Summer 2014 - Do Informatics Nurses Add Value?

by Tess Settergren, MHA, MA, RN-BC
*This article conveys opinions of the author, and does not reflect perspectives of the author’s employer or other affiliates.

“Informatics Nurse?  What do you DO?”  Most, if not all, nurses who are working in a nursing informatics (NI) role are asked questions in this vein at some point in their career. They may also be asked questions like; “Don’t you like to take care of patients?” or “Were you injured or something?”  Sometimes informatics nurses find it difficult to articulate what they do, and how they bring value to patient care.  And they DO bring value.  Informatics has evolved in generally similar directions across many disciplines. Health informatics is probably the broadest term used, and comprises many disciplines and several distinct foci. HIMSS defined health and clinical informatics as interchangeable: “Clinical Informatics (aka Health Informatics) promotes the understanding, integration, and application of information technology in healthcare settings. This helps to ensure adequate and qualified support of clinician objectives and industry best practices1”.

nurseThe American Medical Informatics Association (AMIA) defines clinical informatics as “the application of informatics and information technology to deliver healthcare services. It is also referred to as applied clinical informatics and operational informatics2.”  In this definition, a clinical informatics expert is concerned with application of informatics skills, by any professional discipline, with overall goals of improving use of information and information systems by clinicians.  “Translational bioinformatics is the development of storage, analytic, and interpretive methods to optimize the transformation of increasingly voluminous biomedical data, and genomic data, into proactive, predictive, preventive, and participatory health3.”  AMIA also recognizes the domains of clinical research informatics, consumer health informatics, and public health informatics.  AMIA has developed a clinical informatics board certification preparatory program, intended for physicians already board-certified in any of the 24 clinical specialties. Physicians become certified through examination, and the first group of physicians were board-certified in Clinical Informatics in 2013.  

The American Nursing Informatics Association (ANIA) uses the definition of nursing informatics that was published when the American Nurses’ Association recognized NI as a specialty, in 1992.  The definition has been regularly updated, and will soon be updated again: “Nursing informatics (NI) is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom to nursing practice.  NI supports consumers, patients, nurses, and other providers in their decision-making in all roles and settings.  This support is accomplished through the use of information structures, information processes, and information technology4.”  The American Nurses’ Credentialing Center has provided a board-certification examination for informatics nursing for about twenty years.  ANCC also certifies many other nursing clinical and administrative specialties and advanced practices nurses. Nurse informaticists fulfill various roles in administration, education, research, and practice.  They are hired into well over 1000 distinct job titles by healthcare organizations of all types, payers, HIT vendors, consulting firms, universities and colleges, research groups, and other entities. 

So what?  What differentiates the NI from other informatics disciplines: medical/clinical, pharmacy, health information management, nutrition, dental, and so on?  What is the value proposition?  First, the cornerstone is professional nursing practice—NI’s overall goal, in any setting, is to transform practice, influencing safe, effective, efficient, equitable, timely, patient-centered care and thus health outcomes.  Nursing has a long played a key role in coordinating care, in conjunction with many disciplines and providers and across care settings.  Leveraging technology to support nurses in achieving current and future practice goals, including coordination of care, was a key recommendation in the recent Institute of Medicine report5.  Nurses are well-positioned to add value to HIT-related work because they understand clinical care team workflows and information needs, and can translate those concepts to best configure HIT, influence clinician adoption, and enhance information management.  Some specific areas where nursing practice, informatics, and human change management knowledge add value include the following activities and more:
  • Process improvement/redesign: Streamlining nursing and care team workflows to improve efficiency, effectiveness, safety and reduce potentially unsafe workarounds6
  • Promote clinician adoption of HIT by ensuring usability to support safe and efficient use of and end-user engagement in designing and optimizing HIT
  • Embed evidence-based practice and ensuring appropriate clinical content and decision support (avoiding alert fatigue)
  • Design HIT and other information technologies with clinical intelligence7 in mind, and to enable data mining for practice-based evidence8 and other discoveries
  • Enable semantic interoperability:  Provide nursing standardized terminology content that facilitates more targeted quality improvement, clinical decision support, e-measures, and comparative effectiveness research with goals of analyzing what works/doesn’t work in achieving optimal patient outcomes; moving us from data and information to knowledge and wisdom in practice9
  • Enable higher levels of productivity through judicious use and integration of technologies that support patient care and clinical work, including decision-making, communications, and analytics
  • Foster and measure10 informatics competencies across nursing and interdisciplinary domains: computer skills, information literacy skills, and information management knowledge and skill, with a goal of “making every nurse an informatics nurse”
  • Promote consumer health and advocate for patient-centered technologies to improve the health status of individuals, families, communities, and nations
In summary, informatics nurses bring value in a myriad of roles and areas of focus.  They share broad goals with other informatics professionals around improving health care delivery and population health, and very specific goals that focus on phenomena within the nursing practice domain.  Informatics nurses achieve these objectives through application of the potent combination of clinical acumen, informatics and information technology competencies, process improvement and change management skills, and interdisciplinary collaboration, with a large dollop of translational skills (clinical to technical and back again).
  4. American Nurses’ Association.  (2008).  Nursing informatics: Scope and standards of practice.  Silver Spring, MD: 
  5. Institute of Medicine.  (2011).  The future of nursing: Leading change, advancing health.  Washington, D.C: The National Academies Press.
  6. Collins,
  7. Harrington, L.  (2012).  The role of nurse informaticists in the emerging field of clinical intelligence.  Proceedings of the 11th International Congress on Nursing Informatics: NI2012.
  8. Lang, N. M. (2008).  The promise of simultaneous transformation of practice and research with the use of clinical information systems.  Nursing Outlook, 56 (5), pp. 232-236.
  9. Byrne, M. D, & Lang, N. M.  (2013).  Examination of nursing data elements from evidence-based recommendations for clinical decision support.  Computers, Informatics, Nursing (CIN), 31 (12), pp. 605-614. 
  10. Hunter, K. M. McGonigle, D. M., & Hebda, T. L.  (2013).  TIGER-based measurement of nursing informatics competencies: The development and implementation of an online tool for self-assessment.  Jrnl of Nursing Education & Practice, 3 (12), retrieved from