Michael Smith Foundation for Health Research

Michael Smith Foundation for Health Research

Networking Program – Phase II: Technology/Methodology Platforms

Expression of Interest

PROPOSED PLATFORM

NI-LEARN: Nursing Informatics Leadership, Education and Research Network

Area of Interest

The NI-LEARN platform is being proposed to focus on nursing informatics professional development; curriculum and faculty development; CEU and specialty certification; and the formation of communities of practice for nursing informatics research in B.C. Nursing informatics is “a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice. Nursing informatics facilitates the integration of data, information and knowledge to support patients, nurses and other providers in their decision-making in all roles and settings. This support is accomplished through the use of information structures, information processes, and information technology” (Staggers & Bagley-Thompson, 2002, p. 262).

Nurses are the largest group of health care providers in British Columbia (about 36,000) and in Canada (about 241,000), thus it is critical for the evolution of health-related informatics that nurses become competent and knowledgeable in both theory and practical informatics applications within the discipline and practice of nursing. In essence, due to sheer numbers as well as the amount of time patients spend in the care of nurses, nursing informatics must become a key focus in health informatics initiatives. The role of the nurse has intensified and diversified with the widespread integration of communication technology and information science into health care agencies. The professional nurse is now expected to function well within a technologically advanced health-care environment, carry out higher-level, complex activities, and are held responsible and accountable for the systematic planning of holistic and humanistic nursing care for clients and their families. This is expected to occur within a system challenged by a nursing shortage, heavy workloads and long shift-work hours, tight budgets, modest wages, rising chronic illness, and an increasingly ill hospital population. Nurses are expected to keep abreast of technological implementation within their work environment with little time for professional development activities or in-service attendance. Recent research suggests that competent application of nursing informatics ability can significantly reduce the amount of time nurses spend performing routine tasks such as documentation of data and information, deciphering care directives, providing patient education, and researching critical information to guide patient care.

Health informatics is the general application and study of informatics within the health system. Nursing informatics is an important cornerstone of the more general science of health informatics. “Health informatics, from its inception, has always been disciplinary....informatics applications that are targeted to the information needs of clinicians improve health care delivery and health outcomes. We need to prevent the collapse of health care as we know it through discipline-specific informatics initiatives that prepare specialists to engage in integration.” (Masys, Brennan, Ozbolt, Corn & Shortliffe, 2000, p. 305). “It is critical that registered nurses take their place in developing future knowledge, information and health care services delivery systems.” (2020Vision, 2000, p.8).

Nurses must become proficient in participating in the use of the emerging Canadian Health Infostructure, including the design and use of Electronic Health Records (EHRs), web-based and tele-health initiatives. “As the transition to an electronic health record gains momentum, health-care delivery will need to dramatically reinvent the way it collects, processes, and uses health information. A workforce capable of innovating, implementing, and using health communications and information technology (ICT) will be critical to health-care's success,” (AHIMA, 2006, p. 2). Two contingents are needed to address this critical need: specialists in health information management and competency development in the people who must use health information technology, such as the practicing nurse and other health care professionals.

The NI_LEARN collaboration will develop a four pronged approach to nursing informatics competency in practicing nurses, nursing students, faculty and researchers. These four areas include:

• Continuing Education workshops that can be offered on weekends and in short course formats throughout British Columbia. These workshops will be similar to the Weekend Immersion in Nursing Informatics (WINI) offered by an American collaborative in both US and eastern - midwest Canadian cities. At the current time, education in nursing informatics is usually done in an informal, self-directed way, with little access to credited courses or accessible education. As well, e-learning short courses would augment these compact on-location courses, serving nurses in remote areas, and those unable to devote the time to attend in-person courses. These workshops would grant Continuing Education credit (CEUs) and provide convenient, accessible professional development for practicing nurses who lack the time and resources to pursue formal education in nursing informatics. These credits could be designed in a way that nurses could work toward eventual certification status in nursing informatics.

• A prototype curriculum for incorporating nursing informatics into undergraduate and graduate BC Schools of Nursing curriculum would be developed to foster nursing informatics competencies and knowledge in nursing students. Faculty development initiatives would also be required and planned. E-learning curriculum would augment the on-campus curriculum development to again serve students in remote areas, and those who wish to study using an on-line approach to learning. Although national organizations and initiatives have advocated for the integration of nursing informatics into basic nursing program curricula for several years, to date, nursing schools in BC and across Canada have not succeeded in achieving this to any great extent.

• Specialization development would be undertaken to determine and design a formal program of study to educate nurses to develop nurse informatician specialty skills and knowledge. The BC health system needs expert nurses who can make a valuable contribution to the development, implementation, monitoring and problem-solving involved with implementing the EHR (electronic health record), ensuring trouble free system implementation in health care systems, and training and supporting nurses working with electronic information and data.

• A community of practice for research would be the fourth focus of the NI-LEARN network. Both quantitative and qualitative research is needed to guide evidenced-based applications of nursing informatics theory and applications in the health care system: in hospitals, community health facilities, tele-nursing, and in education. Research is also needed to find ways to cultivate a positive information technology culture in nursing, and develop a cohesive and comprehensive nomenclature for nursing care that provides a legal record of care that captures the nurse's expression of patient assessment, diagnosis, goals, plan of care, care delivered, the patient's responses to care, and the actual patient outcomes within a foundation of domain completeness .

How this initiative is provincial in scope and value added

There is a critical need for development of nursing informatics competencies in nursing students and practicing RNs across the entire province. National and provincial nursing governance organizations support this critical need and are taking steps to include informatics competencies within the expected standards of care by nurses. There is also an urgent drive to set formal standards and to develop comprehensive curriculum (both on site and e-learning) for inclusion in basic nursing education across the province. As well, a definite gap in nursing informatics research is evident. Since nurses are the largest health care provider group, these proposed research and education strategies would enhance health informatics in general, and facilitate a province-wide technologically competent nursing workforce. This initiative would place B.C. in the forefront of Canadian nursing informatics development and education.

How it will enhance B.C.'s international competitiveness

Nursing informatics initiatives have become a global trend: most nations across the planet are currently working on standards and plans for education and research development. Compared to many of these countries, (especially the USA, Britain, and Europe) Canada is far behind in our state of nursing informatics development and strategic planning for education and research.

NI-LEARN could help BC become a leader in preparing a nursing workforce capable of making a meaningful contribution to the development of a cohesive national health care system and in sharing information and services across provincial and even national borders while still respecting unique needs of different national and international regions. BC and Canada are far behind other nations, in developing nursing informatics educational, certification, and research programs.

NI-LEARN TEAM

Co-Chairs (must be from BC)

• Val Cartmel
• June Kaminski
• Dr. Heather Clarke?

• Steering Committee (must be 75% from BC)

Robin Carriere
Dr. Lynn Nagle
Dr. Xing Liu
Dr. Dianne Symonds? / Dr. Heather Clarke[HF1]?
Bev Mitchell[HF2]?
Alyse Capron
Lee Ashbourn? VIHA[HF3]

DEVELOPMENT PROCESS

Key stakeholders -would include all B.C. Schools of Nursing including nursing students and faculty, all Regional Health Authorities and their inclusive nursing workforce, the CRNBC[HF4], the B.C. Ministry of Health (including the Nursing Directorate and its strategic priorities), and ultimately, all BC residents would benefit from the initiatives proposed within this EOI.

Process of Engagement – an inclusive and well-articulatedplanned strategic plan would be developed to facilitate invite collaboration and support with all BC Universities, University Colleges and Colleges that offer Nursing education. RegionalProvincial[HF5] health authorities would be approached to plan continuing education workshops and specialization education for practicing nurses in a variety of care settings. A community of practice will be formed to further nursing research in both education and practice by collaborating with administrators, scholars, and clinicians from around the province.

Key Success Factors include:

- there is national support for initiatives in nursing informatics

- competencies and knowledge base directives are being established by national bodies

- the national nursing shortage provides support to optimize the role of nurses

- the proposed Chairs and Steering Committee have well-established expertise in education and research in nursing informatics and/or information technologies

- this initiative will help prepare nurses to integrate nursing data into provincial and national databases and participate in the development of systems such as the International Classification for Nursing Practice (ICNP) which could translate data from various databases into a universal language

A national standard for a clinical information system (SNOMED) is well on its way to being accepted for pilot testing with one of the recommendations being to work with other other classification systems (including ICNP) to ensure comprehensiveness of clinical information in electronic health records

Key Obstacles include:

– there is a lack of positive information technology culture in nursing

- heavy workloads and lack of time could inhibit nurse participation in initiatives

- providing the infrastructure, including the hardware, software, education necessary to support nurses to develop informatics competencies requires funding, resources and commitment

BUDGET

The initial budget would be mainly allotedallotted to cover expenses related to:

• A thorough Environmental Scan, to collect data and dialogue with Regional Provincial Health Authorities' key spokespeople and the MOH Nursing Directorate, academic liaisons, national and provincial licensing bodies such as the CRNABC and CNA[HF6]

• A carefully thought-out Plan of Action to organize the four proposed initiatives will be done including the articulation of the network's mission, goals, strategies, time-lines, and steps to take to confirm collaborative links with BC Schools of Nursing and Regional Health Authorities.

APPENDIX

• References, Charts/Graphs
• Backgrounds/Experiences of Chairs and Steering Committee Members

[HF1]Would prefer this role rather than co-chair

[HF2]Would be a good choice

[HF3]She was on the same Infoway Work as I was – to do with clinical info systems

[HF4]Spell out

[HF5]To ensure inclusion of PHSA

[HF6]CNA is national and not a licensing body, although it does do certification which is relevant to NI