Nursing Occupations
Proposed by:
Cynthia Lundberg, BSN
Judith Warren, PhD, RN
Nursing Occupations Project
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The problem of EHRs not having a standardized terminology that contains
distinct, unambiguous, understandable, and useful nurse professional
occupations/roles will impact querying.
Lack of specifics will impair research analysis for improving patient safety,
quality of care, and cost effectiveness.
 For example, nursing occupations support research of nursing staff
levels required based upon patient acuity.
 These types of reports can also be used to identify if an inappropriate
level of staff contributed to a medical or medication error and identify
appropriate levels of nurse needed to improve quality patient care.
Nursing Occupations Project
 The requirement of having the ability to query for
professional roles/credentials at the “Is_A” relationship
level is essential when assessing if the appropriate level
of nursing occupation was performing patient care and
how this role affected the quality of patient care.
 The need for unambiguous nurse occupation/roles is
necessary to post-coordinate ”referral to (observable
entity) CID 440379008” and ” referral by (observable
entity) CID 440377005” with the appropriate nurse role.
Risks
 Inability to reach consensus of nursing
occupations/roles for the Core and the country
extensions
 The priority given to the work to will be so low as
to require years before the content is fixed
 Some countries have yet to develop extensions
and so the content may be lost
Process for Conducting the Project
 The hierarchies will be searched for all nursing
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occupations/roles
Proposal made for correct placement
SNOMED code result set will be saved as a value set.
The Nursing SIG will validate the SNOMED CT Nursing
Occupations/role revision proposal
Revisions made as necessary and then submitted to
the Nursing SIG
Beneficiaries
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Patient
 When the role of the nurse is specified, then resources can be
understood and allocated to patient care.
 Nurse caring for the patient:
 Knowing the nursing occupation/role will facilitate identification of
of the impact of care on patient outcomes;
 Knowing what nurses do in their roles
 Researcher:
 Nursing occupation/role data will be consistent and measurable
across multiple enterprises.
Risks
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Inability of the incoming SNOMED CT code to be translated in
receiving system.
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Incoming applications will need a translation methodology for
translating the SNOMED CT code to the nursing terminology
they use.
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There will need to be a process for handling SNOMED CT
codes that do not translate into the terminology used in the
receiving care setting
SNOMED CT Nursing Problem List set will become out of synch
with corresponding nursing terminologies when they release new
versions.
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To mitigate this risk the Nursing SIG will communicate with the
developers to gain their collaboration.
Results
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Nurse role/occupations are a subtype of the Social Context
hierarchy
 SNOMED CT contained 147 nurse role/occupation concepts
 The only defining concepts is the Is_A defining relationship.
 There are no other defining attributes that have been approved
by the IHTSDO which means that the occupations cannot be
fully defined today.
 Of the 147 total role/occupation concepts 129 concepts have been
defined unambiguously, are expressed with a FSN, and have been
defined correctly in the Is_A defining relationship.
Results
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129 concepts are international in scope and are recommended to
remain within SNOMED CT core.
 1 concept is being recommended to be submitted as a new IHTSDO
request.
 “Chief nursing officer “ is being requested so that nursing officer
concepts can be classified under it.
 For example, nursing officer (occupation) CID 158990003 Is_A
Chief nursing officer
 10 are being proposed to be moved from SNOMED CT core to an
extension file as these concepts have been found to be country
specific.
Role/Occupation Concepts Proposed to be
Moved to a Country’s Extension File
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SNOMED CT FSN
CID
Country Extension
Integrated midwife
312485001 United Kingdom / Philippines
Foot care worker
22460300
United Kingdom
Professional initiating surgical case 405684005 United Kingdom
Healthcare service manager
224579007 United Kingdom
Nursing officer – district
158985001 United Kingdom
Nursing officer – division
158987009 United Kingdom
Nursing officer - region
158984002 United Kingdom
Nursing sister
224572003 United Kingdom
Registered nurse First Assist
372102007 United Kingdom
Accident and Emergency nurse
224537001 United Kingdom
Role/Occupations Being Proposed to be
Retired
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SNOMED CT FSN
CID
Professional providing staff relief during surgical procedure 405685006
Sanitarian
45956004
Occupational health service manager
224580005
Occupational health nursing officer
158989007
Midwifery personnel
106294002
Nursing aid
73265009
Other professional nurse
83189004
Theatre nurse
224561008
Results
 Four SNOMED CT concepts have not been defined
appropriately using the Is_A defining relationship
 The concepts identified as having the inappropriate Is_A
have been recommended to be classified under alternate
active SNOMED CT concepts within the Social Context
hierarchy so that their definitions are disambiguated.
Concepts that have been defined with an inappropriate
Is_A
Newly Proposed Is_A Relationships
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SNOMED CT FSN
CID New Is_A FSN
CID
Anesthetic nurse 309445003 Perioperative nurse
415075003
Health visitor 159000000
Professional nurse
106292003
Staff midwife
158995008 Staff nurse
158994007
Registered midwife 309453006 Health visitor/nurse/midwife 309452001
Quality Measures Achieved
 Number of concepts reviewed=147
 What are the current location(s) of nursing
occupations/roles concepts in SNOMED CT?
 Social Context Hierarchy
 Which hierarchy should contain the nursing
occupations/roles concepts?
 Social Context hierarchy
 Number of nursing occupations/roles concepts located
accurately =129
Quality Measures Achieved
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Number of nursing occupations/roles concepts needing to be
moved=0
 Number of concepts to be retired=8
Number of the nursing occupations/roles concepts belonging in the
SNOMED CT Core? 129
Which ones need to be moved to country extensions? =10
Number of the nursing occupations/roles concepts fully modeled
according to the style guide=129
What are the obvious missing nursing occupations/roles concepts=1
Number interactions with Nursing SIG participants
 One conference call in 2010, Fall 2010
Proposed Quality Measures Not Achieved
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The following measures were found to be beyond the
scope of the project
While logically they were measures, as the project
evolved, new understanding occurred
 What attributes should the nursing occupations/roles
concepts have for URU modeling and clarity of use?
 How should they be disambiguated?
Issues from Quality Committee
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Look at ref set work; is this where we need to go
 What about legacy data; should we keep the UK roles in core
because when they are moved to an extension, the extension is n ot
mentioned so people don’t know where to look
 Are the criteria we used to make the recommendation to move to
extension, the reverse of what we need to do to determine if they
belong in core
Questions/Discussion