An Informatics Nurse Speaks

My mother introduces me these days as "my daughter who used to be a nurse." But that's not true - I am and always will be a nurse. I'm just practicing in a different area. Advances in technology have improved our ability to care for patients. What nurses (or others, like my mother) don't often think is that these technological advances also include computer systems. All nurses need to have skills to be able to use a PC, a monitor, or other equipment, just like they need the skills to do a physical assessment. You cannot keep up with the information or reports needed in today's world unless you have some system (besides paper) to help you.

I got into the field of nursing informatics several years ago when I was manager of a hospital ambulatory services department. Being responsible for the business aspects of the department as well as the clinical, I was on the project team for implementation of the new computer systems. I found that my innate curiosity and need to always ask "Why" proved very useful in this endeavor. I also discovered that computers are only a tool; it takes humans to analyze information needs and to plan how to best meet them – a discovery that led me to the field of nursing informatics.

I have never regretted the move! Just as in clinical nursing, you never know what to expect. Although you anticipate what you need to do each day, anything can happen to interrupt those plans and change your priorities. The next thing you know, it’s 5:30 PM and you haven’t been able to do one thing on your to-do list.

I start out each day by turning on my PC. Then I open my email system. I read my new messages and respond when necessary. This usually takes an hour or two. Sometimes an email I receive will require a telephone contact for follow-up, or users may contact me by telephone. Much of the time in my office [is] spent either answering a question, providing clarification, explaining how a function works, or troubleshooting. When I am troubleshooting, I often access the software system with which the caller is having difficulty. This allows me to try to do what the user has done or attempted to do, so I can access whether the caller is using the right function or routine, and using it correctly. If the function is being used appropriately, I try to recreate what the user has done to see if I can elicit the same response or responses that she or he did. This method gives me a better picture of the difficulty and allows me either to solve the problem or to pinpoint a software problem. One day, I logged 6 hours and 45 minutes of telephone time; the majority of which was nonstop.

Sometimes I need to contact one of the vendors to get a problem resolved. Talking with vendors may also include discussing product enhancements, a new product or feature that they are developing and releasing to clients, or an upcoming class or meeting. Software testing is another function of the job. New features or updates may be released that need to be tested. This process involves creating different scenarios in which you enter data and print reports to make sure the software does what it’s supposed to do. This can take hours, days, or even weeks to complete.

Reports are the end result of information processing. When you buy software, you sometimes get standard reports (those that the majority of all users need) but you usually have to write custom reports. Users give me requests for reports that they would like to have. To create them I may be able to modify an existing report, or I may need to create a new one. This involves determining which file or files the information resides in, how the output of the report should look, what fields the report needs to include, what to name it so that the users will know which report to run, and perhaps which menu to put it on. Writing reports can take anywhere from a few minutes to several days, depending on the complexity, as well as the amount of time you can devote (Remember all hose interruptions!). Testing a report is also part of modifying or creating one. As the creator, I need to test it to be certain that it produces what the user wants. Then I need to have the user test it to see if the data and design meet his or her needs.

Another role of the informatics nurse is one of teacher. I develop lesson plans and teaching materials to train the staff on the use of computer systems. Training is done formally or informally, depending on the situation, and can take a few minutes to several days. In addition, I attend meetings, both in my department and with other departments. Many times, I am the leader of the meeting, which also involves putting together the agenda and handouts, and doing minutes. There are also user group and informatics organizations to which I belong.

A key element in this role is communication. When you are working in nursing informatics, you are providing help and support to end users; staff, managers, directors, directors, and vice presidents, as well as the programmers/developers (Very often, the programmer or developer is at your vendor’s location and not in-house). Nursing informatics is extremely dynamic, and I love the challenge. It offers me the opportunity to work with many different people, do many different things, and be creative. This role is never boring!

Judith Hornback, RN, BSN, MHSA

Informatics Nurse Specialist

Senior Consultant, RHI, Inc.

Highland, Indiana