Running head: ROLE ANALYSIS

Informatics Nurse Specialist Role Analysis Jennifer R. Williams Ferris State University

ROLE ANALYSIS Abstract

The accurate analysis of a specialty nurse role can lead to the conclusion of whether an individuals meets the expectations of that role. This paper will discuss a communication with a newly appointed informatics nurse specialist and her input in regards to her knowledge, skills and experience related to clinical knowledge, the informatics role, information technology and the healthcare field. Experience, strengths and weaknesses, the effect on surrounding environment, the incorporation of ethics and culture and the individuals current location in the attainment of the role will be addressed. Finally, a determination will be offered that will indicate whether she is fitting for the informatics nurse specialty role.

ROLE ANALYSIS Informatics Nurse Specialist Role Analysis

The informatics nurse role has just begun to evolve in the healthcare field and is now being utilized at an increasing rate related to the need to incorporate technology into the clinical setting (Lewandrowski, Gregory & Macmillan, 2011). Analise Rowe is currently an informatics nurse specialist (INS) at Memorial General Hospital (MGH) in General, Michigan (Rowe, personal communication, October 25, 2011). Analise has held this position at MGH since its creation approximately 6 months ago. She began her career as a nurse assistant and soon discovered that she had a passion for nursing. She completed her LPN degree in 1987; Analise worked at this level for two years while completing her associates in nursing, obtaining her registered nurse license in 1989. Following graduation, Analise worked in the med/surg department for 2-3 years; she enjoyed this experience, although knew that she wanted to accomplish more within her career (Rowe, personal communication, October 25, 2011). She initiated a change by applying for a CCU position within the same hospital. Analise adapted to this position and soon acquired the skills needed to excel within this department. Her technique did not go unrecognized and she was soon promoted to the lead nurse position. Additional responsibilities of this role included education and mentoring of the CCU staff; the initiation of the electronic medical record (EMR) would soon lead Analise down a path that she had never imagined (Rowe, personal communication, October 25, 2011). In 1997 Memorial General Hospital implemented their first version of the EMR (Rowe, personal communication October 25, 2011). Analise was offered the task of assisting with the education and integration of this new program; she accepted with enthusiasm as she had enjoyed her previous work in educating and mentoring staff (Rowe, personal communication, October

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25, 2011). Administration soon came to realize that there was a need for clinical nurse experience within the information technology (IT) department to assist in the appropriate integration of clinical nursing and technology (Rowe, personal communication). Analise was offered the position of clinical analyst in 1998; she accepted. With the recent fluctuation in the requirements for technology improvement and integration in the healthcare field, Analise was promoted to the informatics nurse specialty role in 2011. Therefore, she has been practicing in the informatics field for 12 years and has approximately 6 months of experience within the INS role (Rowe, personal communication, October 25, 2011). The informatics nurse specialist applies a combination of clinical knowledge, technology literacy, communication, leadership and staff development to the implementation and integration of healthcare technology (ANA, 2008). The INS role has proven to be an essential requirement in the implementation of electronic health records in the acute care setting (Sensmeier, 2010b). It is important to consider the INS role and its impact on multiple disciplines, the nursing profession and organization (Sensmeier, 2011b). Consideration of clinical experience and skills should be evaluated prior to offering this role to an individual (Sensmeier, 2010b). The individuals ability to improve upon their knowledge and incorporate learning experience into the continued goal of role attainment should also be measured (Haag-Heitman, 2008). Focus, Environment, Scope and Competence Role Definition. The focus of the informatics nurse specialist is to improve the health of patients with the creation, incorporation and implementation of information technology into the health care setting (ANA, 2008). The INS optimizes communication and management of health information technology to improve quality of care and patient care outcomes (Sensmeier, 2010b). A combination of leadership skills and clinical competencies assists in the drive of the

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informatics nurse specialists ability to successfully adopt technology into the complex clinical workflow (Sensmeier, 2010b). Communication is also an important aspect of the INS role and is incorporated through multi-disciplinary involvement of the implementation and incorporation of technology in the healthcare setting (ANA, 2008). It is important that the INS incorporate her knowledge, experience and wisdom into the data information format (Matney, Brewster, Sward, Cloyes & Staggers, 2011). Analise describes her position as the interface between clinical systems, nurses and other disciplines (Rowe, personal communication, October 25, 2011). She adds that tasks in this position create a serial affect with even the smallest changes; this affect can transform minor requests into full blown projects. As a result, Analise is responsible for understanding the need to integrate technological information into all aspects of the organization to prevent errors or road blocks in information availability (Rowe, personal communication, October 25, 2011). In addition, Analise expressed that she is an interpreter of technology; she is required to translate information across the technology and clinical continuum to avoid misunderstandings between IT and other disciplines. Scope and Environment. There are a multitude of environments in which the INS can practice. Memorial General Hospital is an acute-care hospital setting; in this case, the environment is comprised of multiple departments and levels of staff (Rowe, personal communication, October 25, 2011). Hence, Analise falls into the coordination, facilitation and integration area of practice (ANA, 2008). In this area of practice, the INS is responsible for being the link to technology transformation in the clinical setting and the hub of information in regards to the incorporation of clinical knowledge (ANA, 2008). This individual may also assist with project management and coordination (ANA, 2008). In this rural area the nurse informatics

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specialist also needs to incorporate development, education, compliance and integrity into her mix of duties (Rowe, personal communication, October, 25, 2011). The acute care environment can be a challenging setting when implementing technological changes (Rowe, personal communication, October 25, 2011). Analise described the need to incorporate all disciplines in the change and the implications of not including all of the departments that need to be involved. She further discussed the importance of creating an effective team to inform, evaluate, create and implement the change. Analise went on to explain that all of the affected areas must be considered in the creation of a new system; this prevents confusion during the integration of the new system. Creating interest in the significance of the change, defining important partnerships and sharing ideas and communicating effectively can assist in decreasing the struggle with resistance of the staff (Tornabeni & Miller, 2008). Analise talked about project management and the complexity of employing new programs into the acute care environment (Rowe, personal communication, October 25, 2011). She elaborated that she is highly involved in creation, troubleshooting, implementation and integration of the health technology programs throughout the hospital. Strong leadership partnerships within the specialty nurse role are imperative; these relationships should evolve with change, thus involving nurse leaders in the incorporation of technological systems (Tornabeni & Miller, 2008). Competencies, Knowledge and Skill. The nurse informatics specialist should maintain competencies in nursing knowledge, technology literacy, professional development and adequate leadership and management skills (ANA, 2008). In comparison with the nursing assessment, the INS should be able to identify technological needs, research and evaluate the appropriate system, create and organize the information and integrate the technology to solve the identified

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phenomenon (ANA, 2008). The competencies required for the INS continue to be an ongoing progression in nursing, although continued research identifies that integral incorporation of informatics into nursing programs, adequate clinical experience coupled with computer literacy, proficient staff development and a confident leadership style are basic needs of the informatics nurse role (ANA, 2008). Analise has had multiple years of clinical experience to incorporate into the technological aspect of the informatics nurse role (Rowe, personal communication, October 25, 2011). She identified that she continues to utilize her nursing assessment skills within the process of her position. She further explained that the incorporation of this nursing knowledge is evident in analyzing the situation, evaluating clinical needs, researching the most appropriate technological fit and implementing a resolution to the problem. Incorporating data, information knowledge, clinical experience and wisdom into the INS role creates a strong foundation for informatics competency and successful integration of technology into usable clinical systems (Matney et al., 2011). Role Competencies Analysis In the INS role 15% percent of informatics nurse specialists gain their knowledge from on the job experience, only 56% have reported having an advanced degree of masters in nursing or higher, and 44% gain their clinical experience in the CCU setting (Anderson & Sensmeier, 2011). Analise is an associates prepared nurse with multiple years of clinical experience enhanced by mentoring and leadership skills acquired during her years of working in the CCU (Rowe, personal communication, October 25, 2011). However, she is aware of the need to continue her education and is currently pursuing her bachelor of nursing degree. Her competencies and years of informatics experience, combined with her involvement in the initial

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clinical computer systems at MGH, define a knowledgeable informatics nurse specialist at the competent level (Haag-Heitman, 2008). With the growing need for the integration of technology within the healthcare field and the requirements of meaningful use, organizations may consider filling INS positions with experienced nurses rather than waiting for the improvement of informatics technology education within nursing programs (Anderson & Sensmeier, 2011). Analise has a good understanding of information technology and how it applies to the clinical setting (ANA, 2008). She is well versed in her clinical experience and what is required to provide quality care and appropriate patient care delivery (ANA, 2008). In another view, Analise may lack education and experience in regards to organization, administration and leadership as she has only acquired the specialists role in informatics a short time ago. However, she does have consistent experience in staff development and mentoring when it comes to identifying departmental and nursing needs during change (ANA, 2008). Strengths and Weaknesses Those that are the least competent in their role have increased difficulty with selfassessment and identification of their strengths and weaknesses (Colthart, Bagnall, Evans, Allbutt, Illing & McKinstry, 2008). The INS should display the ability to complete ongoing selfassessment within her role (ANA, 2008). Analise appeared to have a good understanding of her personal and professional strengths and weaknesses that may affect her job performance (Rowe, personal communication, October 25, 2011). She identified her inability to say no as a personal and professional weakness. Analise explained that she occasionally takes on too many tasks at once, which in turn can create difficulty in meeting project deadlines. In addition, she inserted that she has difficulty dealing with professional failure; she portrayed her feelings of guilt as

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challenging to suppress when a project fails. These thoughts and feelings can often interfere with her ability to concentrate on current or future projects (Rowe, personals communication, October 25, 2011). Understanding the need for improvement can improve role performance (Colthart et al., 2008). Multitasking and prioritization were both identified as strengths in Analises performance (Rowe, personal communication, October 25, 2011). She described the need for the INS to maintain multiple projects at a time while dealing with multiple disciplines. In the acute care setting, this includes project management, system development, implementation, staff development, integration and troubleshooting (Rowe, personal communication, October 25, 2011). Analise included that dealing with multiple issues at a time has never been difficult for her. She also isolated communication as strength; Analise recognizes the importance of utilizing appropriate and adequate communication techniques across the multi-disciplinary departments. As a translator or interpreter between technology and the clinical setting, she finds that the transmission of information from department to department comes easily (Rowe, personal communication, October 25, 2011). The inclusion of personal and professional weaknesses when discussing professional competency is an insightful method. Uncontrolled feelings related to professional failure can create issues of loss within the role; in contrast successful projects can induce empowerment and the perception of success within the role (Andrews, Burr & Angeline, 2011). However, feelings of grief and loss may be associated with the informatics nurse specialists lack of professional education and administrative experience (ANA, 2008). Though these areas were not discussed as weaknesses, it was clear that Analise may lack the confidence of a seasoned manager with her

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internalization of issues on such a personal level (Rowe, personal communication, October 25, 2011). The INS should have indentified strengths in communication, technology literacy, clinical experience and wisdom related to integration of technology in the clinical setting (ANA, 2008). The strengths conveyed included communication and multitasking; it was evident that Analise had confidence within this area of discussion; however additional areas of strengths were suitably noted. Analise was well versed in information technology and its impact on todays healthcare organization. She also revealed an astronomical amount of clinical knowledge in which she incorporates into the creation of technology systems; both of these areas are identified as required competencies for the INS role (ANA, 2008). Self-assurance is related to successful outcomes in the specialist role; in this case Analise has just begun (Andrews, Burr & Angeline, 2011). Orientation of Role Perspective. It is important to consider a patients social well-being and not just the resolution, or absence, of illness (Kilbridge & Classen, 2008). The holistic approach in social care informatics has not had a large impact on nursing informatics thus far (Kilbridge & Classen, 2008). However, there has been recent recognition, in this regard, to the nurse informatics role and the impact that it could have on the social well-being of the patient (Kilbridge & Classen, 2008). Analise had difficulty identifying with the use of the holistic approach within her role (Rowe, personal communication, October 25, 2011). She did acknowledge the utilization of this approach as a clinical nurse, although it was apparent that the concept of linking health care information technology to the patients social outcome remained challenging.

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The systematic approach to nursing informatics is considered to be a risk versus benefits approach that focuses on preventing patient harm (Kilbridge & Classen, 2008). Analise indicates that this is the approach that she utilizes daily within her role (Rowe, personal communication, October 25, 2011). She inserts that each of her tasks is initiated by another; thus demonstrating this approach. The systematic approach does include the use of communication and multidisciplinary involvement, which could pinpoint the creation, evaluation, implementation and integration of informatics systems in the acute setting (Kilbridge & Classen, 2008). Analise was hesitant to conclude that the social well-being of the patient could be directly affected by the actions of her role (Rowe, personal communication, 2008). Key Partnerships. Key partnerships in informatics are needed in order to obtain recommendations and insights that will assist in the successful utilization of technology in the healthcare setting (Tornabeni & Fitzgerald, 2008). Analise identified her key partnerships as systems vendors, information technology, administration, management, clinical staff and other departments within the hospital (Rowe, personal communication, October 25, 2011). She implied that vendors are utilized to purchase programs that may be beneficial to the healthcare setting. She utilizes administration and management to communicate effectively with clinical staff and to assist in the implementation of change. Clinical staff and other departments are utilized for recommendations and input about system usefulness and effectiveness (Rowe, personal communication, October 25, 2011). Collaboration of partnerships is needed in order to advance the nursing informatics specialty, allowing nurses to become the forefront of dealing with breakdown within the health technology system (Tornabeni & Fitzgerald, 2008). Clinical Reasoning and Research. The informatics nurse specialist utilizes research to identify recommendations that apply to a phenomenon of interest (ANA, 2008). Research should

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be utilized to identify, analyze and incorporate evidence based practice into health care technology (ANA, 2008). Analise revealed that she often utilizes research to identify the appropriate system that meets the needs of the both the staff and patients (Rowe, personal communication, October 25, 2011). She provided multiple examples of critical reasoning and how it is imperative to the informatics role. Her ability to apply her clinical experience to the creation and integration of health care systems was evident. Assessment, identification of the problem, planning, implementation and outcome were acknowledged in her role (Rowe, personal communication, October 25, 2011). Although, because this position is new to Analise, it was found that there is a lack of involvement in research and committees that may review current and ongoing evidence based practice (ANA, 2008). Analysis of Role Attainment The competent nurse informatics specialist is seasoned in clinical concepts with multiple years of experience (Kaminski, 2010). This individual is able to identify her short and long term goals and has mastered the ability to incorporate both clinical and technical knowledge into the role (Kaminski, 2010). Analise portrays proficient clinical knowledge with a significant understanding of informatics and information technology in health care (Rowe, personal communication, October 25, 2011). She has multiple years of clinical experience as well as additional leadership, mentoring and staff development experience. She identified with the role of the INS and is able to understanding current problems and issues regarding the creation, implementation and integration of technological systems in the clinical setting. Analise communicates effectively and utilizes a multi-disciplinary systematic approach within her role. The proficient INS is able to understand the cause and effect of her actions as applied to her role (Haag-Heitman, 2008). Analise has this capability, although she lacks the understanding

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that her actions within her role may directly affect patients and their outcomes (Rowe, personal communication, October 25, 2011). At this point, she continues to be task focused and will need to work on identifying additional weaknesses in order to move forward towards improved role attainment. Her perceptions prevent her from gaining proficiency related to her incapacity to grasp the complete picture of the role (Kaminski, 2010). Additional experience in the role will assist with her ability to cope with the role successfully (Kaminski, 2010). In fact, emotional involvement can assist in the progression towards proficient and expert role attainment (HaagHeitman, 2008). Effect of the Role Patient The role of the nurse informatics specialist can directly affect patients by implementing technological systems that can improve patient quality of care and outcomes (Furukawa, Raghu & Shao, 2011). However, the implementation of the EHR alone could have a negative effect on patient outcomes if not executed appropriately (Furukawa et al., 2011). This may be associated with the organizations attempt to decrease nursing hours and face-to-face nursing time with the utilization of technology (Furukawa et al., 2011). In contrast, when health information technology is monitored, and coupled with evidence based practice, patient care outcomes should improve (Sensmeier, 2010a). The effective design and appropriate utilization of health care technology will be an important aspect in the improvement of quality in patient care (Sensmeier, 2010a). Appropriate education and knowledge base, of the INS, will be required to implement the needed governance of information technology in the healthcare realm (Sensmeier, 2010a). Analise clearly recognizes this fact with her pursuance of an advanced degree (Rowe, personal

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communication, October 25, 2011). In addition, the incorporation of the clinical nurses perspective in the creation and implementation of electronic records will only enhance the effectiveness of technology integration (Sensmeier, 2010a). Analise discussed her inclusion of clinical nursing aspects when planning for new system execution (Rowe, personal communication, October 25, 2011). Continued education and ongoing advocacy of clinical nursing, in the informatics process, will contribute to the effectiveness of health information technology (Sensmeier, 2010a). Systems & Profession Nursing. The INS role affects the nursing profession by allowing the voice of nursing to be heard in the realm of health information technology (Sensmeier, 2010a). In addition, the implementation of new technology can contribute to decreased documentation times, increased nurse-patient time, improved communication between settings and a reduction in patient harm (Furukawa et al., 2011). Analise recognizes her direct impact on the nursing profession, indicating the need to include clinical nursing in her decision making process (Rowe, personal communication, October 25, 2011). Moreover, she is directly responsible for the appropriate education of the nurses in regards to the accurate use of the systems. She is also aware of the positive effects that can be accomplished with the proper utilization of evidenced based practice when developing technological health systems. Nurses are advocates for patient centered care; the need to incorporate clinical nurses in the development of health information technology should be apparent to the INS (Sensmeier, 2010a). Management. The INS role directly affects management by requiring useful partnerships to improve the incorporation of information technology within the acute care setting (Tornabeni & Miller, 2008). Management and leaders need to work diligently in the assistance of preparing

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the clinical staff as well as other departments to accept system changes (McLane & Turley, 2011). The incorporation of appropriate information, education technique and identification of early resistance will assist the INS in her goal of successful integration of information technology in the clinical setting (McLane & Turley, 2011). The common mistake of not including management in system change can contribute to project failure (Lewandrowski et al., 2011). Analise focus on partnerships, assists with the affects that technology has on systems (Rowe, personal communication, October 25, 2011). She enters that these relationships are imperative to the implementation of the EHR. Analise is an advocate for organizational committees that include intra-departmental input along with the involvement of leadership and administrative positions (Rowe, personal communication, October 25, 2011). She also has a strong will to advance further into the administrative realm and aspires to be the head of the information technology department in the future of her career. The incorporation of nursing management and administration in the role of the INS allows for the nursing voice to be heard while complex system changes affect the nurse profession (McLane & Turley, 2011). Organization. The appropriate utilization of the INS role within organization, to meet the requirements of meaningful use and the implementation of the EHR, will assist in organization incentives and decrease penalties of not meeting required standards (McLane & Turley, 2011). The appropriate implementation and integration of the EHR will also minimize the impact on patient safety and could improve quality of care (McLane & Turley, 2011). It is important that the clinical analyst role is not confused with the informatics clinician; these roles are separate and are both imperative to organizational success in technology integration (McLane & Turley, 2011).

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The INS should be well-versed in socio-technical assessment, clinical expertise, technology literacy and informatics research (McLane & Turley, 2011). Analise has acquired experience in all of these areas (Rowe, personal communication, October 25, 2011). She has experienced the position of the clinical analyst and is aware of the differences between the two roles. Analise understands the INS role and its impact on organization in relation to reimbursement and incentives that may affect the bottom line. Her apparent short and long term goals are a refreshing sign that she is on the right track to seizing INS role attainment (Rowe, personal communication, October 25, 2011). Ethics Analise discussed her involvement in identifying needs of staff, developing programs for usability and effectiveness and identifying issues in regards to breech of patient confidentiality with the increase utilization of technology in healthcare (Rowe, personal communication, October 25, 2011). With the initiation of the EHR throughout the community; patient information will immediately become available for sharing amongst disciplines (Goodman, 2010). This attempt at improvement of continuity of care has raised concern for some individuals that health information will not be sufficiently protected (Goodman, 2010). In discussing health information technology with Analise, she was immediately aware of the issues related to increased access of patient information with the ongoing use of electronic systems in the clinical setting (Rowe, personal communication, October 25, 2011). She indicated that patient confidentiality is always taken into consideration prior to creation or change in systems. However, with patient information at clinicians fingertips, the patient could receive improved quality of care across multiple disciplines. Reasonably, a physician wouldnt treat a patient without utilizing possessed knowledge from previously treated patients; useful

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information can be obtained by having information available to each discipline (Goodman, 2010). Analise understands that a persons information is important to them; if approached thoughtfully, communities may feel more comfortable sharing information with multiple health professionals in order to improve the breadth of their care (Rowe, personal communication, October 25, 2011). Culturally Competent Practice Elderly. It is crucial for the INS to utilize culturally competent care in the implementation and integration of technology (Moen, Gregory & Brennen, 2007). Cultural considerations can include sex, race, socio-economic status, education, environment and even age (Moen et al., 2007). Analise is aware of the cultural issues within the acute care setting, although implies that her role is not exposed to a significantly diverse environment (Rowe, personal communication, October 25, 2011). Although, Analise did identify the elderly as a large portion of local culture; she is aware that the elderly may have decreased knowledge of technology. Analise ascertains that the elderly need additional education regarding the aspect of care and that technology may impact understanding of their plan (Rowe, personal communication, October 25, 2011). The inclusion of the spouse, children or other family members in care of the elderly patient can assist in decreasing some of the technological learning barriers that these individuals may face (Moen et al., 2007). Analise is sure to assist management and clinical nurses in the identification of these learners in the clinical systems (Rowe, personal communication, October 25, 2011). Patient and Nurse Knowledge Base. When developing, designing and implementing new systems, it is essential that the end user is considered (Jest & Vasperson, 2010). With the

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concept of culturally competent care within her role, Analise identifies with the knowledge base of the patients and staff that may utilize the program (Rowe, personal communication, October 25, 2011). She discussed applying the appropriate education level to the information provided in order to comply with the end users education level, social experience and technological literacy. The individual that will be utilizing the system needs to be able to comprehend its use and the implications attached to its use (Jest & Vasperson, 2010). In addition, nurses utilizing clinical systems are typically obtaining information form a diverse culture of patients; it is important that the translation of information is useable at the lowest possible level of literacy to comply with this need (Jest & Vasperson, 2010). Analise is aware of the different education levels of her end users and attempts to create programs that will be user friendly (Rowe, personal communication, October 25, 2011). A physician could utilize the same system as nurses and nurse aids; it is important that these individuals have the same usability as the physician (Jest & Vasperson, 2010). Conclusion The informatics nurse specialist is vital in the creation, implementation and integration of healthcare technology (Sensmeier, 2011). Maintained commitment and vested interests of departmental partnerships assists in the improvement and likelihood of sustained change (Tornabeni & Miller, 2008). Analise identified multiple relationships that she is able to maintain within her role (Rowe, personal communication, October 25, 2011). The competent INS has years of clinical experience coupled with technology literacy, organization and leadership skills, staff development understanding and integration of all within the role (Kaminski, 2010). Analise has a well rounded understanding of the INS scope of practice and limitations; she actively

ROLE ANALYSIS incorporates standards within her creation of technological systems (Rowe, personal communication, October 25, 2011).

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It has been identified that the nursing profession, management and organization are all affected, in some way, by the INS role. Analise remains highly involved in each of these areas in order to deliver technological systems that meet comprehensive care requirements (Rowe, personal communication, October 25, 2011). Cultural and ethical issues can be identified within the role of the INS. The elderly, patient and nurse knowledge levels were considered by Analise as culture issues in her work environment (Rowe, personal communication, October 25, 2011). Being aware of ones strengths and weaknesses can assist in improvement within the INS role. Analise is aware of these areas, however additional weaknesses were identified in the analysis of her role performance (Rowe, personal communication, October 25, 2011). Yet, with her commitment to self-improvement and continuing education, Analise was found to be at the competent level of role attainment and actively working towards proficiency. To conclude, even though Analise has not yet excelled to the expert level of the INS role, she was found to be an appropriate fit for the INS role in the acute care setting.

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