FEATURE ARTICLE
How to Support the Nursing Informatics
Leadership Pipeline
Recommendations for Nurse Leaders and Professional Organizations
Uba Backonja, PhD, RN, Laura Heermann Langford, PhD, RN, Patricia Joppich Mook, MSN, RN, NEA-BC, CAHIMS
There is a need for nursing informatics leaders. However,
there are not enough people educated and trained in informatics and leadership to fill that need. Therefore, the purpose of this study was to understand how professional
organizations and nurse leaders support nursing informatics leadership development. This cross-sectional, descriptive study collected data via a scan of Web sites for eight
nursing, informatics, and/or leadership professional organizations; interviews and surveys with nursing informatics
leaders within the eight organizations; and a review of Web
site, interview, and survey findings by nursing informatics
leaders involved in leadership development. We found that
nursing informatics leaders and professional organizations
can support the nursing informatics leadership pipeline several ways. Examples included mentoring, education/
training, and providing opportunities for networking and engagement in leadership roles. To help meet the need for
nursing informatics leaders, professional organizations
and current leaders can engage in various activities that provide training, education, and experiences for emerging
leaders.
KEY WORDS: Education, Leadership, Mentors, Nursing
informatics, Societies, Training
ursing informatics (NI) leaders work in various domains, including within healthcare organizations, educational institutions, professional organizations, and
governmental agencies (Table 1, under “Examples of NI
leaders”). Nursing informatics leadership-specific positions,
such as chief nursing informatics officer (CNIO), have been
established as more health information technology (HIT)
is integrated into healthcare,1 bringing great value to organizations
N
Author Affiliations: School of Nursing & Healthcare Leadership, University of Washington
Tacoma (Dr Backonja); Department of Biomedical Informatics & Medical Education, University
of Washington School of Medicine (Dr Backonja), Seattle; Intermountain Healthcare (Dr
Langford), Salt Lake City, UT; Nursing Informatics, College of Nursing, University of Utah (Dr
Langford), Salt Lake City; and Atrium Health (Ms Mook), Charlotte, NC.
The authors have disclosed that they have no significant relationships with, or financial interest
in, any commercial companies pertaining to this article.
Corresponding author: Uba Backonja, PhD, RN, School of Nursing & Healthcare Leadership,
University of Washington Tacoma, 1900 Commerce Street, Box 358421, Tacoma, WA 984023100 (backonja@uw.edu).
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
DOI: 10.1097/CIN.0000000000000827
8
(see links in Table 1 under “American Nursing Informatics
Association,” “Healthcare Information and Management
Systems Society,” and “Scottsdale Institute”). Nursing informatics leaders have the expertise and skills to see beyond the
HIT solution itself to anticipate and plan for improvements
and changes to the HIT that will come down the line; they
also understand the importance of working with users to
learn about their HIT needs (Table 1, under “Scottsdale Institute”). Nursing informatics leaders also have the education
and training to understand how to use HIT to move from
data to information and ultimately to knowledge (Table 1,
under “American Nurses Association”). This allows them
to move from a “tactical to strategic” orientation, leveraging
their ability to act as a liaison between nursing and HIT to
understand nurses' HIT needs and how to facilitate HIT
change to support effective and efficient care.2
Investigating the NI leadership pipeline is one way to
identify strategies to support a sufficient number of NI
leaders in the future. The leadership pipeline is also known
as succession planning and management, which is defined
in the foundational work of Rothwell3 as “any effort designed to ensure the continued effective performance of an
organization, division, department, or work group by providing for the development, replacement, and strategic application of key people over time” (p 6). There has been
long-standing work within nursing and general healthcare
to identify strategies and develop tools to support succession
planning and leadership development,4 and there has been
recent work within NI to identify individually driven strategies to support leadership development.5–9 Much of this
work focuses on the individual to support his or her personal
journey through the NI leadership pipeline. However, for
them to be successful, it is also important to look at the ecosystem in which these emerging NI leaders are navigating the
NI leadership pipeline. Recent evidence regarding gender
disparities in pay10 and leadership11 within informatics, the
lack of underrepresented minorities within informatics graduate programs,12 and institutionalized racism in nursing education and leadership13 suggests that efforts to support NI
leadership development should include investigating how organizations and current leaders support an ecosystem that
enables equitable opportunities for emerging NI leaders.
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Table 1. Web Sites Relevant to Nursing Informatics Leadership Education, Training, and Experiences to Support
Nursing Informatics Leadership Maturity Mentioned in the Article
NI- and leadership
pipeline–related links
Examples of NI leaders
• Alliance for Nursing Informatics
° About ANI: https://www.allianceni.org/about-us
° Emerging Leaders Program: https://www.allianceni.org/ani-emerging-leaders
• American Association of Colleges of Nursing
° Clinical Nurse Leader: https://www.aacnnursing.org/CNL
° Clinical Nurse Leader Tool Kit: https://www.aacnnursing.org/Education-Resources/Tool-Kits/
Clinical-Nurse-Leader-Tool-Kit
° Essentials for Baccalaureate Education: https://www.aacnnursing.org/portals/42/publications/
baccessentials08.pdf
• American Medical Informatics Association
° First Look Program: https://www.amia.org/amia2020/first-look-program
° Nursing Informatics Working Group: https://www.amia.org/programs/working-groups/
nursing-informatics
° Student Working Group: https://amia.org/community/working-groups/student
° Women in AMIA Initiative: https://www.amia.org/women-amia-initiative
• American Nurses Association
° Nursing Informatics Scope and Standards of Practice: https://www.nursingworld.org/nurses-books/
nursing-informatics-scope-and-standards-of-practice-2nd-ed/
° Health IT Policy Engagement Page: https://www.nursingworld.org/practice-policy/health-policy/
health-it/
• American Organization for Nursing Leadership
° Sponsored Journal Nurse Leader: https://www.journals.elsevier.com/nurse-leader
° Emerging Nurse Leader Institute: https://www.aonl.org/education/enli
° Leader2Leader Mentorship & Mentee Program: https://www.aonl.org/resources/mentor
° Nursing Informatics Executive Leader: https://www.aonl.org/sites/default/files/aone/informaticsexecutive-leader.pdf
° Nurse Leader Competencies: https://www.aonl.org/resources/nurse-leader-competencies
• American Nursing Informatics Association
° About the American Nursing Informatics Association: https://www.ania.org/about-us
° The Role of the Chief Nursing Informatics Officer: Position Statement of the American
Nursing Informatics Association Board of Directors: https://www.ania.org/assets/documents/
position/cnioPosition.pdf
• Healthcare Information and Management Systems Society
° CNIO Job Description: https://www.himss.org/sites/hde/files/d7/himss-cnio-job-description.pdf
° Nursing Informatics Committees: https://www.himss.org/membership/get-involved/committees/
nursing-informatics
° Nursing Informatics Workforce Survey: https://www.himss.org/sites/hde/files/d7/2017nursing-informatics-workforce-full-report.pdf
• Institute of Medicine Report the Future of Nursing: Leading Change, Advancing Health: https://www.ncbi.
nlm.nih.gov/books/NBK209872/
• Massachusetts Department of Higher Education Nursing Initiative Future Nursing Core
Competencies©: Registered Nurse: https://www.mass.edu/nahi/documents/NOFRNCompetencies_
updated_March2016.pdf
• Scottsdale Institute 2018 Chief Nursing Informatics Officers: Managing Change and Optimizing
Clinical Innovation: https://scottsdaleinstitute.org/wp-content/uploads/SI-2018-CNIO-Spring-Summitreport.pdf
For a List of NI Associations, Organizations, and Journals See Table 2 in https://www.ncbi.nlm.nih.
gov/pmc/articles/PMC5171559/pdf/ymi-11-0264.pdf
• AMIA's NI Working Group page on NI pioneers: ttps://amia.org/community/working-groups/
nursing-informatics/nursing-informatics-history-project
(continues)
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FEATURE ARTICLE
Table 1. Web Sites Relevant to Nursing Informatics Leadership Education, Training, and Experiences to Support
Nursing Informatics Leadership Maturity Mentioned in the Article, Continued
NI leadership–related
academic programs
Mentor resources
Nursing education and certification
funding examples
• Columbia University School of Nursing NI Residency: https://www.nursing.columbia.edu/courses/
nursing-informatics-residency-nurs8124m
• Duke University DNP Executive Leadership Specialty & Certificate: https://nursing.duke.edu/
academic-programs/dnp-program-nursing/dnp-executive-leadership-specialty-certificate
• University of Kansas Leadership DNP with a health informatics specialty area: https://nursing.
kumc.edu/academics/doctor-of-nursing-practice/health-informatics.html
• University of Maryland School of Nursing MSN in NI: https://www.nursing.umaryland.edu/
academics/grad/nursing-informatics/
• University of Minnesota DNP in NI: https://www.nursing.umn.edu/doctor-nursing-practice-program/
specialty-areas/nursing-informatics
• University of Pittsburgh MN with an NI concentration: https://www.nursing.pitt.edu/degree-programs/
master-science-nursing/nursing-informatics/nursing-informatics-curriculum
• University of San Francisco Executive Leadership Doctor of Nursing Practice: https://www.usfca.edu/
nursing/programs/graduate/doctoral/dnp/executive-leadership
• University of Utah College of NI Certificate: https://nursing.utah.edu/programs/certificates/
graduate/informatics.php
• University of Utah College of Nursing MS in Nursing Informatics: https://nursing.utah.edu/programs/
graduate/ms/nursing-informatics.php
• University of Washington School or Nursing Master of Science in Clinical Informatics and
Patient-Centered Technologies: https://nursing.uw.edu/programs/degree/ms-cipct/
• Vanderbilt University DNP Executive Leadership Program: https://nursing.vanderbilt.edu/dnp/
executive.php
For more programs visit AMIA's Informatics Academic and Training Programs page: https://
www.amia.org/education/programs-and-courses
• Organization of Nurse Leaders of New Jersey mentorship toolkit: http://www.njha.com/media/
391827/ONLNJMentorshiptoolkitdocx.pdf
• HRSA Nurse Corps Loan Repayment Program: https://bhw.hrsa.gov/funding/apply-loan-repayment/
nurse-corps
• Johnson & Johnson Financial Aid database: https://nursing.jnj.com/financial-aid
• Los Angeles County Nursing Incentives: https://dhs.lacounty.gov/office-of-nursing-affairs/home/
nursing-incentives/
• MultiCare RN loan forgiveness program: https://jobs.multicare.org/students-grads/graduate-students/
• Washington State Employee tuition exemption: https://nursing.uw.edu/prospective/tuition-exemption/
Therefore, this article looks at supporting the NI leadership
pipeline from an organizational and current leader perspective.
Additional results from this study from the emerging NI leader
perspective can be found in Backonja and colleagues.14
RELATED LITERATURE
Nursing Informatics and Leadership
Before looking specifically at NI leadership, we provide definitions of related concepts.
Leadership is defined by Kotter15 as:
…a set of processes that creates organizations in the first place or
adapts them to significantly changing circumstances. Leadership defines what the future should look like, aligns people with that vision,
and inspires them to make it happen despite the obstacles (p 44).
Nursing leadership builds on the definition of leadership, being defined as a role in which nurse leaders elicit effective performance from others through motivating others and
developing shared values and expectations with the goal to
support the organization's goals and effectiveness.16,17
10
Nursing informatics is defined in the American Nurses Association Scope and Standards of Practice18 as:
the specialty that integrates nursing science with multiple information
and analytical sciences to identify, define, manage, and communicate
data, information, knowledge, and wisdom in nursing practice. NI
supports nurses, consumers, patients, the interprofessional healthcare
team, and other stakeholders in their decision-making in all roles
and settings to achieve desired outcomes. This support is accomplished
through the use of information structures, information processes, and
information technology. (“Definition of Nursing Informatics” section,
paragraph 1)
Nursing informatics leadership has the same qualities as nursing leadership in addition to supporting identification, implementation, use, and evaluation of HITs into care in
various settings, as well as developing policies related to
HIT.19 Nursing informatics leaders work at various levels, which
can be grouped into novice/beginner, mid-level, and
expert/innovator based on the work of Staggers et al20 and
Benner's21 novice to expert leadership development model.
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Novice/Beginner
Considered novice by Benner21 and a beginning nurse by
Staggers et al,20 these newly emerging NI leaders have the
foundational and fundamental skills to use HIT and use
those skills in practice. An example novice-level role is electronic health record (EHR) super users.22 This is a novicelevel leadership role in which a nurse who has experience
and proficiency in using the EHR trains and supports other
nurses in EHR use and works with the information technology department to address issues with the EHR.
Mid-Level
These are corresponding and experienced nurse and nurse
informatics specialist by Staggers et al20; these more experienced emerging NI leaders are proficient in HIT use and
management and collaborate with stakeholders in the effective and efficient application of HIT to practice. This includes both experienced nurses and informatics nurse
specialists as defined by Staggers et al. More advanced
mid-level NI leaders often have advanced informatics education and training. An example of a mid-level role includes
the informatics nurse or NI specialist, which involves the
management of HIT solutions.23
Expert/Innovator
Nursing informatics leaders considered experts by Benner21
and an informatics innovator by Staggers et al20 often hold
high-level positions in organizations and have obtained education in informatics. They engage in vision development
that reflects the values of the organization and critical appraisal of HIT solutions (Table 1, under “American Organization for Nursing Leadership” and “Scottsdale Institute”).
An example expert-level role is the chief nursing informatics
officer within a healthcare organization. The chief nursing
informatics officer role involves developing an organizationwide vision for NI, developing strategies for HIT implementation and evaluation, and working with other executive leaders
to promote effective HIT use at the organization, among
other responsibilities (Table 1, under “American Nursing Informatics Association” and “Healthcare Information and
Management Systems Society”). Another expert-level role is
being a nurse leader within a HIT company as a chief nursing
officer, where their leadership skills are used to support product development. Nursing informatics leaders also lead academic programs, where they use their NI leadership skills to
support informatics education and training. Leadership positions in government institutions are also held by NI leaders,
where they use their NI leadership skills for advocacy and developing policies (Table 1, under “Examples of NI leaders”).
Several professional organizations have developed resources and mentoring programs to support emerging
leaders as they move from novice/beginner to expert. One
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example specific for NI is the Alliance for Nursing Informatics (ANI), which established an Emerging Leaders Program
(disclosure: the primary author was a part of the program,
and the two coauthors were mentors in the program); this
program was developed to provide mentorship and growth
opportunities through professional organizations including
the American Medical Informatics Association (AMIA) and
the Healthcare Information and Management Systems Society24 (Table 1, under “Alliance for Nursing Informatics”). A
general nursing leadership example is the Leader2Leader
mentorship program established by the American Organization for Nursing Leadership (AONL). The American Organization for Nursing Leadership also has an Emerging Nurse
Leader Institute and publishes Nurse Leader, a journal that
provides content for existing and emerging leaders (Table
1, under “American Organization for Nursing Leadership”).
In addition, academic institutions also have programs in
nursing leadership or NI. For those looking to advance in
leadership, there are Master of Science in Nursing (MSN),
Doctor of Nursing Practice (DNP), and post-certificate programs in healthcare or executive leadership (eg, Duke University, Vanderbilt University, University of San Francisco;
see Table 1 for links to examples of leadership-specific academic programs). The American Association of Colleges of
Nursing (AACN) also provide resources for nursing leadership development, including a toolkit for clinical nurse
leaders, a master's-prepared position developed by the
AACN (Table 1, under “American Association of Colleges
of Nursing”). Nurse leaders that emerge from these programs can gain informatics skills and knowledge through certificate NI degrees, certifications, and continuing education
opportunities to gain NI skills and education (Table 1, under
“NI leadership–related academic programs”). For those
looking to advance in NI, there are MSNs, DNPs, and certificates in NI (eg, University of Maryland, University of
Minnesota, University of Washington, and University of
Utah; see Table 1 for links to these and other examples of
NI leadership–related academic programs). Many of these
NI degree programs include leadership courses (eg, University of Maryland, University of Pittsburgh). There are fewer
programs that explicitly integrate leadership and NI, such as
the University of Kansas School of Nursing's Leadership
DNP that has health informatics as a specialty area (Table 1).
The Role of Professional Organizations and Nursing
Leadership in Developing the Nursing Informatics
Leadership Pipeline and Roles
Because nurse leaders are strategically positioned to identify,
educate, train, and mentor future leaders, they are able to directly create opportunities and a context in which emerging
leaders can start their journey and mature25 (Table 1, under
“Institute of Medicine”). Much of the guidance on bolstering
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FEATURE ARTICLE
NI leadership focuses on what individual emerging leaders
can do to enter and mature through the pipeline, including
developing leadership skills, engaging in leadership opportunities, and seeking mentors; however, it is hard or impossible
for these emerging nurse leaders to act on these recommendations if there are no opportunities available that support
their NI leadership maturity (Table 1, under “Scottsdale Institute”). This is made even more difficult for individuals who
have been excluded from the leadership pipeline because
they come from communities that experience institutionalized discrimination, including Black, indigenous, and other
people of color (BIPOC) and face exclusion from leadership
roles due to operationalization of discrimination in leadership
hiring practices.26
This is where nurse leaders are able to make change—
within their workplace, academic institutions, and professional organizations, nurse leaders use their leadership positions to create and improve practices that nurture emerging
leaders27 (Table 1, under “Institute of Medicine”). This includes developing novel partnerships to foster growth opportunities for emerging leaders and developing mentorship
programs and toolkits.28–31 Therefore, the purpose of this
study was to understand how professional organizations
and nurse leaders support NI leadership development.
METHODS
Design, Setting, and Time Frame
This cross-sectional, mixed-methods, descriptive study was
conducted from November 2018 to September 2019 in the
United States. It was approved by the University of
Washington Human Subjects Division. This study included
three parts: a Web site scan of professional organizations, interviews and surveys with NI leaders within the identified
professional organizations, and a review of interview and
survey findings with NI leaders. Methods for each part are
described below.
Professional Organizations
Sample
Our professional networks and Internet searches were used
to identify professional organizations for nursing, leadership,
informatics, and any combination of these domains. We did
not include academic or hospital organizations as they were
beyond the scope of this study.
Measures and Procedures
We extracted from the Web sites information regarding the
professional organizations' target discipline(s), mission, goals,
leadership structure, NI leadership positions for non–NIspecific professional organizations, and current leadership
education and training opportunities. The purpose of
12
extracting this information was to identify structures and opportunities within the organizations that might support the
NI leadership pipeline. Initial extraction was conducted by
UB; review of extracted information was reviewed by all authors, with LHL and PJM providing feedback on additional
information to extract.
Nursing Informatics Leaders Within the Professional
Organizations
Sample
We used purposive sampling to identify affiliated NI leaders
to interview. We recruited individuals who hold a position
within one of the professional organizations and who have
knowledge regarding programs and initiatives that support
NI leadership development. We identified potential participants based on our review of the professional organization
Web sites and through our professional network.
Measures and Procedures
We sent email invitations to participate to NI leaders; the
email invitation included a description of the purpose of
the study and a link to a consent form (hosted by Qualtrics).
Interviews were conducted by UB, who has a PhD in nursing
and has training and 10 years of experience conducting qualitative research. She did not have working relationships with
any of the interviewees and was professionally known by two
of the participants; all participants were told that UB was an
ANI Emerging Leader and that this study was part of that
program. Participants were interviewed over the phone or
in person at a professional conference and audio recorded.
The interviews lasted 30 to 40 minutes and were guided by
questions developed to elicit information about informatics
or leadership training and education opportunities provided
by the professional organization with which the participant
was affiliated. They were also asked to discuss what helped
them become an NI leader. See Table 2 for the interview
questions. The questions were developed by UB and assessed
for face validity by LHL and PJM. Recordings of interviews
were transcribed by UB for analysis. After the interviews, participants were sent via email a link to the online survey that we
developed (hosted by Qualtrics). The survey included closedand open-ended questions about the leadership, nursing,
and/or informatics professional organization the participant
was affiliated with and characteristics about the participant.
Questions about the organization's leadership opportunities,
education, and training were guided by a leadership selfassessment.7 Questions about NI opportunities, education,
and training were guided by research by Collins et al5 and
the Nursing Informatics Competencies for Nurse Leaders
self-assessment tool.6,9 At the end of the survey, the participants could provide additional thoughts. The surveys were
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Table 2. Example Questions From Interviews With Nursing Informatics Leaders
• To the best of your knowledge, what are the current leadership or informatics training opportunities available through the organization?
• What are some ways in which the organization can in the future support leadership or informatics training?
• Thinking about the current and emerging needs in informatics and healthcare leadership, what are some ways in which informatics or
leadership training may need to change?
• What are some ways in which someone who wants to become a nursing informatics leader could engage with your professional
organization to become a nursing informatics leader?
developed by UB and assessed for face validity by LHL
and PJM.
Nursing Informatics Leaders Engaged in Leadership
Development
FINDINGS
Sample
We used convenience sampling to recruit two NI leaders
who had been involved in developing or engaging in programs to support the NI leadership pipeline. We identified
them through our professional network and recommendation by interview participants.
Measures and Procedures
Email invitations were sent to potential participants inviting
them to review the findings from the Web site scan, interviews, and surveys. Participants were informed in the email
of the purpose of the study and that UB was an ANI Emerging Leader doing this work as part of that program. If they
agreed to participate, UB sent them synthesized findings
from the Web site scan and interviews and scheduled a review session to discuss their impressions. The review session
was conducted by UB. One participant had a previous professional relationship with UB, who conducted the interviews; the other had no previous working relationship with
UB. The review sessions were held in person in a public
space or via phone and lasted about 30 minutes. Session
were open ended, where participants provided feedback on
the findings from the Web site scan, interviews, and surveys.
UB asked follow-up questions based on the feedback provided by participants. Notes from the discussion were taken
during the meeting.
Analyses
Directed content analysis was completed to identify themes
across our three data sources.32 Themes identified across
the interviews were developed based on specific information
about the professional organizations that was asked (eg, current training opportunities) and literature described in the
“Measures” section regarding leadership self-assessment
and NI competencies. Themes identified from the NI leader review were based on specific information about organizationbased education and training opportunities as well as feedback
related to those findings. UB developed the codebook and
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coded the transcripts. UB discussed with LHL and PJM
the codes and coded content to get feedback.
Descriptive statistics were calculated to provide summaries of quantitative data from the surveys.
Sample
Web Site Scan
We identified eight professional organizations representing
nursing (organizations 1, 7, and 8), NI (organization 2), nursing leadership (organization 3), and informatics (organizations 4–6) (Fig. 1). Seven organizations are national
(organizations 1–4 and 6–8), and one organization is international (organization 5).
Interviews and Survey
We recruited eight individuals for the interviews and surveys.
Seven of the eight participants completed the postinterview
survey. Among those seven, participants had on average
37.6 (SD 10.6) years of experience in nursing (range, 21–
48 years). They had 24.3 (SD 12.1) years of leadership experience (range, 12–47 years) and 23.0 (SD 12.6) years of experience in informatics (range 0–36 years). Within their
professional organization, participants had on average 15
(SD 7.5) years of experience engaged in training or education opportunities at their professional organization (range
4–21 years). In the following sections, participants are indicated as P with a number corresponding to the professional
organization for which they reported (eg, P4 is the participant reporting on organization 4). We recruited two NI
leaders for the interview and survey findings review. We indicate their feedback in this article as NIRa or NIRb.
Ways Current Nursing Informatics Leaders and
Professional Organizations Can Support the Nursing
Informatics Leadership Pipeline
Build More Leadership Development Opportunities
All participants stated that there is potential within their
professional organizations to support the NI leadership pipeline through bolstering existing leadership development opportunities and leveraging the organization's strengths to
provide new opportunities. Specifically, they noted the
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FEATURE ARTICLE
FIGURE 1. Professional organizations by scope included in our study of education and training opportunities in leadership
or informatics.
potential of creating new or leveraging existing partnerships
with other professional organizations to create new NI leadership or education opportunities. For example, P3 stated that
their professional organization offers “a host model where an
organization could host, having us come to provide leadership
development for teams, or between several organizations.” Survey findings yielded examples of cross-organizational partnerships for NI leadership training or educational opportunities
to members. This includes cohosting webinars and events,
working with other professional organizations on publishing
articles, and collaborating with universities to provide educational or certification opportunities. Participants suggested that
future partnering could also include educational institutions, as
some professional organizations already provide support for
members in obtaining certifications, degrees, or continuing education through opportunities with a college or university.
One participant noted that even if opportunities exist,
they should be made accessible to all potential emerging
NI leaders. P6 stated, “I think we want to make sure that everyone has that opportunity if they want it. And so maybe having
formal programs could be helpful in that regard so there's more
access, more even access to leadership opportunities.” NIRb
stressed the importance that NI leadership opportunities
need to be open to all regardless of degree, where you got
your degree, and who you know.
14
Provide Opportunities to Engage in Leadership Positions
Several participants described that their professional organization's
leadership structure allowed members to move through the
leadership structure, from starting as a member of a committee or local chapter, taking on a leadership role on the committee or local chapter, then being elected to the professional
organization's board. Based on Web site scan findings, organizational structures include most often a board of directors elected or
appointed to their positions. For organizations that represent a coalition of professional organizations, leadership consists of representatives from member organizations and a smaller team of
leaders who oversee the overall organization. Each professional
organization with a general informatics scope (organizations
4–6) has an NI subgroup with its own leadership structure.
Leaders of these NI subgroups are elected to their positions.
Raising Awareness of Nursing Informatics
Participants mentioned the need within professional organizations to raise awareness and understanding of NI. This included supporting understanding of the importance of NI
and NI leadership roles among general nursing organizations, organizations that include other medical practitioners,
and informaticist-based organizations. For example, NIRa
stressed the importance of NI leaders continuing to talk to
noninformatics professionals (nurses, chief nursing officers,
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and physicians) and hospital organizations about the importance of NI leaders.
Participants gave suggestions on how to raise NI awareness.
P8 stated that there are opportunities for NI professional organizations to “coordinate [with] and offer opportunities for those
[nursing] organizations to have a weekend immersion for what
we are doing around nursing informatics. I think we could start
with something as simple as that, getting the leaders of all those
other organizations aware … [of] how nursing informatics is integral to their profession even though they are not informaticists.”
Another way to raise awareness of NI is for leaders and professional organizations to support NI education and training. P7
discussed the importance of including “informatics competencies at the undergraduate level and the exposure of the
nurses in their clinical practicums.” NIRa stated that it is important that nurse leaders get leadership positions outside of
their professional organizations, including seeking executive
nurse development and getting nurses on boards.
Encouraging Emerging Leaders
Participants recommended that current leaders within professional organizations use existing organizational mechanisms to support individuals moving through the leadership
pipeline. This includes reaching out to emerging NI leaders
and encouraging them to run for leadership positions within
a professional organization such as running for positions within
(1) NI-specific committees/groups to gain development opportunities within NI and (2) the larger leadership, nursing, or informatics professional organization to get name recognition with
the broader membership. Participants also suggested nominating
emerging and current leaders for awards within and outside organizations to help support recognition. P4 suggested that
“what might be good is aggregate all these awards and create
a list, like Nursing informatics awards or recognition opportunities across all the groups.”
Finally, some participants noted the importance of encouraging nurses they encounter or work with who are not
informaticists but have potential in informatics. This encouragement can come in the form of invitations to participate in
informatics projects or supporting them in seeking informatics training/education. Several participants noted that their
personal journey toward becoming an NI leader involved a
superior noting their interest in HIT while working as an
RN and being encouraged by them to participate in an
HIT implementation project or seek formal training/
education in informatics. NIRa suggested that professional
organizations could provide administrative support for current NI leaders to help them identify emerging NI leaders.
Be Mentors or Provide Mentorship Opportunities
Mentorship was noted by several participants as an important
component in leadership development. However, only two of
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the eight organizations had clearly defined mentorship programs on their Web sites. Participants noted the importance
of existing leaders to provide mentorship to junior nurse
informaticists. Building a mentorship networks something that
existing leaders and professional organizations could facilitate.
Leadership positions within professional organizations and
conferences can provide networking opportunities.
Provide Education and Training Opportunities
The interviews, survey, and Web site scan demonstrated the
importance of education and training for NI leadership development. Participants noted the importance of organizations providing these opportunities. In our Web site scan,
we found that professional organizations 2, 3, 5, 6, and 7
mention supporting education of members within their missions and/or goals. Training opportunities varied based on
the professional organizations' member base; this ranged
from new nursing graduates just starting clinical practice to
established nurses who have been recognized as leaders in
their field. Seven of the eight professional organizations
had clearly accessible content within their Web sites regarding education and training opportunities they provide.
Six of eight had education and training opportunities in
leadership including webinars, continuing education, online courses, certification courses, journal clubs, and selflearning available online. Leadership-specific opportunities
on the Web sites included mentoring programs, books,
webinars, leadership academies or institutes, Fellows programs including one for leadership, and review courses to
support attaining certification.
There was variation across the organizations in the number and type of competencies covered and education/
training opportunities available. The number of leadership
competencies addressed in education/training opportunities
ranged from 0 (organization 5) to 6 (organizations 3 and 6) of
6 total competencies (Table 3). The number of NI competencies addressed in education/training opportunities available
ranged from 0 (organizations 5 and 7) to 10 (organization 4)
of 10 total competencies (Table 4).
DISCUSSION
In this study, we sought to understand how NI leaders and
professional organizations can support the emerging NI
leadership pipeline. Strategies identified were building more
leadership development opportunities, raising awareness of NI,
and encouraging emerging leaders. By supporting emerging
NI leaders thru the NI leadership pipeline, NI leaders and professional organizations have opportunities to foster better patient
care, decrease turnover and burnout, and provide leadership sustainability for organizations27,33,34 (see links in Table 1 under
“American Organization for Nursing Leadership”). Supporting
the NI pipeline is critical for healthcare—more and more HIT
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FEATURE ARTICLE
Table 3. Competencies for Nursing Leadership as Drawn From Dermenchyan and Jeffery7 Addressed in
Education/Training Opportunities Available From Nursing and Informatics Professional Organizations
Professional Organization Number
Competency
1
2
3
4
5
6
7
Global thinking: The ability to think beyond your current role and practice and apply new perspectives
that will improve and optimize your role and practice
Self-leadership: The ability to assess, manage, and develop yourself to pre-serve and optimize
relationships and add value to the outcomes of your organization
Visioning: The ability to create a clear view of the preferred future resulting from global analysis
to lead other people and the organization to this preferred future
Consensus building: The ability to achieve shared understanding within groups to promote strong
teamwork and garner commitment and participation of others to achieve solutions and effect
positive change
Delivering effective messages: The ability to deliver effective messages to motivate others to
thought and action
Knowing and committing to your cause: The ability to demonstrate knowledge and commitment to the
mission, values, and goals of the organization or your cause
The survey was not completed for organization 8.
Key: gray = competency addressed, teal = competency not addressed.
systems, including EHRs, are being implemented into clinical
care,35 and NI leaders have the competencies to support the success of these systems.5
Recommendations
Based on the findings of our study, we recommend that NI
leaders advocate for and get involved in efforts to establish
NI leadership pipelines within their organizations and develop actionable strategies to support emerging NI leaders
through the pipeline. This can be by working with education
and practice partners to ensure that nurses' leadership and
informatics knowledge and competencies reach the appropriate level for their certification, education, and experience.
We also recommend current NI leaders work to ensure that
advancement opportunities are made available to those in the
NI leadership pipeline, from novice to expert.20,21 This can include supporting nursing programs in effectively providing
leadership and informatics education and providing opportunities for new nurses to gain leadership and informatics experience and knowledge after graduation. Nursing informatics
leaders in education could also support NI leadership development opportunities and awareness of NI by engaging in efforts
Table 4. Nursing Informatics Competencies for Nurse Leaders as Drawn From Collins et al5 and Phillips et al6 That
Were Addressed in Education/Training Opportunities Available From Nursing and Informatics Professional
Organizations
Professional Organization Number
Competency
1
2
3
4
5
6
7
Inclusion of nursing information within the HIT system
Communicating a system and nursing vision about the benefits of HIT
Ability to ensure that nursing values/requirements are represented in HIT selection and evaluation
Budgeting using technology
Data-based planning and decision making through the utilization and synthesis of HIT system data
Ability to collaborate with other departments regarding project management and resource allocation
for HIT system implementation
Ability to collaborate with chief medical officer peers related to HIT and needs of nurses and physicians
Ability to collaborate with interprofessional teams in the HIT selection process
Ability to advocate for the development (or purchase) and use of integrated, cost-effective HIT
systems within the organization
Ability to involve frontline staff in the evaluation of HIT systems related to their practice
The survey was not completed for organization 8.
Key: gray = competency addressed, teal = competency not addressed.
16
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January 2022
to align nursing and informatics competencies. Monsen et al36
provide a framework to align AACN and AMIA competencies,
which nursing programs and professional organizations
could use to bolster NI training, education, and awareness.
For professional organizations, we recommend they find
ways to take advantage of their unique mission, structure,
reach, and membership to support the NI leadership pipeline. They should learn about other organizations' work that
supports the NI pipeline to support (a) cross professional organization opportunities to create training or educational
experiences that help future NI leaders grow and (2) an understanding of how a professional organization can apply
their unique strengths to fill training/experience gaps that
exist across nursing and informatics organizations. New educational and leadership experience opportunities could be
developed using existing measures, including NI and leadership self-assessment tools.5,6,8,9
Professional organizations with experience providing education
and training can provide new or expand existing continuing education courses related to informatics or leadership that are low cost
or free. This could encourage more nurses to consider NI as a career path and help raise awareness of NI within nursing, which
aligns with previous research on opportunities and challenges in
NI.37 To help support leadership development opportunities for
members at various levels of experience and education in nursing
and/or informatics, professional organizations can look at existing
models that can be applied to their mission, leadership structure,
and membership. This can include identifying frameworks to understand key concepts for scalability and portability of leadership
training or educational opportunities (eg, Framework for Developing Women Leaders38). Finally, as indicated in Figure 1, there are
no organizations that have a mission to support leadership and informatics; although the ANI's mission encompasses NI leadership,
it is a coalition of organizations that does not have general membership. Therefore, informatics, nursing, NI, and nursing leadership organizations will likely need to serve as the venues for
providing opportunities for emerging NI leaders to gain knowledge and training needed to mature.
Actions to Implement Recommendations
One way that NI leaders and professional organizations can
identify specific, actionable ways in which to support the NI
leadership pipeline is using Staggers' work on NI leadership20 and Benner's model21 as other scholars have done
within nursing.39,40
Novice/Beginner: Entering the Nursing Informatics
Leadership Pipeline
Nurse leaders and professional organizations have opportunities to build on the exposure that novice nurses have to
leadership and informatics through their nursing education.
Baccalaureate programs are required to cover various concepts
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related to leadership and informatics as required in the AACN
Essentials for Baccalaureate Education (eg, Essential II regarding
leadership and Essential IV regarding informatics) (see Table 1 for
link). Other nursing core competencies exist that emphasize leadership and informatics, including the Massachusetts Nurse of the
Future Nursing Core Competencies, or either leadership or informatics41 (see Table 1 for links to competencies). Unfortunately,
there is variability in the level of informatics training and education in undergraduate programs given the lack of faculty with expertise in informatics; however, strategies exist for undergraduate
programs to use to integrate informatics content into their programs.42 Therefore, NI leaders in academia can work within
their institution and across institutions to implement these
strategies to bolster quality education in informatics.
Nursing informatics leaders within nursing practice organizations, such as clinical or public health organizations, can
build on the core competencies for leadership and informatics
that novice nurses have been exposed to in their education.
Nurse leaders can use existing competencies to identify areas
of improvement and develop programs and opportunities
for nurses to address current gaps in informatics and leadership. An example is building on current nurse residency
programs to offer residencies in informatics, like the NI
Residency at Columbia University (Table 1).
Professional organizations can use their membership and networking opportunities to provide mentorship and leadership experience within their organization, as recommended in the
Institute of Medicine's report “The Future of Nursing: Leading
Change, Advancing Health” (p 5) (see Table 1 for a link to the
report). Given how important mentorship and networking are
to leadership development, professional organizations are in a
unique position to provide these opportunities. For example,
the AMIA has a First Look program for undergraduate women
in informatics and/or STEM and Women in AMIA Initiative
that provide virtual support and in-person opportunities at their
Annual Symposium. They also have a student work group and
provide leadership opportunities through their working groups
including the NI working group (see Table 1 for links to these
programs). Professional organizations may also provide an idea
venue for mentors to develop their mentorship skills, as having
a well-prepared pool of mentors is critical to provide mentorship
opportunities. Guidance and toolkits exist29 (Table 1, under
“Mentor resources”), but more research is needed to identify
what skills NI leaders need to effectively mentor emerging NI
leaders and to develop programs to help NI leaders gain
those skills.
Mid-Level: Moving From Being a Novice to an Nursing
Informatics Leader
To support novice nurses' maturity in leadership and informatics, NI leaders and professional organizations have opportunities to provide training and experiences that bolster
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FEATURE ARTICLE
confidence, skills, and expertise. For example, NI leaders in
clinical settings can develop formal nurse leader development programs as part of a wider succession planning strategy as demonstrated by Nghe et al43—these programs can
help nurses identify areas of improvement, for example,
using existing leadership or NI competencies5–9,44 (see competencies links in Table 1). An example of this is a training
program for new nurse leaders that integrated leadership
competencies described by Weber et al.45 Nursing informatics leaders involved in succession planning can also develop
new NI leadership positions along the NI leadership pipeline
to provide emerging leaders growth and maturity options
and meeting evolving NI leadership needs.
Specifically, for experienced nurses, as defined by Staggers et al,20 current NI leaders can develop opportunities
within their organizations to help identify ways to move to
the next level of being an informatics nurse specialist. Experienced nurses can be provided structured opportunities to
assess competencies described by Staggers et al to identify
opportunities to gain those competencies. Nursing informatics leaders can help develop programs to support experienced nurses in gaining needed competencies through
additional schooling or certification, such as working with
hospitals and governments to develop loan forgiveness, reimbursement, or tuition exemption programs for returning to
school or completing board certification (eg, Los Angeles
County in California, Washington State, MultiCare hospital
system, Health Resources and Services Administration
Nurse Corps Loan Repayment program) (Table 1, under
“Nursing education and certification funding examples”).
For an informatics nurse specialist who want to mature to
move up to being an expert/innovator, professional organizations can provide opportunities for growth guided by the
competencies described by Staggers et al.20 Professional organizations can develop resources, such as the AACN nurse
leader toolkits (Table 1 under “American Association of Colleges of Nursing”), that provide guidance to informatics
nurse specialists on how they can gain competencies needed
to grow. Building on mentoring programs that focus on
novice/beginner nurses (eg, AMIA's First Look program),
professional organizations can provide structured opportunities for informatics nurse specialists to find mentors who
are experts/innovators.
Nursing Leadership”). Another way to mature as an NI
leader is to engage in leadership opportunities or leadership
development initiatives within professional organizations.
For example, the Healthcare Information and Management
Systems Society Nursing Informatics Committee and ANI
have opportunities for nurse leaders and executives to engage
in leadership activities such as providing domain expertise to
professional organizations as thought leaders, engaging in policy development, and supporting mentoring and networking
activities (see Table 1 for links). Once in positions of power
and influence, NI executives can create a vision for their organizations, including professional organizations, to support the
NI pipeline. This can include working with other executives
and leaders to bridge education and practice to foster knowledge, skill, and experience opportunities for emerging NI
leaders at various stages in the pipeline.
Expert/Innovator: Being an Nursing Informatics Leader
LIMITATIONS
Reaching the end of the NI leadership is not an endgame—
being an NI leader still involves maturity and growth to become executives and thought leaders. One way to mature
and become an executive is seeking advanced education, as
suggested by our study participants and described in a position paper from the American Organization for Nursing
Leadership (Table 1, under “American Organization for
This study has a limitation in that only one person per organization was interviewed and surveyed for this study. It is
possible that their views and insights are unique and do not
reflect all the possible ways that the organization supports
NI leadership development. Future research could involve
recruiting multiple individuals in various leadership positions
within the organizations to get a more comprehensive
18
ENSURING EQUITABLE NURSING INFORMATICS
LEADERSHIP DEVELOPMENT OPPORTUNITIES
As noted by P6 and NIRb in our study, there should be NI
leadership development opportunities available to those
who want them regardless of their degrees and connections.
Individuals from marginalized and underrepresented communities might not have the same NI leadership development opportunities as their privileged counterparts. This is
because the modes of moving through a leadership pipeline
favors those for whom leadership structures were built,
allowing them to more easily enter and stay in the pipeline
compared with those who are disadvantaged and face structural bias due to institutionalized racism and other characteristics either individually or intersecting.13,46,47 Any work
done by NI leaders and professional organizations should acknowledge and address institutional and interpersonal barriers. Therefore, NI leaders and professional organizations
need to understand how these institutional and structural
barriers came to be and how they are operationalized implicitly and explicitly to identify ways to equitably support
leadership development.13 This will allow them to identify
mechanisms to break down those barriers and develop equitable access to NI leadership development opportunities, as
indicated by P6 and NIRb. There are examples of mentorship and leadership development programs to support
emerging minority nurse leaders.48,49
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January 2022
understanding of the organization's offerings. We also did
not interview individuals in the organizations who are at
novice and mid-level positions in the NI leadership pipeline;
therefore, we are unable to get feedback or triangulation regarding the recommendations provided by our participants.
Future research could look across the pipeline to see if there
is concordance in ideas for how to support maturity through
the NI pipeline. One researcher was involved in coding the
data and therefore there was no checking for validity in the
coded transcripts.
12. Wiley K, Dixon BE, Grannis SJ, Menachemi N. Underrepresented racial
minorities in biomedical informatics doctoral programs: graduation trends
and academic placement (2002–2017). Journal of the American Medical
Informatics Association. 2020;27(11): 1641–1647. doi:10.1093/jamia/
ocaa206.
13. Waite R, Nardi D. Nursing colonialism in America: implications for nursing
leadership. Journal of Professional Nursing. 2019;35(1): 18–25. doi:10.
1016/j.profnurs.2017.12.013.
14. Backonja U, Mook P, Langford LH. Calling Nursing Informatics Leaders:
Opportunities for Personal and Professional Grow. OJIN: Online Journal of
Issues in Nursing. 2021;26(3) Manuscript 6.
15. Kotter J. Leading Change. Boston, MA: Harvard Business Review
Press; 2012.
CONCLUSION
There is a continued proliferation of HIT in healthcare. To
support integration and evaluation of these technologies, we
need nurses with education and experience in informatics
and leadership. In our study, we identified ways emerging
NI leaders and nursing organizations can support emerging
NI leaders through the NI leadership pipeline. Nursing informatics leaders including those working within professional organizations can use our recommendations to establish and
support activities that support the maturity of future NI leaders.
16. Giltinane CL. Leadership styles and theories. Nursing Standard. 2013;
27(41): 35–39. doi:10.7748/ns2013.06.27.41.35.e7565.
17. Almost J, Wolff AC, Stewart-Pyne A, McCormick LG, Strachan D, D'Souza C.
Managing and mitigating conflict in healthcare teams: an integrative review.
Journal of Advanced Nursing. 2016;72(7): 1490–1505. doi:10.1111/
jan.12903.
18. American Nurses Association (ANA). Nursing Informatics: Scope and Standards of
Practice. [eReader, R2 Digital Library]. Silver Spring, MD: American Nurses
Association; 2015. https://www.r2library.com/Resource/Title/1558105794.
19. Parker CD. Nursing informatics leadership: helping craft the profession's
future. Nursing. 2014;44(12): 23–24. doi:10.1097/01.NURSE.
0000456384.48273.a7.
20. Staggers N, Gassert CA, Curran C. Informatics competencies for nurses at four
levels of practice. The Journal of Nursing Education. 2001;40(7): 303–316.
Acknowledgments
This project was completed with support from the ANI Emerging
Leaders Program. We thank our study participants for their insights.
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