Hello Nursing Informatics - The Nurses You Didn't Know Existed

 You use bandages, lorazepam, ventilators, and sterile gloves.  I use relational databases, SQL, ontologies, standard terminologies for interoperability, and clinical decision support.  We’re both providing patient care.  We both want the best possible outcome for the patients we serve.  We are both nurses.

I’m writing this to better answer those who want to know what in the world Nursing Informatics is.  When I first ran across this Informatics Nursing thing – honestly, I didn’t even realize that my hospital had a couple of informatics nurses, much less who they were or how I contacted them.  I couldn’t ask them about their job.  Looking online wasn’t a whole lot of help either.  I got a few textbook type definitions, but not a lot that was really useful for what it actually meant or what informatics nurses actually did in the real world.  I found a number of of links to new and cutting-edge technology that might appeal to those in the field, but I couldn’t get a real-world description of the job and the purpose.

So let’s get to it:

I’m an Informatics Nurse.  Or a Nurse Informaticist.  Or a nurse who does informatics. Yeah.  One of those. I improve patient care using clinical information and technological tools, incorporating my background of clinical/nursing knowledge (There are clearer and more official sounding definitions of Nursing Informatics you can Google on your own).  That can mean a lot of different things.

As a nurse, you likely have a love-hate relationship with technology.  Technology has undeniably changed the world, and resulted in monumental improvements in efficiency, communication, process improvement, precision, and reliability.  The degree to which we’re surrounded by technology is attestation to the level of the improvements it’s made in the world around us.  You enjoy that little gadget you’re holding in your hands right now reading these words on.   You love the technology that allows you to watch your patient’s heart rhythm at any second from inside the room or out at the nurse’s station.  You love that you can (…hopefully by now…) look up your patient’s labs and clinical notes on most any computer in your facility.  And at the same time, you dislike the tedious, cumbersome, unnatural, and impersonal process of charting everything you do with a patient.  I get it.  I’ve been there.  I used to be an ICU nurse too.  As much as I love what technology allows us to accomplish today, there were so (…SO…) many times I wanted to scream at the software I was using as an ICU nurse.

[Let’s be honest, I still want to scream at so much of it – but that’s another subject – or 5,000 subjects – for another time].  So many times I’ve said to myself “Wouldn’t it be helpful if ____ information were on the screen here” or “Wouldn’t it be nice to have a reminder to do _____ based on these clinical data in the system?” or “Wouldn’t it be nice to have an information button here with helpful information on these data on my screen?” So many times I’ve thought that “Wouldn’t it be nice if an actual clinical nurse were consulted in the design of how this software works and what it shows??”

Hello, nursing informatics.

Yes, I’m that nurse.  And no, I haven’t begun solving all that I want to solve in electronic medical record software (Not even close … yeah, I want to scream about it to anyone who will listen … which usually just means an occasional 2-hour rant to my wife as we both get fired up about this or that problem that needs to be fixed… *sigh*).  I look at the technology in my life that has improved my life in so many ways -- Shared shopping lists, walkie-talkie apps, maps that magically show you where you are, instantly look up anything (No, seriously, Google, “Clark Gable bacon number” or any other actor for that matter) , social media to connect with distant friends, exercise trackers, or to-do-lists and reminders… and I say to myself ...  why ... WHY can’t we have this kind of improvement in healthcare??  With as important as healthcare is, why can’t we have technology to help us accomplish the things we’re wanting to accomplish faster, easier, more accurately, and less obtrusively?  Along with amazing technology advances that let us play a real-time farm simulation game with distant friends on our tiny portable devices, for goodness-sake, let’s also use technology to remind clinicians about an order they’re missing, or an alert that a hematocrit is significantly different than the patient’s baseline, or to help document more efficiently, or help guide toward and suggest the most appropriate clinical choices based on certain coded rules.

Sure, let’s keep using our incredible technology to play our silly little games if we want, but let’s start putting it to work to make the overwhelmingly complex job of our clinicians a little bit (or a lot?) easier, and ultimately to achieve better patient outcomes, as well as improving and saving lives at the same time.  That’s what matters.

I mean, my goodness -- with technology, we can deposit a check from a kitchen table.  We can control the lights and the garage door of our house from 1500 miles away with a smart phone.  We can have text messages read to us and reply completely hands-free and eyes-free when our phone senses that we’re driving.  We can get up-to-the-minute updates on weather across the globe.  And then you sit down for an ICU RN shift handoff, and you get handed a clipboard and you hand-write the information that your patient’s lives are literally relying on onto an 8 ½ x 11 white paper, hoping you didn’t misunderstand anything, and that they remembered to tell you everything (and you know how smoothly that always goes … don’t you…).  When it comes to reliable data transfer, in a battle between ICU nurses and CandyCrush, I’d rather see the ICU nurses win – but right now, I’m putting all of my money on CandyCrush – and I’ve never even played it.

It’s time that healthcare graduates from 1996.  Or in some cases, 1969.  Or worse.

The fairytale story the public sees about how healthcare operates is … well, a fairytale story.  They see TV commercials of $2,000,000.00 surgical robots and rotating 3D medical imagery spread across six screens with three scholarly-looking medical people intently looking at it and one of them wearing glasses and pointing at radiology images.
The public thought is “Look at all of the computers!  Look how expensive healthcare is!  This must be the most technologically advanced industry in the world!  Surely nothing could go wrong." What they don’t realize is that the majority of healthcare is real live people with real live limitations making real-live decisions and far too often, things go wrong or very wrong.  As complex as modern healthcare is, what clinicians are being asked to do is honestly super-human now.  It can’t be done.  They need better supportive tools to help them do their jobs that they want to be doing.

We’ve reached a point in healthcare where it is now clinical informatics that has to take the next steps to achieve future significant, widespread, and long-lasting impacts in patient health, safety, outcomes, and cost efficiency.  And we’ve just getting started.

My mission is to advance the combination of human clinical skill with the precision and reliability of technology to consistently deliver the best care possible to the patient’s I serve.

That is [some of] Nursing Informatics.  That is what matters.