A Day in the Life of An Informatics Nurse
1. Background Information
My name is Suzanne Brown and I work as an informatics nurse in one of the Dublin academic
teaching hospitals. I work in the Information Management Services (IMS) Department as part of a 4
person nursing informatics team. My official title is Assistant Nurse Coordinator Computer Services.
I qualified as a registered general nurse in Dublin in the 80’s. As was popular at that time, I went to
Australia with friends for a year. On my return I spent 4.5 years in the UK where I qualified as a
midwife and a Neonatal Nurse. It was in the area of neonatal nursing that I spent the majority of my
clinical career. I returned to Ireland and worked for a number of years in the Neonatal unit of one of
the Dublin maternity hospitals. Working in the unit was very rewarding but it came to a point where
I needed a change of direction.
When I qualified as a nurse it was through the apprentice training system as opposed to today’s
nursing degree program so I went to college in 2001 to get my nursing degree. It was during the
college course that I became aware of the area of informatics, which was completely new to me. I
found it fascinating and felt that it was an area that I would be interested in working in. With that in
mind I continued in college and completed by MSc in Health Informatics in 2005.
Informatics jobs were scarce in Ireland but luckily a job was advertised for an informatics nurse in
this hospital as I was finishing my study. I started working here the same month as I finished my
MSc.
2. Role of informatics
I work with three other nurses in the Nursing Informatics team. We are involved in all
aspects of the ICT solutions that the nurses use, from development/selection (in some
cases), to training and implementation. In the hospital the main systems the nurses use are
PatientCentre (our EPR), a rostering system and a patient dependency system. Our work is
very varied as no two days would be the same. We all have our own projects that we lead
on as well as collectively supporting all the systems that nursing use. We undertake a lot of
training, both in the classroom and at ward level. All nursing staff starting in the hospital
complete a full 7 day orientation program and one full day is for IT training. We also do oneto-one and small group training sessions at ward level as it is often difficult for the staff to
be released from the wards for training.
We run informatics educational sessions/study days for external informatics students, both
from Ireland and abroad and occasionally give university lectures on informatics to nursing
students.
Some of the projects that I have led on have been in-house IT developments. In these cases I
worked with the nurses and the programmers to develop suitable functionality. I was then
responsible for the resultant implementation. I am also involved in other projects that are
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not necessarily IT related but I am there to advise the groups on what they need to consider
with regard to future IT developments. This is certainly the case with the nursing
documentation group. The core nursing documents are being redesigned at the moment.
We do not yet have clinical documentation in our EPR but I sit on the group to advise them
from the informatics perspective.
An important part of my work is building up good working relationships with the nursing
workforce. This is really important as, when it comes to training & implementations you
need to be viewed as impartial. Although the majority of my work is nurse related I do
occasionally work with other disciplines in the hospital.
3. Critical factors that lead to successes
If I had to name the most important factor that leads to successes in my work I would say it is good
communication, from start to finish and understanding the workflow processes. Also understanding
the key drivers for a project’s implementation is important. Nurses are more inclined to view an
implementation favourably if they can see what benefit it will be to them. Nursing IT solutions are
usually implemented by our nursing team. There may be some exceptions to this rule but generally it
is the case and has worked very well for us in terms of system adoption and user satisfaction. We are
always open to feedback and will try to address any issues that are raised.
There are some projects/functionality that we develop for staff because they have come to us
looking for a solution to a problem. There are other ones that we are asked to do by senior hospital
management. This means that sometimes whether a nurse uses new functionality is for her/him to
decide and sometimes it is compulsory. This can have a bearing on training as it can be more
challenging to train staff that may have reservations about what the benefits are to them.
One of the projects that I am lead on is electronic Nurse Specialist Referrals. Some of the Clinical
Nurse Specialists (CNSs) working in the hospital approached the department to see if there was a
way that they could get their patient referrals sent to them electronically. We worked with them and
developed “Nurse Referrals”. With this functionality, patients are referred to them and they record
the care they give to the patient, electronically. Reports can then be produced on their activity. Four
specialities were involved in the initial pilot. There are now 38 specialities using this functionality. In
2012 over 13,500 referrals were sent and 35,000 visits were recorded. This is one project where I
have learned lessons. Once the initial group of interested CNSs were using the system I approached
other CNSs to set them up as well. I discovered that there is no point training someone to use
functionality they are not particularly interested in, if it is not mandatory for them to do so. The best
advertising for the nurse referrals comes from those who are already using the system, and most of
the more recent groups have contacted me because their colleagues have recommended it to them.
I am always conscious that projects I am involved in should not be seen as IT projects and that there
always should be a clinical champion for the project. In the case of the Nurse Referrals, the Senior
Nursing Managers in the hospital are now encouraging their CNSs to use of the system to record
their direct patient care.
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4 Systems Engagement
The hospital collects a set of nursing care and patient experience metrics on a bi-monthly basis. A
software solution has been developed in-house for electronic data capture and reports generation. I
worked with the Nursing Quality Manager and the programmer on the development of the software
solution.
The hospital has an electronic rostering system. Our Bank Management System was developed
in-house and is a complementary component of the rostering system. Vacant ward shifts are
communicated to the Bank office, while, concurrently, staff notify the Bank office of their availability
to work overtime. By synchronising available staff and vacancies, the Bank Management System
facilitates the selection of suitable staff to fill vacant shifts as they occur. I am project lead on the
Bank Management System project. I was involved in all aspects of this project, from development
and testing to training and implementation and my involvement continues today.
As mentioned previously I worked with an in-house programmer to develop the Nurse Referrals
software. I now have the tool at my disposal to set up new users when needed. I also carry out all
the training and on-going support for the nurses.
All patients in the hospital have a “Readiness for Discharge” status entered by the ward nurses once
they are admitted. As they approach their estimated discharge date their status may be changed to
reflect any outstanding things that need to be done/in place to enable their discharge to take place. I
worked with an in-house programmer, the Patient Flow Department and the pilot wards to develop
the software. I was again involved in all aspects of this project, from development and testing to
training and implementation and continue to lead on the project from the IT perspective.
I am also involved in many other projects, from our electronic Patient Dependency system, nursing
documentation redesign, nurse training on the IT systems for both qualified and student nurses to
name but a few. I also representative the Nursing Informatics team at our senior IMS projects
meetings.
A lot of day-to-day work is spent on supporting staff using our existing systems, from such basic
things as reactivating passwords and talking nurses through a particular process, to helping to
address particular requests that nurses ask of us. All members of the Nursing Informatics team have
the knowledge to advice nursing staff on any of the system they use, rather than just been able to
offer support for our own particular projects.
5. Future plans
I am employed in the hospital on a nursing grade. Operationally, I report to both Nursing (to the
Assistant Director of Nursing, Nursing Quality Manager) and to the head of the IMS Department. We
(Nursing Informatics team) prioritise our work depending on a number of factors such as:
The impact to nursing of a situation existing
The level of cover in the Informatics team on any particular day. At present I am the only
member of the team working fulltime. On days, where cover is less than optimal, basic
ongoing support has to take precedence over other work
The importance Senior Nursing Management place on a particular situation
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We do, however, have a lot of autonomy over how we work and can organised our own workloads
once due care is taken with the above points.
We do not have a fully integrated EPR yet and clinical documentation is a major element that is
currently missing. Nursing documentation is one of my big interests and I would love to be involved
in implementing clinical documentation in the hospital when that need arises. This has been given a
high priority by the senior hospital management so I am hopeful that this will become a reality in the
near future.
There are not yet a large number of nursing informatics jobs in Ireland so the potential to move to
other areas is limited. As long as there are exciting developments going on in the hospital and I find
the job stimulating I will continue to work here. However, I would never rule out the possibility of
moving on if an ideal job came along.
The title of this podcast is “A day in the life of an informatics nurse” and I seem to have been writing
a lot about what I do. I would just like to finish by saying that none of what I do would be possible if
it wasn’t for the team of people who work in the IMS Department. I may know what needs to be
done and can implement it in practice but they are the people who make that a reality.
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