Much has changed since nursing informatics (NI) became an established nursing specialty practice. The scope of practice statements and standards of practice have been revised at 5-year increments to reflect the changing expectations and evolution in nursing and informatics practice. A new resource describing the contemporary scope of practice statement and standards of NI practice has just been released.
Happy 15th anniversary! In 1992, the American Nurses Association's Congress of Nursing Practice supported the recommendation of the Council on Computer Applications in Nursing to officially recognize NI as a nursing specialty. The Council had submitted a report presenting the evidence that addressed the National Board of Nursing Specialties' 10 criteria of a specialty. The evidence included the first definition of NI as a specialty that integrates nursing science, computer science, and information science in identifying, collecting, processing, and managing data and information to support nursing practice, administration, education, and research and to expand nursing knowledge. Note the focus on the life cycle and management of data and information in support of the four domains of nursing: practice, administration, education, and research.
That definition remained unchanged in the publication of The Scope of Practice for Nursing Informatics in 1994.1 This 15-page resource provided brief answers to the "who," "what," "where," "when," "why," and "how" of NI practice. Remember that life, healthcare, and information systems were much simpler then. Windows 95 had not yet been released; networks and the Internet were essentially "new kids on the block"; and cell phones were not ubiquitous.
Publication of The Standards of Practice for Nursing Informatics followed in 1995 to provide more specifics of NI practice in the form of standards and the accompanying measurement criteria.2 At that time standards were defined as "authoritative statements in which the nursing profession describes the responsibilities for which nurses are accountable."2(p1) Those NI standards incorporated six practice standards of assessment, diagnosis, identification of outcomes, planning, implementation and evaluation; eight professional performance standards; and five domain standards. Both The Scope of Practice for Nursing Informatics and The Standards of Practice for Nursing Informatics served as foundational references for the American Nurses Credentialing Center's (ANCC) NI certification that became available in late 1995. The certification examination was the first ANCC computer-based test and was first offered in December 1995.
The American Nurses Association (ANA) expects specialty nursing scope of practice statements and standards of practice to undergo review and necessary revision at least every 5 years or more frequently if changes in the specialty practice warrant. In 1999, the ANA convened a workgroup of informatics nurses that was charged to complete such a review and create a consolidated scope and standards document that reflected the template language of the 1998 Standards of Clinical Nursing Practice.3 Extensive and spirited discussions developed the new definition of NI and addressed the challenges of crafting standards of practice and accompanying measurement criteria that built on the prescribed standards framework but described a nonclinical practice. The resultant draft was widely disseminated for public comment and then slightly revised based on those comments before moving into the two-tier ANA review process.
The Scope and Standards of Nursing Informatics Practice was published in 2001 and again served as a resource for the ANCC's NI Content Expert Panel responsible for oversight of the NI certification.4 The new definition of NI included communication, knowledge, decision-making, patients and other providers, information structures, information processes, and information technology. The standards of practice described a problem-solving framework, and the standards of professional performance included the new standard of communication. Although the Scope and Standards of Nursing Informatics Practice was intended to guide NI practice, identify content that needed incorporation in educational curricula, and serve as a resource to regulatory and legal entities, the workgroup established to create the 2004 Nursing: Scope and Standards of Practice relied heavily on the content and language to inform its thinking and writing activities.5 International colleagues have also used this NI resource within their environments.
"Time flies when you're having fun" also holds true in the professional standards environment. The calendar date and significant changes in the healthcare environment mandated that a workgroup be convened in 2005 to review and revise the NI scope and standards. More than 25 volunteers from diverse work and geographic settings spent 18 months formulating a totally revised scope of practice statement, a slightly modified NI definition, and completely new standards and measurement criteria. This work also underwent a public comment period and follow-on revision before submission to the ANA's two-tier review process.
Nursing Informatics: Scope and Standards of Practice (2001) defines NI as "a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice. NI supports consumers, 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." Just as the 2001 NI scope and standards raised the bar with the inclusion of knowledge in the definition, this version does the same with the addition of wisdom, a key content issue for evidence-based practice, development of decision-support tools, and nursing knowledge bases as our experienced nurses exit the profession for retirement or other career opportunities
The US national government's influential push for the integration of informatics solutions in the healthcare industry, pay for performance, and reduction of medical errors now provides even more diverse opportunities for informatics nurses and informatics nurse specialists to lead key initiatives within some of these areas. Similarly, the increasing complexity of healthcare services and systems, coupled with the exponential expansion of data, information, and knowledge, require new competencies for nursing and NI practice. This prompted the NI scope and standards workgroup to present the scope of practice framework around three content areas: the description of metastructures, concepts, and tools of NI; functional areas for NI; and informatics competencies.
The inclusion of several figures helps to visually present the concepts and relationships of data, information, knowledge, and wisdom; the levels and types of automated systems that support the use and generation of data, information, knowledge, and wisdom; and models of the relationships of healthcare informatics specialists. The table of the matrix of informatics competencies by NI functional areas provides a new compilation of published work in this area. The informatics competencies matrix will prove helpful to faculty developing curricula and helpful to employers in establishing selection criteria for hiring informatics nurses for current and future positions and for defining performance goals and career ladders for staff. The extensive reference list directs interested readers to additional valuable resources.
The Standards of Nursing Informatics Practice introductory paragraphs include three overarching principles that are inherent in every aspect of NI practice and should be considered by informatics nurses and informatics nurse specialists when addressing the standards of practice. The Standards of Nursing Informatics Practice contain two sections (Standards of Practice and Standards of Professional Performance) that reflect the template language from the standards content in Nursing: Scope and Standards of Practice.5 "Standards are authoritative statements defined and promoted by the profession by which the quality of practice, service, or education can be evaluated."5(p49)
The Standards of Practice provide specific statements that address assessment, problems or issues, outcomes identification, planning, implementation, and evaluation. Three additional standards about coordination of activities, consultation, and health teaching, health promotion, and education for informatics solutions complement the implementation standard. Each standard includes a series of measurement criteria to further explicate the expectations associated with the standard. The Standards of Practice describe the essential knowledge work of an informatics nurse that can be labeled problem solving or the nursing process.
The 10 Standards of Professional Performance include separate standards statements and accompanying measurement criteria about education and lifelong learning, evaluation of one's professional practice, quality of NI practice, collegiality, collaboration, ethics, research, resource utilization, and leadership. The standard for advocacy has been added because of its importance in all practice settings for the informatics nurse and informatics nurse specialist.
The extensive compilation of the informatics competencies and the enumeration of specific measurement criteria may seem daunting. Just remember that standards should always guide practice, as does the Code of Ethics for Nurses With Interpretive Statements.7 However, real-world practice will require thoughtful application of the appropriate competencies and measurement criteria.
As you examine the new Nursing Informatics: Scope and Standards of Practice, do consider consulting the enclosed appendices of the previous versions of the Nursing Informatics: Scope and Standards of Practice to reflect upon our significant 15-year history and then envision what opportunities are ahead. 6 What a different informatics world we will see in another 5 years!
It's not too early to begin planning for the next edition. So, as you identify and meet the challenges and opportunities associated with implementing this work within various practice, education, administration, and research settings, compile your recommendations for improvements in the language and content of the standards and measurement criteria. Then forward that list to the ANA's Department of Nursing Practice and Policy. You can purchase the Nursing Informatics: Scope and Standards of Practice from Nursesbooks.org via telephone at 1-800-274-4262 or online at http://www.nursebooks.org.
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