Has nursing informatics come of age?

I was never part of the ‘in-crowd’ at school.  Don’t get me wrong I wasn’t unpopular, I just wasn’t one of those girls who everyone seems to want to be.  I wonder if it was because I chose the wrong subjects.  I was good at science.  Physics, maths and biology were my favourite subjects.  I was even a science prefect…..  I was too busy with Bunsen burners to spend as much time as I needed to focus on my disco moves, to be part of the disco gang.

I recently read a BBC piece about the number of girls opting to study Physics and I started to wonder whether anything much had changed since 1976 (I know!) when I did my ‘O’ Level options.  Physics was one of my best subjects and, more importantly, whether there were any parallels with my later nursing career.

 Anne 1975

This is a picture of me at the time I would be choosing my ‘O’ level options (maybe not the coolest girl in school!)

Nursing seems to have a love-hate relationship with informatics – this is well described by Judy Murphy in her article ‘Technology and Nursing’ (http://www.himss.org/content/files/jhim/23-2/JHIM_Spring_4Murphy.pdf).  Like Judy, my experience is that on one hand many nurses tell me they don’t want to change the way they do things, that technology will just ‘get in the way’, that nursing is about caring not computers and yet on the other hand, I meet converts who would not give up their systems/mobile technology/digital pen/ website for anything, they see these tools as essential things they need to offer the best care they can.  For those nurses working in IT departments for a long time they were unlikely to be invited to any nursing parties and in many cases I think the nurses in these areas seem invisible!  They sometimes still tell me they don’t have access to their nurse directors and are not part of the nursing teams.  I really don’t understand why is the case.

The label of ‘geek’ certainly doesn’t help.  So what is a geek? I’m not actually sure of the clear definition but I found one that said ‘person with an eccentric devotion to a particular interest, for example a computer geek.’  While I might be eccentric – I hope so, it’s sort of glamorous to be eccentric these days – I don’t actually think I’m a geek.  I think many geeks see the label as a badge of honour; they would be horrified to have me included in their ranks as I am actually often technically inept.  I can’t programme and I can’t code.  I’m not intrinsically interested in the details of systems in the same way as I’m not interested in the engine of my car – Graham at the local garage takes care of that for me and our IT help-desk often have to help me out in the same way for my computer. I’m interested in people and care.

So, how, then, did a non-geek end up in my job?  For me it was all about potential and keeping the choices for nursing; believing that nurses can decide for themselves and technology shouldn’t be imposed.

When I started working at NHS Direct I think we were at the vanguard of nursing informatics in many ways.  Setting up NHS Direct was all about technology, telephony, data, and then it was choosing able nurses who could blend good nursing assessment skills with supportive technology to offer safe care remotely.  When we were very first setting up the service I would sit in a room with a group of senior nurses and the IT and call centre people would talk to us – it was plain it mainly went over our heads; for me that wasn’t good enough.  We needed to understand otherwise we were going to have to work the way the technology worked! I seemed to be most determined to try to work it out.  I stuck with it, as I’m fond of saying, I ‘stayed in the room’ and I feel clear that we got a better outcome for our teams as a result.  So my career in informatics was launched – and yes it was an accident!

NHS Direct 1999

This is the official press photograph when we launched our NHS Direct service locally. It was the best job I’ve ever had – how many times in a career do you get the chance to establish a totally new service?

That was just the start of it.  From then onwards I was the IT nurse.  It was essentially the start of my nursing informatics career.

More recently I am starting to see things changing and I’m wondering if nursing informatics is coming of age, whether unlike Physics it’s starting to move to become more accepted as part of modern care.  The truth is we have assimilated many technical innovations into nursing practice over many years – we just don’t seem to see them as ‘informatics’.  Most complex areas of advanced nursing use informatics routinely; they use medical devices, information systems or are involved in research where data has huge significance.

But the future is important.  I define informatics as the use of information in care/practice, service improvement, education and research and by my definition it’s everyone’s business.  It’s no longer about the computer.  Can we have the right information at our finger tips to help us to give optimal care?  Can we share information to help patients have the best experience of care? It’s also about whether we can measure the outcome of the care we provide.  Do we collect the right information in the patient’s record for the patient to be confident of what we do? Can we compare our performance to others to be able to benchmark our practice – all this for me is informatics.  The technology is often an enabler – its not the key.

So perhaps those weeks at NHS Direct, when I was learning the new language of computers that led me to this place I was lucky to be at such an important and leading edge part of nursing.  I’d like to think so.  So I’m working on trying to make informatics the cool place to be.  It’s a space that has potential to support nursing innovation, for us to offer better and different care for patients.  Don’t get me wrong – I don’t believe we need to use technology for everything or collect data about everything.  But that’s the point really.  We need to choose carefully and wisely and if we do we will get the best out of it for patients and use measurement and technology for best effect.  But equally in an world where the need to be transparent, accountable and focused on better outcomes, using information is essential.  This is, for me, the heart of informatics.

If you are interested in measuring nursing I commend this publication to you ‘High Quality Care Metrics for Nursing’ (Maben, Morrow, Ball, Robert 2012). It can be accessed on the web here:


6 thoughts on “Has nursing informatics come of age?

  1. A great read and lovely to rad about your story as to how you got into this field of nursing and Geek is the new Chic in my mind at least!

    I wholeheartedly agree that we must exploit informatics to improve efficiency of services and outcomes for patients. It is my hope that informatics will become, if it isn’t already, a key component of all nurses’ knowledge and skill-set. The more nursing leaders like you championing the cause will only help this grow further.

  2. Interesting viewpoint, Annie. I’m slightly in disagreement with you but in a good way!

    My background – ex nurse/ midwife / scbu nurse and then an information & communication undergrad and then postgrad focusing in the early 2000’s on IT implementation in the NHS (never completed).

    One of the huge barriers (in my opinion) of the information for health programme was its focus on and encouragement of large top down technology focused ‘solutions’ (I say solutions because in my opinion, ‘problems’ were never fully identified and understood in any sort of clear way.) This really encouraged worship of the technology (the toys for boys effect as I call it). The atmosphere at the time to me was more ‘lets get a microwave link built so we can beam stuff around the authority’ rather than we have all this information to move – lets start there. All the investment into technology for the EHR and no agreement on the basic information to put in there at the start of the project. As part of an undergrad placement at a HA, I was given the job of finding what information was out there to put on a website / intranet. Wow, you’d have thought I had kicked over a hornets nest! One dept refused to speak to me because they said ‘their protocols (based on national standard protocols) were theirs and they weren’t going to let anyone outside their trust (ie not even on an intranet shared only with other professionals) even look at them because, well the protocols were theirs. The head of the IT dept I directly reported didn’t even realise there was so much information out there. Technology, ie hardware, really was the mantra of the day. And technology really appears very complicated and fixed to those who are not experts.

    My own view of information is possibly 180 degrees away from the norm. I view information more as a process than an outcome in itself, a process that adds some value to the interactions between human beings. Viewed in that sense – nursing has always been about informatics, the job of caring has always been about measuring, recording, interacting with patients to ascertain needs and using both learned and intrinsic skills to act on all of that. I don’t think that until recently that this has been more widely recognised amongst either the nursing profession or the IT experts employed to implement IT within the NHS because of the focus on technology.

    I’m glad to see that nurses are amongst those taking the lead to put the process back centre stage because that is what it is all about – how do we use these tools (because that is what essentially technology is) to add value to what we do for the partners in our care – the patients!

    Hope this makes sense!

  3. I don’t think we are disagreeing at all! We are definitely in the same space. Thank you for your thoughts.

    Just to say, I’m not sure that nursing informatics has been totally driven by the ‘centre’ but has also suffered from a lack of connection to the profession. Say ‘technology’ and nurses for a decade in my experience are likely to vacate the room. It was my leadership ambition to help them understand, be less fearful and in doing so encourage them to stay. I think as a profession we are make great progress but I deliberately focus on patient care and information rather than technology. The approach makes the conversations more fruitful nurses are driven generally with the desire to improve. Talking techno, generally, will make them walk away.
    Thank you so much for taking the time to comment!

  4. Nurse geek here and proud of it …… brilliant blog post. I totally agree that technology is the enabler. We have a responsibility to care for our patients in the best way we possibly can, this means that we need to look out for and embrace new ways of working that enhance patient care. As a profession we need to open our minds and look beyond what we usually do and ask “How can we do this better?” With technology having such a large presence in all of our lives we are more aware than we have ever been, I agree Nurse geeks – sorry nurses enthusiastic about health informatics – are truly coming of age!!

  5. hi Friends,
    I ended up here by googling for IT Nurse education requirement. and clear cut to say…it was an amazing blog post. thanks a lot for the thought. I need to divert my focus of career to this sector sooner or later but really confused by the stage which i am now. I am a newly qualified RGN in UK, working in a dementia-setup. Anybody can help me with suggesting a course or opportunity related to IT nursing? I love technology and am to some extent good with computers. I got a BSN and 1 year of experience. Please help me!

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