1. Skiba, Diane J. PhD, FAAN, FACMI
  2. Rizzolo, Mary Anne EdD, RN, FAAN

Article Content

Numerous driving forces are energizing efforts to ensure that the next generation of nurses is prepared to practice in a patient-centered, technologically savvy healthcare environment. In 2004, the establishment of the Office of the National Coordinator for Health Information Technology and their strategic plan to ensure that the electronic health record is available to all by 2014 served as a catalyst to create the Technology Informatics Guiding Education Reform (TIGER) Initiative.1 This grassroots effort held a summit in 2006 to bring together more than 120 leaders from nursing professional organizations, vendors, government, and informatics organizations around a singular exploratory focus: "Creating a vision for the future of nursing that bridges the quality chasm with information technology (IT), enabling nurses to use informatics in practice and education to provide safer, high-quality patient care." As a result of the summit, the TIGER vision was crafted as follows: "to enable nurses to use informatics tools, principles, theories, and practices to make health care safer, more effective, efficient, patient-centered, timely, and equitable by interweaving enabling technologies transparently into nursing practice and education, making information technology the stethoscope for the 21st century." At the summit, 3- and 10-year plans were created, and individual professional organizations made a commitment to ensure that all nurses, current and future, will have the necessary knowledge and skills to practice in the ever-changing technology-rich healthcare environment.


According to Skiba and Dulong,2 the TIGER Initiative embraces knowledge leadership and the effective use of social and intellectual capital to reach an intended target. Knowledge leadership brings together the intellectual capital from its network, in this case, more than 40 nursing professional organizations that were selected to represent the broader nursing community. The goal was to bring in these organizations and then use their social capital and infrastructure to bring forward the TIGER Initiative agenda and dissemination throughout their organization. "The success of the TIGER Initiative depends largely upon the extent to which the social capital of the broader nursing community is leveraged."2


One such organization was the National League for Nursing (NLN), a professional organization dedicated to excellence in nursing education. The NLN, founded in 1893 as the American Society of Superintendents of Training Schools for Nurses, was the first organization for nursing in the United States. Their mission is to promote excellence in nursing education to build a strong and diverse nursing workforce. Within the NLN structure, there are various advisory councils and task groups to facilitate the mission and goals of the organization. One such advisory council is related to technology and has a long, rich history within the NLN. The NLN, along with the American Nurses Association (ANA), was the first professional organization in the 1980s to have councils devoted to informatics.3


The purpose of the Educational Technology and Information Management Advisory Council (ETIMAC) is to promote the effective use of technology in nursing education, both as a teaching tool and an outcome for student and faculty learning, and to advance the integration of information management into educational practices and program outcomes. Two specific informatics goals of this council are the following:


* Provide input to professional organizations and other relevant groups regarding the continued refinement of informatics competencies for nurses


* Evaluate the extent to which and the ways in which current curricula prepare students to achieve the informatics competencies (ie, computer literacy, information literacy, and overall informatics competencies) for the nurse as outlined in the ANA's Scope of Practice for Nursing Informatics



To read more about ETIMAC, you can go to


Within this council, a Task Group on Informatics Competencies was charged with conducting a comprehensive review of the literature on informatics competencies for various levels of education and found that although the competencies were clearly identified, there was limited adoption by nursing schools to incorporate the competencies. In response, the task group also developed and implemented a survey to determine the extent to which current nursing curricula prepare students with necessary informatics competencies. In March 2006, the task group sent separate but similar e-mail surveys to NLN member and nonmember faculty and nursing education administrators. The survey asked how schools were addressing informatics in the nursing curriculum. A total of 540 deans/directors and 1557 faculty responded. The results demonstrated that while most schools of nursing focused on computer and information literacy, there was limited involvement in the attainment of informatics knowledge and skills. Informatics content in prelicensure course work covered topics related to issues (privacy, confidentiality, security and impact of electronic health records, documentation, and bar-code medication systems). Personal digital assistants (PDAs), software for care plans, and clinical information systems were the least likely to be incorporated into courses. One disturbing finding was that faculty and administrators failed to distinguish between teaching with technology and teaching about technology. It was clear that many equated taking online courses with knowledge and skills in informatics. Teaching with technology was often equated with how they were meeting the informatics competency. For more information about the results of this study, Thomson and Skiba4 provided a summary of major findings. Based on the work of this task group, the initial draft of the NLN position statement "Preparing the Next Generation of Nurses to Practice in a Technology-Rich Environment: An Informatics Agenda" was formulated and eventually approved by the NLN Board of Governors in May 2008.


This NLN position statement is a call for action to prepare the next generation of nurses with the necessary informatics competencies to provide safe and quality care. To address this call for action, the Informatics Agenda developed a set of recommendations for faculty, deans, and directors of schools and departments of nursing and the NLN itself.


The focus of faculty recommendations is on their own professional development in the area of informatics so that they can facilitate the integration of informatics in the nursing curriculum. The following is a sample of the recommendations for nursing faculty:


* Participate in faculty development programs to achieve competency in informatics


* Designate an informatics champion in every school of nursing (1) to help faculty distinguish between using instructional technologies to teach versus using informatics to guide, document, analyze, and inform nursing practice and (2) to translate state-ofthe- art practices in technology and informatics that need to be integrated into the curriculum


* Identify clinical informatics exemplars, those drawn from clinical agencies and the community or from other nursing education programs, to serve as examples for the integration of informatics into the curriculum



For the administrators of nursing programs, the recommendations focused on providing leadership to promote the informatics agenda and provide necessary resources to incorporate informatics competencies into the nursing curriculum. The following is a sample of the recommendations for deans/directors/chairs:


* Provide leadership in planning for necessary IT infrastructure that will ensure education that prepares graduates for 21st century practice roles and responsibilities


* Provide opportunities for faculty development in informatics


* Urge clinical agencies to provide hands-on informatics experiences for students


* Establish criteria to evaluate outcomes related to achieving informatics goals



Finally, the position statement also recommends to the NLN a set of recommendations to continue their leadership and advocacy role in the informatics agenda. The following are some of those recommendations for the NLN:


* Disseminate this position statement widely


* Participate actively in organizations that focus on education in nursing informatics to ensure that recommendations from those organizations are congruent with the NLN's positions on curriculum


* Use ETIMAC and its task groups to (1) develop programs for faculty, showcasing exemplar programs, and (2) disseminate outcomes from think tank


* Encourage and facilitate accrediting bodies, regulatory agencies, and certifying bodies to reach consensus on definitions related to informatics and minimal informatics competencies for practice in the 21st century



To access a copy of the NLN position statement "Preparing the Next Generation of Nurses to Practice in a Technology-Rich Environment: An Informatics Agenda," you can log on to


The NLN is working to address these recommendations. With the heavy emphasis on faculty development in the position statement, a new task group was appointed. The purpose of this task group is to formulate a comprehensive plan for faculty development related to the integration of informatics into the nursing curriculum. Their tasks are as follows:


* Identify exemplars and examine how innovative schools of nursing have integrated informatics into the curriculum and prepared their graduates to practice in the current practice environment


* Develop curriculum guidelines related to incorporating informatics as a core competency in the nursing curriculum across all educational levels


* Develop a Web resource site that provides information and links to teaching strategies, assignments, exercises, active learning experiences, case studies, and software that is available and targeted to specific informatics learning outcomes


* Draft a comprehensive plan for a faculty development series that would prepare faculty to incorporate best practices for integration of informatics competencies into the curriculum


* Establish and monitor an electronic "eCommunity" on strategies and best practices to integrate informatics competencies into the nursing curriculum



To read more about the Faculty Development Task Group related to informatics competencies, you can log on to


In summary, the NLN has been instrumental in helping to create an informatics agenda for the nursing education community. It is closely aligned with the TIGER Initiative and is using the social and intellectual capital of the NLN membership to fulfill its commitment to ensure that all nurses, current and future, will have the necessary knowledge and skills to practice in the everchanging technology-rich healthcare environment.


Special thanks go to the Task Group on Informatics Competencies who worked on the position statement (Roy Simpson, Brent Thompson, Kathryn Doughtery, Suzanne Shore, Barbara Vickers, Darlene Mathis, and Vicki Elfrink) and the Task Group on Faculty Development Related to Informatics Competencies (Brent Thompson, Julianna Brixley, Patricia Allen, Valerie Gooder, Kathy Martin, Carol Kupniak, and Helen Heiskell).




1. Technology Informatics Guiding Education Reform. The TIGER Initiative: evidence and informatics transforming nursing: 3-year action steps toward a 10-year vision. [Context Link]


2. Skiba D, Dulong D. Using TIGER vision to move your agenda forward. Nurs Manage. 2008;39(3):14, 16. [Context Link]


3. Skiba D. Moving forward: the informatics agenda. Nurs Educ Perspect. 2008;29(5):300-301. [Context Link]


4. Thomson B, Skiba D. Informatics in the nursing curriculum: a national survey. Nurs Educ Perspect. 2008;29(5):312-316. [Context Link]