Running head: BUILDING INFORMATICS COMPETENCIES
DNP Project Prospectus
Building Informatics Competencies of Chief Nurse Executives
Christine Gamlen, MSN, RN
University of San Francisco
Dr. KT Waxman and Dr. Amy Nichols
December 17, 2012
1
BUILDING INFORMATICS COMPETENCIES
Building Informatics Competencies of Chief Nurse Executives
Executive Summary
Technology is integrated into the fabric of health care and has essentially become
part of the core fiber as nurse executives play a significant role (American Organization of Nurse
Executives, 2011). The Technology Informatics Guiding Education Initiative (TIGER) has
identified that all nurses in every role must be prepared to make health information technology
“the stethoscope of the 21st century” (TIGER, n.d., para. 1). Nursing management’s role in
organizational transformation and health information technology is pivotal, however, nurse
leader competencies for health information technology are ill defined or lacking (Westra &
Delaney, 2008).
One recent qualitative research study was completed which addressed the current state of
Chief Nurse Executives (CNE) information management and technology competencies
(Simpson, 2012). Simpson interviewed seven CNE’s of integrated delivery networks (IDNs)
using the American Organization of Nurse Executives (AONE) Information and Technology
Competencies to identify and validate the gaps between stated competencies in the selection,
development and use of healthcare information technology (HIT). One competency,
“demonstrate awareness of societal and technological trends, issues and new developments as
they relate to nursing” (AONE, 2011, p. 11) was found to be completely void (Simpson, 2012).
The purpose of this project is to further validate this competency of the CNE and create a
toolkit to satisfy the gap. This will better position the CNE to create a vision and strategy that
can leverage technology to support nursing practice and improve patient outcomes.
BUILDING INFORMATICS COMPETENCIES
3
Background
Information technology (IT) has made a significant impact on the healthcare industry in
the last decade (Frost & Sullivan, 2007) and will continue to do so in the future. The HIT market
was valued at around $11 billion in 2008 and is estimated to exceed $24 billion by 2015
("Research and Markets," 2009). The United States is a key economy driver in this market,
contributing 37% towards the global health care market in 2008 with an expected increased
contribution to 48% by 2015 ("Research and Markets," 2009).
Additionally, this significant growth in HIT has the potential to improve the health of
individuals and provider performance, yielding improved quality, cost savings and greater
engagement in their own health care. During a recent review of health information technology
effects on patient care outcomes, Buntin found that 92% of reviewed articles reached the
conclusion that patient outcomes were positive overall (Buntin et al., 2011).
Federal mandates and innovative incentives for adoption have been implemented to
include Health Information Technology for Economic Clinical Health (HITECH) Act as part of
the American Recovery and Reinvestment Act (ARRA) of 2009 to accelerate the use of HIT
(Buntin et al., 2011). This legislation was designed to expand the benefits of HIT on a much
broader scale than has been achieved to date. Building on that effort, the Affordable Care Act of
2010 underscored the importance of HIT in achieving goals related to health care quality and
efficiency.
Accomplishing the goal that all Americans have an electronic health record (EHR) by
2014 will require health care leaders to be prepared to select, adopt, implement and leverage
EHRs as well as other health information technologies (Westra & Delaney, 2008). The
successful adoption and implementation of the EHR depends almost exclusively on the
BUILDING INFORMATICS COMPETENCIES
4
department of nursing (Simpson, 2012) the largest workforce in the hospital setting. The United
States 3.1 million nurses ("ANA," 2012, para. 1) make up the largest group of users of EHR
systems, and their direct use of the EHRs continues through each patient encounter.
Historically, nursing education did not include informatics competencies, thus current
nurse managers and nurse executives may not be adequately prepared to use or lead change in
the use of HIT (Westra & Delaney, 2008). This trend in information management is likely to
receive more emphasis in the future (Staggers & Lasome, 2005). Technology skills, “once the
purview of the sacred few, are now essential tools of the masses” (Staggers & Lasome, 2005, p.
204).
Technology advancements have increased at a dramatic rate, while attempts at
incorporating a basic set of technology and information management competencies for nurses at
various levels of education and practice have been dragging (Hart, 2008). Furthermore, the
health profession as a whole has shown slow progress in using technology and information in the
various forms (Hart, 2008). There is a concern that nurse leaders may not be adequately
prepared to lead change in this technological revolution that has profound implications for
nursing practice (Westra & Delaney, 2007) As a result, healthcare organizations are beginning to
emphasize the need for informatics competencies appropriate for nursing leadership roles
(Westra & Delaney, 2008). AONE is one of the few nursing organizations that have included
information management and technology in their nurse executive competencies (AONE, 2011).
Social technologies such as Facebook and Twitter are quickly being recognized for the
significant impact they can have on healthcare organizations ([HIMSS] website, n.d.).
Healthcare examples of social media being used are the messaging of progress from surgical
suites to family and friends of the patient and as a mechanism to stay in touch with youth to help
BUILDING INFORMATICS COMPETENCIES
5
them remain compliant with diet and care regimens (HIMSS website, n.d.). Nurse leaders can
also use social networking such as providing a venue for online charts on various health-related
topics, or serving as a bulletin for posting events such as health-related seminars and community
activities (Tariman, 2010). Understanding the role and implications for technology beyond the
walls of the hospital are critical to nurse leaders’ effectiveness.
Project Overview Statement
Nurses are expected to provide safe, competent, and compassionate care in an
increasingly technical and digital environment. A major theme in this new healthcare
environment is the use of information systems and technologies to improve the quality and safety
of patient care. Nurses are directly engaged with information systems and technologies as the
foundation for evidence-based practice, clinical-decision support tools, and the electronic health
record (EHR). Unfortunately, not all nurses are fully prepared to use these tools to support
patient care. The TIGER Informatics Competencies Collaborative sought to evaluate the current
preparedness of the nursing workforce and propose a set of minimum informatics competencies
that all nurses need to practice in today's digital era. (TIGER Informatics Competencies).
This DNP project focuses on information management competencies for the nurse
executive. Very little is known about the level of CNE’s information technology-related
competencies at the executive decision-making level (ANA, 2012. These competencies are
typically obtained on the job or through HIT workshops (Simpson, 2012).
During 2012, as part of a research capstone requirement for Doctorate of Nursing
Practice, Roy Simpson, DNP, RN conducted a qualitative study utilizing an ethnographic
method to identify and validate gaps between informatics competencies of CNEs working in
integrated delivery networks (IDNs) and the information technologies as stated in the AONE
BUILDING INFORMATICS COMPETENCIES
6
Nurse Executive Competencies (AONE, 2011). The research identified and validated the gap
between actual CNE competencies at IDNs as they apply to the evaluation, selection and use of
HIT, and the information management and technology competencies outlined by AONE. The
gap centered on one specific competency from the AONE list: “Being able to demonstrate
awareness of societal and technological trends, issues and new developments as they relate to
nursing” (Simpson, 2012, p.80). According to Simpson, “Not a single informant CNE used the
interview opportunity to explain their nursing-centric vision for technology in their organization”
(Simpson, 2012, p. 80). Instead, the CNE’s viewed HIT as a problem to be solved and an
implementation to be completed versus a strategic asset that can be used to improve patient
outcomes and enhance efficiency of nursing operations (Simpson).
Goals and Objectives
The primary goal of the project is to create a framework and toolkit for chief nurse
executives that will increase competency demonstrating awareness of societal and technological
trends, issues and new developments as they relate to nursing. This toolkit will include the
following:

Outline of technical modalities that are available such as websites, podcasts, and blogs,
etc. with definition, purpose, and use cases applicable to role

List and description of relevant modalities that will provide technological trends, issues,
and new developments as they relate to nursing

Outline of available social networking opportunities such as Facebook, LinkedIn,
Twitter, to include definition, purpose, use cases applicable to role

Subset menu of technical modalities and social networking opportunities that can be
explored every week
BUILDING INFORMATICS COMPETENCIES
7
Risk Assessment
Inherent in every project are risks. The following risks identified with mitigation
strategies include:

The CNE may not see the value of enhancing awareness of societal and technological
trends, issues and new developments
o Contact AONE representative(s) to determine source of information management
competency and why it is important
o Develop a survey and administer to a group of CNEs to determine gap in
knowledge societal and technological trends, issues, and new developments

CNE may be concerned with confidentiality of findings
o Provide an agreement to participate that states confidentiality and anonymity of
findings
QI Method
The Plan-Do-Study-Act (PDSA) methodology will be used as the model for improvement
providing an overarching framework for testing change ideas expected to make improvements
(Nelson, Batalden, & Godfrey, 2007). This model has two parts that begin with three questions
to help focus the improvement work: “What are we trying to accomplish; how will we know that
a change is an improvement? and What changes can we make that will results in an
improvement?” (Nelson et al., 2007, p. 273). Subsequently, this leads to the second part that
directs running tests of change using the scientific method of PDSA (Nelson et al., 2007). This
improvement model guides the process forward for testing ideas to better ensure a successful
project.
Detailed Statement of Work
BUILDING INFORMATICS COMPETENCIES
8
A work breakdown structure (WBS) is available (Appendix A). It supports the six phases
as outlined in the Time and Cost Summary section. The (WBS) provides a structural view into
the project and is presented in an Excel hierarchical structure format
(http://www.projectmanagementdocs.com/project-planning-templates/work-breakdownstructure-wbs.html).
Time and Cost Summary
The project will take eight months from the initial start date as demonstrated in the
GANTT chart (Appendix B). This project will begin upon submission and approval of the DNP
Project Prospectus and end with implementation and evaluation of the project by the project
chair and co-chair. It does not include final project documentation. The following is an outline
of the six phases of the project:
1.) Data collection phase will include further internet review on societal and technological
modalities, literature review on executive nurse information management competencies,
qualitative interviews with IT and nursing leaders and visionaries, and review of
literature on best practices for survey development. Roy Simpson is author of doctoral
capstone on which I am basing my project. Tom Clancy, is Associate Professor at
University of Minnesota School of Nursing. Both are identified in my WBS and will
participate in my project.
2.) Development and implementation of preliminary survey that will address different
components of the competency gap of awareness and knowledge of societal and
technological trends, issues, and new developments as they relate to nursing.
3.) Analysis of survey and development of toolkit.
4.) Completion of pre and post-test design.
BUILDING INFORMATICS COMPETENCIES
9
5.) Implementation of the pre-test and toolkit to selected CNE’s. The candidate will use the
toolkit for one month.
6.) Evaluation of the toolkit through post-test and phone interviews with the candidates.
The financial cost of the project is minimal as the majority of the work will be completed
by a doctoral student (Appendix C). The total number of hours required for the completion of
this project is 240 hours. A student from University of San Francisco will be sought for
consultation on best practices for survey development and a review of the survey draft.
Evaluation Plan
The DNP (student) will implement evaluation of the project with a post test and use of
SWOT analysis through interview of the candidates by phone. The assessment of the external
and internal environments is known as the SWOT analysis (strengths, weaknesses, opportunities,
and threats)(Larson & Gray, 2011). All the information from the post test and the interviews will
remain anonymous. The project evaluation will include a summary of the process and a
reflection on lessons learned during the process.

Strengths: Were the objectives met? What 3 societal and technological trends, issues,
and developments did you learn? What was the best discovery you made in this process?
What positive experiences did you have in the process? Was the time that you spent on
the toolkit worthwhile? In what way was it or was it not?

Weaknesses: What was the most difficult part of this toolkit activity? What would you
alert future recipients of toolkit?

Opportunities: Could this toolkit be implemented at a system level? How do you
recommend disseminating this toolkit to other CNE’s? Would you recommend this
toolkit to other CNE’s?
BUILDING INFORMATICS COMPETENCIES

10
Threats: How can you convince other CNE’s that this competency skill is important?
These questions will be reviewed, edited and or expanded in the course of the project as
outlined.
Conclusion
The Institute of Medicine report on the Future of Nursing asserts the U.S. healthcare
system has the opportunity to transform itself with nurses as active leaders in this transformation
(HIMSS Nursing Informatics Committee, 2011). The use of healthcare information technologies
continue to grow, requiring the need to continually refine and creatively find effective ways to
help nurses adapt to evolving informatics requirements (Schleyer, Burch, & Schoessler, 2011).
This DNP project builds on previous nursing research that has identified gaps in CNE
competencies related to information management competencies. Increasing these competencies
of CNEs will allow nurses to lead, strategize and create the nursing vision to advance the
healthcare transformation through the use of HIT.
BUILDING INFORMATICS COMPETENCIES
11
References
About ANA. (2012). Retrieved from
http://www.nursingworld.org/FunctionalMenuCategories/AboutANA
American Organization of Nurse Executives. (2011). Enhancing clinical outcomes by leveraging
technology. Retrieved from
http://www.aone.org/resources/member/toolkit/AONE_Toolkit_Leveraging_Technology.
pdf
American Organization of Nurse Executives. (2011). The AONE Nurse Executive
Competencies. Retrieved from
http://www.aone.org/resources/leadership%20tools/PDFs/AONE_NEC.pdf
Buntin, M. B., Burke, M. F., Hoaglin, M. C., & Blumenthal, D. (2011, March). The benefit of
health information technology: a review of the recent literature shows predominantly
positive results. Health Affairs, 30, 464-471. doi.org/10.1377
Frost, & Sullivan (2007). U.S. hospital information systems continue to evolve. Retrieved from
https://www.frost.com/sublib/display-market-insight-top.do?id=93346579
HIMSS Nursing Informatics Committee. (2011). HIMSS position statement on transforming
nursing practice through technology and informatics. Retrieved from
http://www.himss.org/handouts/himsspositionstatementtransformingnursingpracticethrou
ghtechnologyinformatics.pdf
HIMSS website. (n.d.). http://www.himss.org/ASP/topics_topics_FocusDynamic.asp?faid=603
Hart, M. D. (2008, November/December). Informatics competency and development within the
US nursing population workforce. CIN: Computers, Informatics, Nursing, 26(6), 320329. Retrieved from
BUILDING INFORMATICS COMPETENCIES
12
http://journals.lww.com/cinjournal/Fulltext/2008/11000/Informatics_Competency_and_D
evelopment_Within_the.4.aspx
Larson, E. W., & Gray, C. F. (2011). Project Management (5th ed.). New York, NY: McGrawHill/Irwin.
Nelson, E. C., Batalden, P. B., & Godfrey, M. M. (2007). Quality by Design. San Francisco, CA:
Jossey-Bass.
Schleyer, R. H., Burch, C. K., & Schoessler, M. T. (2011, March). Defining and integrating
informatics competencies into a hospital nursing department. CIN: Computers,
Informatics, Nursing, 293(3), 167-172. Retrieved from
http://itnep.org/sites/default/files/Article%205.pdf
Simpson, R. (2012). State of contemporary informatics competencies for chief nurse executives
(Unpublished doctoral dissertation). American Sentinel University, Burmingham,
Alabama.
Staggers, N., & Lasome, C. E. (2005, July/August). RN, CIO: An informatics career. CIN:
Computers, Informatics, Nursing, 23(4), 201-206. Retrieved from
http://journals.lww.com/cinjournal/Fulltext/2005/07000/RN,_CIO__An_Executive_Infor
matics_Career.7.aspx
TIGER. (n.d.). The TIGER Initiative - Vision. Retrieved from
http://www.tigersummit.com/Vision.html
Tariman, J. D. (2010, February). Where to draw the line: professional boundaries in social
networking. ONS Connect, 25, 10-13. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2891246/
BUILDING INFORMATICS COMPETENCIES
The future of the healthcare it market to 2015 - healthcare reform in the US to boost growth.
(2009). Retrieved from
http://www.researchandmarkets.com/research/6baef8/the_future_of_the
Westra, B. L., & Delaney, C. W. (2007, July-August). Informatics competencies for nursing
leaders. Nursing Outlook, 55, 2010-2011. Retrieved from http://0web.ebscohost.com.ignacio.usfca.edu/ehost/detail?sid=592add2b-0bbd-4342-9c63afa8b6752faf%40sessionmgr111&vid=4&hid=126
Westra, B. L., & Delaney, C. W. (2008). Informatics competencies for nursing and healthcare
leaders. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2655955/pdf/amia-0804-s2008.pdf
13
BUILDING INFORMATICS COMPETENCIES
Appendix A
Work Breakdown Structure for DNP Project
Building Information Technology Competencies for Nursing Executives
Work Breakdown Structure Outline
The Work Breakdown Structure begins upon approval of the DNP Project Prospectus.
1
1.1
1.1.1
1.1.2
1.1.3
Data Collection
Review of literature
Review of literature related to nursing competencies
Review of literature related to health informatics management
Review of literature of current societal and technical modalities that impact healthcare and
nursing
1.1.4
1.2
1.3.1
1.3.2
1.3.3
1.3.4
1.3.5
1.3.6
1.3.7
2
2.1
2.1.1
2.1.2
2.1.2
2.1.3
2.1.4
2.1.3
2.1.4
2.1.5
2.1.6
2.1.7
3
3.1
3.1.2
3.1.3
3.2
3.2.1
3.2.2
3.2.3
3.2.4
4
Review of literature on best practices for survey development
Determine role of Tom Clancy and Roy Simpson
Development of qualitative interview questions draft
Review of interview questions by DNP project chair, 2-3 other experts
Identification of interviewees
Request consent to be interviewed
Interview question revision based on feedback
Qualitative interviews with IT and nursing leaders and visionaries
Analysis and summary of interviews
Survey Implementation
Finalize literature review of best practices of survey development
Consult with USF expert on surveys
Determine survey scope, content, logistics of survey
Create draft of survey based on literature review, interviews and consultation
Review of survey by USF consultant, project chair and co-chair
Revision of survey based on feedback
Identify target group for survey
Complete authorization and documentation requirements for survey
Complete survey
Analysis of survey
Review of survey analysis by project chair and co-chair
Development of toolkit
Based on review of literature, interviews, and consultation with key advisors - draft toolkit
Review of toolkit by project chair, co-chair, consultants, key advisors
Revisions of toolkit based on feedback
Determine number of CNE's to receive and evaluate toolkit
Determine list of CNE's to receive and evaluate toolkit
Create invitation to participate (consent)
Distribute consent
Signed consent
Development of pre / post test
14
BUILDING INFORMATICS COMPETENCIES
4.1
Based on review of literature, interviews, and consultation with key advisors – pre-post test
completed
4.1.2
4.1.3
5
5.1
5.1.1
5.2
5.2.1
5.2.2
6
6.1
6.2.1
6.2.2
6.2.3
6.2.4
Review of pre-post-test by project chair, co-chair and USF consultant
Revisions to pre / post-test based on feedback
Implementation of toolkit
Check-in weekly with CNE by phone
Be available by email or phone for questions during implementation
Develop interview questions for post implementation evaluation
Review of interview questions by DNP project chair, co-chair, 2-3 other experts
Revision of interview questions based on feedback
Evaluation of toolkit
Schedule 1 1/2 hour session for phone interview of CNE
Complete phone interviews with CNE's
Document phone interviews
Analysis of phone interviews
Share analysis with project chair, co-chair
15
BUILDING INFORMATICS COMPETENCIES
16
Appendix B
BUILDING INFORMATICS COMPETENCIES
17
Appendix B
BUILDING INFORMATICS COMPETENCIES
18
Appendix B
BUILDING INFORMATICS COMPETENCIES
19
Appendix B
BUILDING INFORMATICS COMPETENCIES
20
Appendix B
BUILDING INFORMATICS COMPETENCIES
21
Appendix B
BUILDING INFORMATICS COMPETENCIES
22
Appendix B
BUILDING INFORMATICS COMPETENCIES
23
Appendix B
BUILDING INFORMATICS COMPETENCIES
24
Appendix B
BUILDING INFORMATICS COMPETENCIES
25
Appendix B
BUILDING INFORMATICS COMPETENCIES
26
Appendix B
BUILDING INFORMATICS COMPETENCIES
27
Appendix B
BUILDING INFORMATICS COMPETENCIES
28
Appendix B
BUILDING INFORMATICS COMPETENCIES
29
Appendix B
BUILDING INFORMATICS COMPETENCIES
30
Appendix B
BUILDING INFORMATICS COMPETENCIES
31
Appendix B
BUILDING INFORMATICS COMPETENCIES
32
Appendix B
BUILDING INFORMATICS COMPETENCIES
33
Appendix B
BUILDING INFORMATICS COMPETENCIES
Appendix C
DNP Project Budget
Expenses
Quantit
y
Cost
100
Total
$200
$0
$200
Cost
0.485
Total
$49
$0
$49
Cost
0.45
0
30
24
Total
16
0
$300
$24
$340
Cost
10
2
Sub-total Events
Total
$200
$40
$0
$0
$240
Total Expenses
$828
Salaries
Description
USF Student/Faculty Survey analyst
Analyst fee $100 per hour
2
Sub - total Salaries
Travel
Description
Gas
.485 per mile
Quantit
y
100
Other
Sub-total Travel
Supplies - Administrative
Description
Stamps
mailings, thank you cards
Administrative
phone, workspace, internet
Paper and Ink
Survey Software
Quantit
y
30
0
10
Survey Monkey, Select Plan
1
Sub-total Supplies
Quantit
y
Compensation
Description
Participants
Starbucks card
20
Thank you cards
Experts
20
Gifts
Other