1. McCormick, Kathleen A. PhD, RN, FAAN, FACMI, FHIMSS
  2. Newbold, Susan K. PhD, RN-BC, FAAN, FHIMSS, FAMIA

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Recognizing her significant contributions to pioneering the field of nursing informatics for over 40 years, Virginia K. Saba, EdD, RN, FAAN, FACMI, was inducted as a Living Legend in the American Academy of Nursing in 2002. This tribute highlights her contributions in nursing informatics, certification of nurses in informatics, and her development and research of a coded standardized classification of nursing-the Clinical Care Classification (CCC) System.

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Dr Saba died on November 20, 2021, while on a trip to Indianapolis for the Sigma Theta Tau Biennial Convention in Indianapolis, IN. She was there doing one of her favorite activities, presenting the Virginia K. Saba Nursing Informatics Leadership Award to the 2021 recipient, Dr Suzanne Bakken. This award has recognized nine nursing informatics leaders since its inception in 2005. Dr Karen A. Monsen is the most recent of the 17 recipients of the American Medical Informatics Association Virginia K. Saba Informatics Award also endowed by Dr Saba in 2005.


For over 42 years, she and Dr Kathleen McCormick have published Essentials of Nursing Informatics.1 The first book was published in 1986 after the two taught a course at the National Institutes of Health Graduate School on Computers in Nursing. Virginia, and her coauthors, developed the sections describing what is a computer and the applications in education and research. Dr McCormick, and her coauthors, developed the sections on applications in nursing practice. Now in its seventh edition, the book is used by numerous schools of nursing and has educated many informatics nurses and non-informatics nurses. One feature is a mapping to the ISO 9001 Certified American Nurses Credentialing Center examination to enable informatics nurses to study for certification. Dr Saba has contributed to the certification of nurses in informatics since the certification inception.


Working as an officer in the United States Public Health Service as a nurse for over 20 years (retiring at a rank of 06/Captain), her early work focused on what comprised nursing data and how it could be used to improve nursing's visibility. She received a United States Public Health Service Commendation Medal for her contribution in manpower and management information system studies.



Following her United States Public Health Service career, Dr Saba worked on the development of an internationally recognized coded nursing terminology. The CCC System was created to support the electronic capture of discrete patient care data for documenting the "essence of care" for nursing and measuring the relationship of nursing care to patient outcomes. There have been 11 research publications documenting the use of the CCC in nursing care.2 Currently, the CCC is managed for further development and research by the Hospital Corporation of America, Nashville, TN (HCA Healthcare) since 2020 and is free for all to use. Dr Jane Englebright, former Chief Nurse Executive and Senior Vice President of HCA, says that with Virginia's consultation, HCA Healthcare embedded the CCC into the EHR (Meditech) at its 186 hospitals across the country.3 The original workflows that HCA used are available to the public in the virtual library of Sigma Theta Tau International Honor Society of Nursing in Indianapolis.4


On the HCA CCC system Web site,5 there is a helpful code-builder that allows the user to use the six steps of the nursing process recommended by the American Nurses Association: (1) assessment, (2) diagnosis, (3) outcomes identification, (4) planning, (5) implementation, and (6) evaluation. The nurse can enter the information and receive the corresponding code to nursing diagnoses or nursing interventions.


In addition to HCA, other organizations within the United States are disseminating the CCC. According to Dr Avaretta Davis, Deputy Chief of Nursing Informatics, Veterans Health Administration (VA): "We are very excited to integrate the CCC System into our care planning tools at the VA. With it, we can map interventions to outcomes and ultimately use data for improving patient outcomes."3 Dr Seth Wolpin, Clinical Associate Professor, University of Washington School of Nursing, states: "I've been working with the CCCS for over 16 years, and I continue to be impressed with how it can be used to document the nursing process. It is critical that we can connect nursing assessments and actions with patient outcomes."3 At the 2019 CCC User Conference in Nashville, TN, Karen Hughart, Senior Director, Nursing Informatics, Vanderbilt University Medical Center, presented the integration of the CCC into their Epic EHR.6


The CCC codes have been linked to SNOMED, LOINC, and ICNP enabling worldwide dissemination. The persons engaged in developing the three versions of the CCC since the beginning in 1991 are acknowledged on the current CCC Web site.7



Most published research studies, resulting from the Finnish use and development (FinCC), have been conducted at the University of Eastern Finland in Kuopio, Finland.1 Saranto et al8 summarize the progress to date in their chapter entitled "Nursing Informatics Innovations to Improve Quality Patient Care on Many Continents." In this chapter update, Dr Saranto and coauthors describe the FinCC11 research projects of graduate students who further developed, adopted, and integrated the CCC to measure the impact on quality and outcomes of care in nursing practice.



Dr Saba was on the faculty of several universities including the University of Maryland, Baltimore; Georgetown University, Washington, DC; and the Uniformed Services University, Bethesda, MD. She received honorary doctoral degrees from the University of Maryland Baltimore; Excelsior College in Albany, NY; the University of Athens in Greece; and the University of Eastern Finland in Kuopio, Finland.


In summary, Dr Saba has numerous publications and awards for her contributions to nursing and informatics, certification, and the CCC. Through this tribute, the impact and legacy of Dr Virginia Saba continues through the awards she established, the resources she provided to continue her coded classification to make nursing visible and provide a coded standardized nursing terminology for nursing research, and continued support of quality nursing-sensitive patient outcomes. She educated and mentored many nurses and others who have continued her extraordinary work. It was a privilege to collaborate with Virginia for 42 years.




1. Saba VK, McCormick KA, eds. Essentials of Nursing Informatics. 7th ed. New York, NY: McGraw-Hill Publishing; 2021. [Context Link]


2. Muller-Staub M. Improving patient outcomes through SNLs. Paper presented at: 13th ACENDIO Conference; March 20, 2021. [Context Link]


3. HCA Healthcare. Clinical Care Classification System: coding for nursing. 2022. [Context Link]


4. HCA Healthcare. Clinical Care Classification System: ideal nursing workflows to support the development of information technology solutions. 2019. [Context Link]


5. HCA Healthcare. Clinical Care Classification System: online code builder. 2022. [Context Link]


6. Hughart KL. Clinical Care Classification (CCC) utilization at Vanderbilt University Medical Center. 2019. [Context Link]


7. HCA Healthcare. Clinical Care Classification System: acknowledgement of contributors linking the CCC to SNOMED, LOINC, and ICNP and the advisory board for updates. 2022. [Context Link]


8. Saranto K, Kinnunen UM, Jylha V, Liljamo P, Kivekas E. Nursing informatics innovations to improve quality patient care on many continents. In: Saba VK, McCormick KA, eds. Essentials of Nursing Informatics. 7th ed. New York, NY: McGraw-Hill Publishing; 2021: 677-691. [Context Link]