Bridging Nursing and Technology: An Evidence-Based Proposal for a Nurse Informaticist Role Focusing on Improved Outcomes

As a nurse attending the recent state Nurses Association meeting, I was intrigued by the presentation given by a nurse informaticist on the positive impacts of her role in her healthcare organization. Our organization is currently undergoing substantial technological changes as we implement a new electronic health record (EHR) system and other health information technologies. Based on the nurse informaticist’s presentation and my research into the field, I believe adding a similar role could greatly benefit our organization during this transitional period. I spoke with our Chief Nursing Officer and Human Resources manager about the potential of proposing a new nurse informaticist position, and they asked that I prepare a proposal outlining the evidence-based benefits of such a role. This proposal aims to justify the need for a nurse informaticist who can facilitate the optimal use of technology to improve communication, patient care quality, safety, and satisfaction.

Nursing Informatics and the Nurse Informaticist 

Nursing informatics can be defined as “the specialty that integrates nursing science with multiple information and analytical sciences to identify, define, manage and communicate data, information, knowledge and wisdom in nursing practice” (ANA, 2022). Nurse informaticists thus serve as a bridge between nursing and information technology, using their expertise in both fields to enhance systems and processes. Their key roles and responsibilities involve:

• Leading implementation, optimization, customization, and maintenance of clinical information systems
• Facilitating the adoption of new technologies through education and training of end-users
• Enhancing workflow efficiency and quality of documentation
• Improving clinical decision support features and data accessibility
• Promoting data integrity, privacy, confidentiality, and security
• Conducting analytics on EHR data to identify areas for clinical improvement
• Staying abreast of technological advances relevant to patient care and nursing practice

By serving in these critical capacities, nurse informaticists enable nurses and the broader care team to fully leverage cutting-edge IT tools, with the ultimate goal of improving patient outcomes, safety, and experience.

Nurse Informaticists in Other Healthcare Organizations

Incorporating nurse informaticists into healthcare organizations has become an increasingly common best practice. These professionals are highly collaborative, working closely with Chief Nursing Officers, Chief Medical Information Officers, IT specialists, analysts, educators, and frontline clinical staff. They provide in-depth informatics expertise while also intimately understanding nurses’ needs and the nursing perspective, allowing them to effectively mediate between the nursing and IT spheres.

For instance, nurse informaticists at Cleveland Clinic played instrumental roles in the customization and adoption of their new EHR platform, serving on implementation teams, educating end-users, modifying order sets and documentation tools to better meet clinician needs, monitoring efficiency and patient safety impacts, and continually optimizing system configuration post-go-live (Iuppa, 2022). This level of nurse informaticist involvement across the entire implementation and optimization lifecycle has been linked to more effective EHR adoption and utilization in multiple large hospitals.

Impact of Full Nurse Engagement in Health Technology 

Patient Care 

Several studies reveal that nurse informaticist-led optimization of EHRs and other health IT significantly improves patient outcomes. Nurse informaticists at UNC Health Care improved EHR functionality related to pressure ulcer prevention and achieved a 37% pressure ulcer rate reduction over 18 months (Santo & Redfern, 2020). By optimizing EHRs and ancillary technologies for nursing workflow and documentation needs, nurse informaticists empower nurses to provide higher quality, safer care.

Protected Health Information Nurse informaticists are vital to the effective management of protected health information (PHI), including privacy, security, and confidentiality. Drawing on their expertise in nursing practice, standards, regulations, and technologies, they promote the development of health IT tools and policies that safeguard PHI without compromising usability or patient care (ANA, 2022). Specific evidence-based strategies a nurse informaticist could institute include:

• Routinely auditing systems’ PHI access logs for unwarranted access
• Ensuring endpoint encryption on all organization-issued mobile devices
• Conducting annual risk analyses and privacy impact assessments
• Leading role-based access control initiatives to tighten data access
• Implementing multi-factor authentication for system login
• Educating staff on safe PHI handling policies and procedures
• Serving on committees focused on PHI security and ethical data use

These interventions would significantly augment our organization’s PHI protections.

Workflow

Multiple studies reveal that nurse informaticist involvement in EHR adoption and optimization improves nurses’ perceptions of the EHR’s usefulness and ease of use while reducing the documentation burden. Targeted enhancements to system configuration and clinical decision support tools also boost nursing workflow efficiency.

For example, nurse-informed revisions decreased documentation time for admission assessments by 50%. Such efficiency gains expand nurses’ availability for direct patient care. Additionally, a specialty hospital found that nurse informaticist-led optimization allowing reuse of charting from previous shifts increased nursing overtime by 3,000 fewer hours annually, equivalent to $90,000+ savings (Schoenbaum & Carroll, 2020). By streamlining workflows and documentation, nurse informaticists create substantive time and cost savings.

Return on Investment 

While nurse informaticist salaries entail significant upfront costs, their initiatives to improve care quality, safety, efficiency, and technology usability deliver even greater financial returns.

As noted, nurse informaticist-driven EHR changes contributed to reductions in key adverse events like pressure ulcers and falls. A single prevented pressure ulcer or fall can save $30,000-$90,000 in excess healthcare costs per patient. Efficiency enhancements enabling nurses to expand direct patient care while cutting documentation time and overtime expenses also produce major cost savings. Estimates indicate that 2-5X salary return on investment ratios are readily achievable from nurse informaticist hiring at large hospitals. Our organization would likely realize similar, if not greater, financial returns given the pivotal nature of the nurse informaticist role during extensive IT transformations like our imminent EHR implementation.

Opportunities and Challenges 

This EHR launch represents prime opportunities but also substantial challenges. Our nurses are currently overwhelmed managing their current workload alongside demands to adopt and learn this completely new system. Without support, burnout and resignation rates may climb. A nurse informaticist could prevent such issues by easing the transition through optimized education, training, and post-implementation system improvements, facilitating better workflow and usability. They could also open doors for nurses to engage more actively with the technologies transforming our practice.

However, securing stakeholder buy-in and cooperation poses challenges. Some clinicians may be resistant to adjusting workflows or learning new technologies. Many nurses also have significant anxieties about EHR implementation, given their suboptimal experiences with IT rollouts in the past. Our nurse informaticist would need to build trust through transparency, meaningful solicitation of user feedback to drive ongoing optimizations, and consistent support. However, with persistent relationship-building across disciplines and departments, alongside leveraging the empathetic insight their nursing lens provides, I am confident our informaticist could surmount these hurdles.

Summary of Recommendations

1. Nurse informaticists smooth major health IT adoption like our upcoming EHR go-live by optimizing system configuration and functionality for nursing workflow. This drives user buy-in and mitigates burdens preventing optimal nursing care.
2. They enhance the realization of patient safety and care quality gains from new technologies via customization for nursing documentation and practice needs. Targeted improvements driven by their informatics expertise tangibly improve outcomes.
3. Even conservatively estimated financial returns from enhanced care quality, reduced adverse events, and expanded nursing productivity and capacity outweigh the costs of nurse informaticist hiring.

References

American Nurses Association (ANA). (2022). Nursing informatics scope and standards of practice. Nursesbooks.org.

Iuppa, N. (2022, November 21). Improving the Electronic Health Record Experience for Nurses. Consult QD. https://consultqd.clevelandclinic.org/improving-the-electronic-health-record-experience-for-nurses/

Santo, K., & Redfern, J. (2020). Digital Health Innovations to Improve Cardiovascular Disease Care. Current Atherosclerosis Reports, 22(12). https://doi.org/10.1007/s11883-020-00889-x