Why aren’t nurses keeping ahead of the IT tsunami?

December 2015 Vol 15 (6)

Too few nurses are actively involved in the IT projects impacting on everyday nursing care of patients. Nursing Review reports on Kim Mundell’s recent speech to the National Nursing Informatics Conference on why more nurses need to be involved and what barriers may be getting in the way.


Kim MundellNurses need to step up if they want to ride the tsunami of technological change heading health’s way. If not, they might get crushed by it.

This is one of the messages that Kim Mundell, a former nurse who 18 months ago became the first chief executive of Health Informatics New Zealand, shared at the National Nursing Informatics Conference held in late October. She told the sold-out Christchurch gathering that six months into the job it first hit her – ‘where were all the nurses?’

She had met the stalwarts of the nursing informatics community – Karen Day, Michelle Honey and Denise Irvine – but with nursing the largest health workforce she believed many, many more nurses should be amongst the ‘movers and shakers’ of the health informatics community.

“Nurses will be the ones using many of the technology solutions that are rolled out; nurses should have a strong influence on IT decision-making,” Mundell told the conference. “But, at the moment, you don’t have enough of an influence.

“For informatics projects to succeed, it is vital that these projects happen with nurses; not to nurses.”

So she went on a mission to find out what was holding nursing back in the informatics world. She first went hunting for clinical nurse leaders active in informatics, which led her to nursing directors Sheree East (Nurse Maude) and Denise Kivell (Counties Manukau DHB) and through them to NENZ (Nurse Executives of New Zealand), which resulted in the two organisations co-hosting the Christchurch conference.

HINZ also decided for 2015 to focus its free Health Informatics Primer events at nurses and offered NENZ nurse leaders the opportunity to have one of the 10 primer events (the primers are two-hour introductions to health informatics delivered by experts) held in their area. “They are designed for nurses who are interested [in health informatics] but have no idea where to start.” The high levels of interest in the initial primers saw the event funders, the National Health IT Board, triple the funding so it was hoped up to 30 primers would be held before the end of the year.

“After meeting all these enthusiastic nurses from around the country who turned up to these free events it became very clear that the barrier wasn’t a lack of interest. But there are barriers,” said Mundell


Breaking barriers

Mundell realised that a very big barrier to increased nurse involvement in health informatics was a lack of money, in all its forms, including nurses struggling to access professional development funding for health informatics training or events, particularly if informatics are not a core part of the nurse’s job.

She said that can lead to a ‘chicken and egg’ situation whereby a nurse keen to take an IT role may first need more knowledge but can struggle to access the knowledge as they don’t have IT in their job description.

“So it’s only the most tenacious who get anywhere.” There are also problems in getting travel funding and conference leave to attend conferences – particularly if conferences are out of town or are for more than a half a day or a day.

Isolation was another barrier faced by nurses that HINZ would like to help overcome by connecting like-minded people. “I’ve lost count of the number of times someone has told me about a project they are struggling with, and heard the same thing from someone else 100km away at a different organisation,” said Mundell. “And neither knows the other person exists. So they continue on in isolated, frustrated pockets.”

Mundell said one of the saddest barriers she became aware of was  nurses’ intense frustration at not being heard within their organisation.

“Some felt completely unsupported by management – and held back from being involved in projects because it wasn’t their job and they were getting out of their box.

“Others felt powerless, totally powerless to effect change and completely unsure who on earth to talk to to take their ideas for improvement forward. There’s this great enthusiasm that’s bubbling under there, that is held down and held down. And again it’s only the most tenacious who do anything.”

Mundell said HINZ is actively working to support nurses to be more involved in the informatics community and in HINZ, which she describes as “the Switzerland” of professional bodies as the membership is made up of health professionals, researchers and the IT industry.

She says HINZ support has included donating 20 free scholarships for nurses new to the field to attend the Nursing Informatics and HINZ conferences, which grew to 30 because of “impassioned” calls from keen nurses. It also funded the travel expenses of nursing informatics keynote speaker Karen Monsen from the United States.

A nurse is also on the working committee that is working on New Zealand following Australia in offering an online course in health informatics competencies. And Mundell would like to see a nursing informatics conference once again held alongside next year’s HINZ conference, which in 2016 is being held in partnership with two international telehealth conferences.

10 reasons why nurses should be more involved with informatics*

To have influence
To ensure IT changes support nursing practice and patient outcomes, nurses need to be involved right from the beginning of the project.

To develop an IT vocabulary
If nurses become familiar with IT language and vocabulary they can better articulate their IT needs in a way that technology experts can understand.

To keep nursing needs in the spotlight
If nurses don’t get involved in IT discussions then other clinicians – probably doctors – will make the decisions instead.

To better link IT solutions with clinical outcomes
Having nursing input to an IT project can ensure that the impact on daily nursing workflows and patient care is taken into consideration at each step.

To find out what others are doing
If nurses are connected with others in the informatics world they may find others have already found an IT solution for the same problem.

To learn from each other’s successes and failures
Likewise nurses can also benefit from other people’s experiences – good and bad – in delivering complex health IT change projects and share their own experiences.

To gain the confidence to say ‘STOP’
Nurses with some IT knowledge, vocabulary and connections are more likely to be able to say ‘stop’ if an IT project is causing more issues than it’s solving.

To ride the wave (not get crushed by it)
Nurses need to be ready and competent to ride the tsunami of technological changing impacting on health care or risk being swept away by it.

To rebuild an active nursing informatics community
Nursing led the way 15 years ago by running a world congress in nursing informatics in Auckland. and by coming together again can effect change.

It’s a good career move
Health informatics is a high-growth area and there are new, innovative career options opening up for nurses.

*Summarised from Kim Mundell’s presentation to the National Nursing Informatics Conference.

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