2002;51(6):383–390
  9. Weaver CA, Skiba D. TIGER Initiative: Addressing information technology competencies in curriculum and workforce. CIN: Comput Informat Nurs. 2006;24(3):175–176

 This work is funded through the Robert Wood Johnson Executive Nurse Fellowship for the primary author.

PII: S0029-6554(07)00141-8

doi:10.1016/j.outlook.2007.05.005

Nursing Outlook
Volume 55, Issue 4 , Pages 210-211, July 2007

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