There is a lively discussion underway about whether clinical – and specifically nursing – informatics should be recognised as a speciality within a profession.
Some might suggest this is a new conversation, but it’s not. Computers may not have existed in the time of Florence Nightingale, but debates about the use of information to improve care certainly did.
Florence was known as a statistician before her move into nursing; and perhaps that is what made her maintain her focus on collecting and using information throughout her clinical career.
She was a pioneer in the use of graphic presentations of data, and used them to great effect to lobby for improvements in hospital hygiene after her return from the Crimean War.
Informatics and nursing: always intertwined
It is not essential to have this interest in mathematics to be able to describe yourself as an informatics nurse. In fact, informatics has now become so part of routine clinical practice that we could all describe ourselves as informatics nurses.
Better still, we could lose the unhelpful split entirely and recognise that all nurses have a responsibility to understand their role in the area of information and technology.
Even if you think you’re not interested in informatics or are a bit tech-phobic – you will be involved in using technology and information every day. If we don’t get involved in the development, we will be unable to complain if systems are complex and difficult to use.
Software developers welcome working with the people who will be using their technology, because it helps them increase the usability of a system.
You don’t need a qualification in coding to be able to explain why it makes sense to have a system which can be taught quickly and easily to a newly registered nurse, keeping him or her clinically involved rather than in a classroom.
Nursing processes will always keep the patient at the heart of what we do, so it’s important that any technology to be used can be done ‘at the bedside’ and it’s critical that nurses are able to articulate this.
In addition, the influence of informatics and technology is only going to grow. This really will become a central part of what it means to be a frontline nurse delivering excellent patient care.
In this chapter, we explore the many ways in which nurses are already central to informatics – and how they can continue this role as technology marches on.
Monitoring patients
Nursing is an ever-evolving profession. One important recent change has been the tools we use to monitor our patients. The sphygmomanometer has been replaced with the Dinamap, and in critical care areas electronic monitoring equipment has now been the norm for over 30 years.
That means nurses are well placed for the next steps towards fully automated electronic collection of data to monitor patients.
The use of mobile technology to capture physiological observations is being led by nurses. Their day to day work in capturing this information, and using it to plan and deliver care, makes nurses best placed to comment on the development and implementation of such systems.
It is not just ‘informatics nurses’ who do this. Frontline clinicians are vital to both the configuration and development process, and to handling practicalities like ensuring there are enough devices available to maintain safe care.
It is these people who can explain to IT staff that their current ward processes have them split into teams and that the majority of observations data is captured by unregistered practitioners – intelligence that is vital to planning a successful implementation.
They will also explain that, as coordinators of care, they need to be able to monitor not just one patient but also the full ward.
They will explain that the ability to make a quick and easy referral to critical care outreach – ideally an automated one – is crucial, but that on Sunday evenings the referral actually goes to an on call anaesthetist.
These insights are vital in ensuring that informatics and IT works, and they are insights which are held by nurses.
Documentation
How observations and interactions are documented by nurses is a popular topic for discussion. Many feel we now spend too much time recording patient interactions and not enough on the interactions themselves.
There are significant possibilities for improvement in the way we record care delivery as part of the wider health record of an individual. Shared care records (across health organisations) will be an essential and very welcome tool for nurses.
Duplication of data collection is frustrating for both professionals and patients, and nurses are often best placed to discuss who should be included in the sharing of information to deliver care. The current role of nurses as ‘gatekeepers’ to the full information record of their patients means the nurse’s voice is crucial in this important informatics debate.
Patient safety
Monitoring and improvement of patient safety is another role that has always been undertaken by nurses. The nurse is often perceived as the patient’s advocate, which leaves him or her well placed to push for improvements in patient safety. This is another strong tie between nursing and informatics.
Many nurses are keen to get involved in patient safety programmes within their organisations. They will be keen to collect information to inform such programmes, though sometimes may not realise that this process can have value within a whole organisation as well as within their own team.
Nursing can help ensure that information collection is worthwhile. Nurses will argue vocally that they should not be expected to collect data if it cannot be used for the benefit of their own patients.
They will also explain that returning such information to them a year after it was collected, or in a format that needs a statistics degree to understand it, is not acceptable. Similarly, they can help to make sure that time is not wasted collecting information which is already being recorded elsewhere.
Change management
Change management (and its linked field of service improvement) are now at the heart of nursing practice.
The reason nurses continue to want to be involved in change is both because they understand the positive impact this often has for patients, but also because they are good at it. Successful change isn’t about making people do things differently; it’s about winning their hearts and minds such that they want to do things differently.
It is often the case that nurses are truly at the forefront of innovation without even realising it. They observe their own and others’ day to day practice, and they can often see a ‘different way’, understanding what would help them to work smarter, without working harder.
It is these golden ideas that need to be captured by informatics professionals when they are developing new technology. Nurses also understand the power of data collection when planning change.
We are able to understand that to make a powerful argument to executive boards and to frontline colleagues, we must be able to prove (and document) the value and impact of the change.
Conclusion
Nurses already have the skills to be involved in this technological revolution. They understand the use of data and information, and the requirement to improve efficiency and reduce cost while not compromising the safety and quality of care.
Technology is impacting on all areas of our lives, changing the way we do things; from booking a holiday to teaching our children to read. Mobile devices are an ever-present part of life in 2015, and it is natural that we would want to extend the efficiencies we are able to make into our healthcare practice.
Nurses, with their continuous link to the patient, are absolutely best placed to drive this. You don’t have to be a techie or a geek to want to make sure that you are delivering the very best care you can for patients, and making sure use of technology and information is embedded within every interaction is now part of the role of every nurse.
About the author: Jo is lead nurse – informatics at Leeds Teaching Hospitals NHS Trust. She has been in the post since 2013. She was previously a clinical nurse educator, and a clinical nurse specialist.