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TABLE OF CONTENTS 

List of Members of National Advisory Council on Nurse Education and Practice ...................... 3


EXECUTIVESUMMARY ................................................................ 5


SECTION I: NURSING INFORMATICS ................................................. 7


Building the Infrastructure .............................................................. 7


Nursing Informatics as a Specialty ....................................................... 8


SECTION II: NURSING INFORMATICSINEDUCATIONAND PRACTICE.......... 12


Division of Nursing InformaticsFunding ................................................. 12


InformaticsEducation Models .......................................................... 13


Student Preparation in Nursing Informatics ............................................... 16


Faculty Preparation in Nursing Informatics ................................................ 18


PracticingClinicians’Preparation in Nursing Informatics ..................................... 19


summary .......................................................................... 20


SECTION NATIONAL NURSING INFORMATICSWORK GROUP .............. 21


Description of Members .............................................................. 21


Context for Identifying Informatics Needs and Initiatives .................................... 21


Method for Identifying Informatics Needs and Initiatives ..................................... 21


Nursing InformaticsNeeds ............................................................ 21


Proposed Nursing InformaticsInitiatives ................................................. 22


SECTION IV: POLICY ISSUES. GOALS. AND OPTIONS ............................. 23


Educate Nursing Students and Practicing Nurses in Core Informatics Content .................... 23


Prepare Nurses with Specialized Skills in Informatics ....................................... 23


Enhance Nursing Practice and Education Through Informatics Projects ......................... 23


Prepare Nursing Faculty in Informatics ................................................... 24


IncreaseCollaborativeEffortsin Nursing Informatics ....................................... 24


References ......................................................................... 25


APPENDICES


A. Nursing Informatics Organizations .................................................... 29


B.National Nursing Informatics Work Group Members ..................................... 32


National Advisory Council on Nurse Education and Practice i

The views expressed in this document are solely

those of the National Advisory Council on Nurse

Education and Practice and do not necessarily

represent the views of the Health Resources and

Services Administration nor the U.S. Government.
MEMBERS OF THE NATIONALADVISORY 

COUNCIL ON NURSE EDUCATIONAND PRACTICE 

(asof April 1997) 

CHAIR Marla E. Salmon,ScD,RN 

Director, Division of Nursing 

Bureau of Health Professions 

Health Resources and Services 

Administration 

Rockville, Maryland 

CO-CHAIR Vivian M. Lifflefield, PhD, RN 

Dean and Professor 

School of Nursing 

University of Wisconsin 

Madison, Wisconsin 

MEMBERS Dyanne Affonso, PhD, RN 

Dean and Professor 

Nell Hodgson Woodruff School of 

Nursing 

Emory University 

Atlanta, Georgia 

Carole A. Anderson, PhD, RN

Dean and Professor

College of Nursing

The Ohio State University

Columbus,Ohio

Charon Asetoyer, MA

Executive Director 

Native American Community Board 

Lake Andes, South Dakota

Shelly S. Crow, MSN, RN

SecondChief

Muscogee Creek Nation

Tulsa, Oklahoma

Maryann Fralic, DrPH, RN

Vice President for Nursing 

The Johns Hopkins Hospital

Baltimore, Maryland 

Bruce W. Goldberg, MD

Assistant Professor 

Department of Family Practice

Oregon Health Sciences University

Portland, Oregon

Charlene M. Hanson, EdD, RN

Professor of Nursing

Georgia Southern University

Statesboro, Georgia 

Barbara J. Hatcher, PhD, RN

Acting OfficeChief

Office of Maternal and Child Health

District of Columbia Commission of

Public Health 

Washington, DC 

Margie N. Johnson, PhD, RN

Dean and Professor

School of Nursing and Allied Health 

Tuskegee University 

Tuskegee, Alabama 

Judith K. Leavitt, MEd, RN

Director

GenerationsUnited

Washington, DC

Gloria J. Myers, JD

Attorney

Asheville, North Carolina

Geri Marullo, MSN, RN

Executive Director 

American Nurses Association 

Washington,DC

Robert V. Piemonte, EdD, RN 

New York, New York 

Judith G. Richardson,JD

Attorney

Boston, Kentucky

Sally E. Ruybal, PhD, RN

Professor of Nursing

College of Nursing

University of New Mexico

Albuquerque, New Mexico

Sherry L. Shamansky,DrPH, RN 

Seattle, Washington 

Antonia Vilarruel, PhD, RN

Assistant Professor 

University of Pennsylvania

Philadelphia, Pennsylvania 

IrisSanchez

University of Texas-Pan American

Edinburg,Texas

National Advisory Council on Nurse Education and Practice 3 
Theresa A. Varela, MSN, RN 

New York University 

New York, New York 

Jenny A. Webb 

Virginia Highlands Community College 

Abington, Virginia 

EXECUTIVE 

SECRETARY 

Elaine G. Cohen, MS, RN 

Division of Nursing

Bureau of Health Professions 

Health Resources and Services 

Administration

4 National Advisory Council on Nurse Education and Practice 
EXECUTIVESUMMARY 

The National Advisory Council on Nurse Education and 

Practice (NACNEP)is responsible for advising the 

Secretary on ways to enhance the health of the public 

through development of the registered nurse workforce. 

NACNEP recognized a need to more adequately prepare 

the registered nurse workforce to manage information 

using technology. 

Federal initiatives focused on building the Nation's 

technology infrastructurewill help to create an 

environment that allows nurses to use technology 

routinely in deliveringcare. For example, the National 

Information Infrastructure (MI) initiativefocuses on 

enhancing the basic infrastructurefor telecommunications 

and computer technology in all sectors of the U.S. 

economy. The NII will add value to health care if people 

use information technologies to access and manage 

information. Realizing benefits from the NII is dependent 

on the quality of information;the availability of easy-touse software applications; the developmentof network 

standardsand transmission codes; and the availability of 

people to organize information,develop applications, 

maintain the network, and educate individuals to use the 

systems. 

An information infrastructureis very importantto health 

care. Information has become a capital good, with a 

value similar to labor, materials, and financial resources, 

Effective information management separates the 

economic survivors from the non-survivorsin today's 

health care environment. 

Nursing informatics (NI) is a specialty whose activities 

center around information management and processing 

for the nursing profession. The Division of Nursing (DN) 

further defines nursing informatics as combining nursing 

science, information management science, and computer 

science to manage and process nursing data, information, 

and knowledge to deliver quality care to the public, 

particularly disadvantaged and underserved populations. 

Although many industries such as banking and travel 

readily adopted information technology, health care 

providers, including nurses, are slower to use computers 

for information processing. The literature was examined 

to determine the state-of-the-art in NI. Available data 

indicate the following situation. The nursing culture 

needs to promote acceptance and use of information 

technologies as basic tools for information management 

and exchange. Computers are available in schools of 

nursing; however, infrastructure support in terms of 

personnel, planning, and budgeting is often lacking in 

schools of nursing. Computer technology that is available 

is not fully utilized. Information technology must 

facilitate, not hinder information exchange. Practicing 

nurses are not necessarily computer competent. More 

nursing informatics educationalprograms are needed. 

The DN and NACNEP recognized a need to identify 

initiatives that would more adequately prepare the 

Nation's nursing workforce to use technology to manage 

information for education and practice and to help 

patients gain access to health care information. As a 

result, NACNEP commissioned a panel of experts to 

advise them in setting the Nation's future direction for 

using informatics in nursing education and practice. 

Nineteen panel members, known as the National Nursing 

Informatics Work Group (NNIWG), were selected from 

nursing informatics experts across the country. The 

members are recognized for their outstanding 

contributions to nursing informatics in a variety of work 

settings,including practice, industry, education, and 

government. These individuals have expertise in decision 

support,distance education, informatics education and 

competencies, information systems, languages and 

taxonomies, and telecommunications. 

At the beginning of the 2day meeting, NNIWG members 

were informed of the mission, authorization,and strategic 

directions of the DN and the national priorities of the Health 

Resources and ServicesAdministration (HRSA). Five 

NNIWG members presented position papers, challenging 

their colleaguesto considerthe current status, future 

directions,and major barriers to reaching full use of cutting 

edge information technologies, telecommunications, distance 

learning, data sets, and information systems. Data from the 

literatureon faculty's informaticsneeds, students' computer 

competencies, and availability of computers were presented 

to review further the status of NI. 

A nominal group technique was used to identify and 

prioritize informatics needs. NNIWG members were 

assigned to one of two subgroups. Subgroupmembersin 

turn each stated one nursing informatics need that was 

recorded without discussion. Rounds continued until 

members had no further ideas to list or time had expired. 

Ideas were then expanded,combined, rephrased, or 

eliminatedwith consent of the originatorof that idea. 

Using a weighting method, needs were prioritized. 

National Advisory Council on Nurse Education and Practice 5 
Five assumptions were foundational to identifying 

informatics needs and developingpolicy goalsfor NI 

education and practice: 

1)Learners are students, faculty, and clinicians. 

2) Nursing informatics must be considered within 

an interdisciplinary context of partnerships and 

collaboration. 

3) Efforts should target disadvantaged and 

underserved populations. 

4) Initiatives should be responsive to other 

governmentfunding priorities. 

5) Collaboration amongFederal agencies and 

between Federal and private entities is necessary. 

Eight categoriesof NI needs were identified: 

1) Education and curriculum 

a) Identify and incorporateinformatics skills 

and competencies for all levels of education 

(basic, graduate, post-graduate, continuing 

education, and informatics specialization). 

b) Teach information seeking and evaluation 

behaviors that consider age, learning styles, and 

motivation. 

c) Integrate nursing science with NI education 

and practice to encourage innovations in 

nursing practice. 

2) Demonstration projects for telenursing, patient 

education in the community, patient-specific clinical 

decision support systems, virtual courses, and 

consumer education about the nurse as a broker of 

information. 

3) Development of models of nurse-patient 

encounters using technology including shared 

decision-making, consumer health information 

acquisition, multiproviders,and optimal ways to 

interact with systems. 

4) Preparation of faculty in informatics including 

Internet effective distance education schemes, 

and benchmarking strategies for technology 

education. 

5) Collaboration on informatics initiatives with 

partnerships 

a) Collaborate at Federal, academic, industry, 

and community levels. 

b) Form partnerships among these groups. 

c) Develop technology supported models of 

community development to identify new roles 

and to maximize use of technologies. 

6) Integration of nursing informatics into practice 

a)Include informatics in nurse-managed 

clinics. 

b) Link nurse-managed clinics and practices. 

c) Identify barriers to using technology. 

7)Additional informatics programs 

a) Develop innovative programs that share 

expertise and resources. 

Link regions to deliver informatics 

education. 

8) Interdisciplinary focus in informatics 

a) Determine if informatics can be used as a 

model for interdisciplinaryeducation. 

b) Develop interdisciplinarypartnerships within 

universities and colleges to support informatics 

research and development. 

Based on prioritized informatics needs, assumptions, and 

the expertise of NNIWG members, NACNEP 

recommends the followingNational InformaticsAgenda 

for Nursing Education and Practice: 

1) Educate nursing students and practicing nurses in 

core informatics content. 

Federal resources should promote the inclusion of core 

informatics skills and knowledge leading to competency 

in nursing undergraduate, graduate, and continuing 

education programs. 

2)Prepare nurses with specialized skills in informatics. 

Federal funds should support innovative nursing and 

health informatics programs that teach specialized 

informatics skills needed to develop information 

technology that supports the national health goals of 

providing accessible, high quality, and cost-effective 

care. 

3)Enhance nursingpractice and education through 

informaticsprojects. 

The Federal government should fund innovative, 

collaborative telecommunication projects that would 

enhance the quality of clinical practice for populations at 

risk and contribute to the education of health care 

providers. 

4) Prepare nursingfaculty in informatics. 

Federal resources should support increased nursing 

faculty preparation in informatics through the use of 

collaborativeprograms and technology. 

5 )Increase collaborative efforts in nursing 

informatics. 

Federal resources should support efforts to facilitatethe 

advancement of informatics in nursing through 

collaboration among public and private organizations. 

6 National Advisory Council on Nurse Education and Practice 
SECTION I: NURSING INFORMATICS 

Building the Infrastructure 

The National Advisory Council on Nurse Education and 

Practice (NACNEP) was established by Title VIII of the 

Public Health ServiceAct to advise the Secretary of 

Health and Human Services on the programs of the 

Nurse Training Act. As part of its review of the Nurse 

Training Act, NACNEP turned its attention to the 

shapingof the registered nurse (RN) workforce to meet 

the public’s health care needs. NACNEP’s purposes 

under its charter were broadened in 1994 to explicitly 

meet this responsibility for advising the Secretary on 

ways to enhance the health of the public through the 

development of the RN workforce. 

The Division of Nursing (DN) and NACNEP recognized 

a need to idmtify initiatives that will more adequately 

prepare the Nation’s nursing workforce to use 

technology to manage information for education and 

practice and to help patients gain access to health care 

information. As a result, NACNEP commissioned a 

panel of informatics experts, the National Nursing 

InformaticsWork Group (NNIWG),to recommend 

future direction for nursing informatics (NI) education 

and practice for the nation. 

Federal initiatives focused on building the Nation’s 

technology infrastructure will help to create an 

environment that allows nurses to use technology 

routinely in deliveringcare. For example, the National 

Information Infrastructure (NII)initiative focuses on 

enhancing the basic infrastructurefor 

telecommunications and computer technology in all 

sectors of the US economy, including health care.’ Such 

an infrastructure will provide a seamless web of 

communications networks, computers, databases,and 

consumer electronics that allows users to access a 

tremendous amount of information. The NII has the 

potential to revolutionizeinformation management 

within health care, thereby cutting unnecessary medical 

costs and improvinghealth care access and quality.2 

The NII will only add value to health care if people can 

use and benefit from it. Ability of the M I to realize 

these goals is dependenton the quality of its 

components. An obvious component is the hardware 

available to access information. Other components, 

equally as important to a successfulinformation network 

but often overlooked, are (a) the information itself, its 

medium, accuracy, timeliness, and reliability; (b) easyto-use software applicationsto access, organize, and 

manipulate information;(c) network standards and 

transmission codes that allow different sites to exchange 

information, while protecting individuals’ privacy and 

security;and (d) people to organize information, develop 

applications,maintain the network, and train individuals 

to use the systems. 

The information infrastructure is very important to 

health care. Tapscott and Caston3 remind us that 

information has become a capital good, with a value 

similar to labor, materials, and financial resources. 

Swart4 emphasizesfurther the value of information by 

indicating that data has become the basis of power in 

organizations. Effective information management 

separates the economic survivors from the non-survivors 

in today’s health care environment. In spite of the 

importanceof processing information, health care trails 

other industries in spendingfor information technology. 

Less than 2 percent of the health care industry’s annual 

budget is spent on information system purchase and 

implementation,while industriessuch as banking spend 

12 percent of their operating budget on information 

processing technologies.5 For too long health care has 

been concerned with the cost and justification of 

purchasing information technology, rather than adopting 

a philosophy that accepts this technology as a critical 

part of doing business. Zielstorff6 recently noted a 

decreasing focus on the cost of systems and an 

increasing concern with the technology’s ability to 

capture data, produce needed information, and transmit 

that information to other partners in existing health 

information networks. This shifting view should help 

health care move more rapidly to adopt needed 

information technology. 

It is an exciting time for NI. With its focus on the 

development and use of information and technology, NI 

is in an excellent position to help nursing become at least 

an equal partner with other health care providers in using 

the NII. Many informatics specialists believe that if 

nursing does not more readily adopt and use 

technologies in education and practice to meet the 

information needs of patients and nurses, other health 

care providers and business entrepreneurswill use those 

same technologies to replace nurses. 

The DN and NACNEP recognize the important role of 

informatics in preparing the Nation’s nursing workforce 

to abandonmanual information processingfor newer 

and more productive technologies. The DN defines NI 

as combining nursing science,informationmanagement 

science, and computer science to manage and process 

nursing data, information, and knowledge to deliver 

quality care to the public, particularly to disadvantaged 

and underserved populations. The activitiesof NI 

center around information management and processing. 

Information management involves the collection, 

organization, aggregation, storage, retrieval, and display 

of data in a way that supports nursing practice and 

National Advisory Council on Nurse Education and Practice 7 
education. At the individual patient care level, data are 

processed into information and knowledge by nurses as

they make decisions regarding the delivery of care to 

their patients. As data are further organized and 

aggregated, they can be retrieved in a purposeful way 

and used to evaluate the outcomes or responses of 

patient populations to various treatment modalities. 

Aggregated at a higher level across patient populations, 

data (as information)are used to establish policy for the 

public's health. 

Information technologies are essential tools to facilitate 

the management of information used by all health care 

providers, including nurses. Information technologies 

include computers and softwarepackages such as word 

processing, database management, spreadsheets, 

graphics presentation, as well as the Internet and World 

Wide Web systems. Mastery of these basic tools is 

commonly called computer literacy and is an expected 

outcome for all nursing students to achieve in their basic 

educational program.7 

More advanced information technologies that can be 

used by nurses in practice and education include 

decision support systems, expert systems, clinical 

information systems, data repositories,distance 

education systems, and telehealth systems. Informatics 

processes vital to information management include using 

system design, selection, implementation, and evaluation 

principles; and developingand coding representative 

languagesfor communicating health information to 

patients, their families, other providers, and policy 

makers. 

Nursing Informatics as a Specialty 

Informatics is not a new concept-it has been around for 

as long as people have recorded their thoughts, ideas, 

and observations for others to see. Information has 

always been the product of informatics. To be useful to 

health care, information must be collected, stored, 

retrieved, and displayed so that it is accurate,timely, 

understandable, easily accessible, and usable for 

practitioners, students, or policy makers to reach 

appropriate decisions. Recognition of the need for 

information in today's health care environment and for 

improved but less expensive technology has resulted in 

tremendous growth in the use of information 

technologies such as information systems, databases, 

desktop computers, personal digital assistants,laptops, 

modems, and the Internet. These tools have increased 

the focus on informatics. 

Since the 1970swhen hospital-wide information systems 

were first installed, nurses have worked in hospitals, for 

vendors, or as consultantsto design, develop, and install 

information systems and technologies. It was not until 

1992that NI was recognized as a specialty by the 

American Nurses Association (ANA).8 To qualify as a 

specialty, NI exhibited the same attributesthat are 

required of all specialties: practice differentiated by 

definition,domain,scope of practicel and standards; 

educational programs for preparing nurses to practice in 

the specialty; a mechanismfor credentialing nurses in 

the specialty;organizational representationof the 

specialty;and a research program.9-10 

Nursing is the largest group of health care providers with 

more than 2 million practicing RNs.11 They have many 

needs related to NI. Standardized vocabularies are 

needed to describe: patients from nursing's perspective, 

interventions delivered by nurses and other providers, 

and outcomes of care received. Information 

technologies are needed to link those entities in a way 

that practice can be evaluated in terms of access, cost, 

and effectiveness. These areas of concern are the 

essence of NI practice. Nursing informatics is described 

as the essential infrastructurefor quality assessment and 

improvement in nursing.12 The importance of NI in the 

development of information technologies is again 

emphasized by Zielstorff, Hudgings, and Grobe13 as they 

discuss essential characteristicsof information systems 

needed for professional nursing practice. 

Definition 

The definition of NI is dynamic, changing to reflect the 

maturation of the specialty. NI was first defined ass the 

disciplineof applying computer science to nursing 

processes.14 A year later it was characterized as a focus 

that uses information technology to accomplish 

nursing's functions or tasks.

15 Although widely used, 

these two definitions limited NI to mean the use of 

computer technologies. 

In 1988Grobe expanded the description of NI to include 

application of information scienceprinciples and theory 

in studying, analyzing, and managing information.16 A 

widely disseminated definition of NI appears in a classic 

and pivotal article by Graves and Corcoran17 that 

describesthe study of NI. The authors define NI as 

combining nursing, information, and computer sciences 

to manage and process nursing data to use in the delivery 

of health care. These two definitions acknowledge the 

inclusion of conceptual frameworks and theories such as 

information processing theory, decision theory, language 

development, human-computerinterface issues, and 

application of the system development life cycle in NI 

practice. If used to guide curricula, the latter definitions 

assure development of more representative informatics 

education that teaches informatics concepts, notjust 

computer literacy. Buildingon the two definitions, the 

8 National Advisory Council on Nurse Education and Practice 
Scope of Practice forNursing Informatics document 

also describes NI as a specialty that combines nursing, 

computer, and information sciences in organizing, 

processing, and managing data and information to 

support nursing practice. It adds that NI expands 

nursing knowledge.7 

Domains of Interest 

The nursing phenomena of interest are client, health, 

environment, and nurse. Because it is grounded in 

nursing, NI shares interest in these four phenomena, but 

adds to them a focus on all data, information, and 

knowledgeinvolved in nursing7,17 Representation of 

data in a meaningful way is essential if isolated facts and 

observations are to be aggregated and used to make 

decisionsregarding the public’s health. It isthe 

responsibility of informatics nurses to establish language 

that represents nursing’s practice yet interfaces with 

languages used by other health providers. 

A position statementfrom ANA18visualizes that 

nursing’s language will move along a continuum from a 

collection of nursing terms to a unified language and 

recognizes 

finally to a uniform language. The ANA currently 

the Nursing Minimum Data and five 

languages as representative of nursing: North American 

Nursing Diagnostic Association”, Nursing Intervention 

Classification (NIC)22,Nursing Outcomes 

Classification23,the Omaha System24, and the Home 

Health Classification.25 The ANA is developing an 

evaluation system that will allow information system 

software to be critiqued for its compliance with one of 

these five nursing languages.26 Informatics scholars 

have evaluated the fit of nursing’s languages with 

taxonomies used by other healthcare providers and have 

determined that more work needs to be done with 

language development.27-29 

Nursing informatics scholars continueto develop 

components of nursing’s language that have not been 

completely addressed. Grobe30 is developing a Nursing 

Intervention Lexicon and Taxonomy for chronic illness. 

Ozbolt, Fruchtnight, and Hayden31are using existing 

data from a consortium of hospitals to develop standard 

terms and codes for recording nursing care in patient 

records. 

Renner and Swart32released a report on the Patient Core 

Data Set (PCDS) designed for use by multiple 

disciplinesin aggregating patient data across health care 

settings. The PCDS identifies a core of common data 

elements and provides uniform definitions and coding 

that is consistent with both the Health Level 7 (HL7) and 

American Society for Testing and Materials (ASTM) 

electronic data interchange standards. Because 

standards are built into PCDS, it will be easier to 

establish a longitudinal health and medical record for 

patients. 

Solving issues of data representation through language is 

critical to the transfer of data across different systems, 

different groups of practitioners, and different 

geographic locations. The Health Insurance Portability 

and Accountability Act of 1996legislatesthe use of 

national standard data sets for financial and 

administrative data. McCormick and colleagues33 

indicate this law may influence additional data sets as 

well. Nursing as a whole must reach consensus about 

language standards,identify a working set of standards, 

or develop schemes to link like terms if it is to have a 

representative language included in national standards. 

Unless nursing is represented in language standards, 

many questions about its best practices and patient 

outcomes will go unanswered. Without data that 

demonstrate its contributionto patient outcomes, nursing 

will become even more invisible in health care delivery. 

Scope of Practice and Standards 

In 1994,the ANA convened a panel of informatics 

experts to develop the Scope of Practicefor Nursing 

Informatics that outlines in detail what is and is no NI 

practice.18 The panel acknowledged that use of 

applications software is imperative for NI practice, but 

insufficient to define it. Within nursing, NI focuses on 

the methods and technologies of information handling 

needed for practice. In the document nursing practice 

refers to patient care, research, education, administration 

and informatics. Information handling includes 

organizing, processing, and managing data and 

information. Nursing informatics practice spans both 

direct and indirect clinical practice, dependingupon 

whether individual or aggregate level data are being 

processed into information and used for decisionmaking. 

The scope of practice makes it clear that informatics 

nurses must interface with other informatics disciplines 

to implement effective information solutions. It seems 

logical to describe NI as one of several disciplinespecific informatics practices that fall under a more 

general rubric of health informatics. Medical and dental 

informatics are other examples of discipline-specific 

informatics practices. Included in the activitiesof health 

informatics are: 

1.Identifyinginformation to be collected and 

processed. 

2. Creating databasesfor storing data. 

3. Developing user-friendly screens to enter data 

and retrieve information. 

National Advisory Council on Nurse Education and Practice 9
4. Educating users to work effectivelywith 

information technology. 

5. Preparing users to maximize use of available 

information systems. 

6. Installing and maintaining health care information 

systems. 

7. Developing distance education and telehealth 

systems for information exchange. 

Although very similar to health informatics, NI activities 

are performed from a nursing perspective. Brennan34 

points out that each health profession (a) provides 

perspective, (b) illuminates values and beliefs, (c) 

denotes a practice base, (d) produces unique knowledge, 

(e) distinguishesgroups of practitioners, (f) focuses 

attention on certain phenomena, (g) provides needed 

language, and (h) provides context to words. Using 

clinical experience and knowledge, informatics nurses 

are prepared to add the dimension of nursing to the 

health informatics viewpoint. This assures that 

information systems represent and facilitate nursing 

practice. Information is organized, collected, stored, 

displayed, and retrieved so that it supports nursing 

practice and education. As an example, informatics 

nurses work to include nursing language vocabularies in 

information systems so nursing practice can be 

adequately documented and evaluated. The role of 

nurses who can combine expertise in informatics with 

experiencein education or practice will expand as 

information and technologies become integral parts of 

the health care infrastructure. 

To become a specialty, a field of practice must develop 

standards. In 1995, the ANA convened a second expert 

panel to develop the Standards of Practice forNursing 

Informatics document.35 It describes the responsibilities 

of RNs who practice NI at the generalist level (called 

informatics nurses) and was used as a foundation for 

developing the certificationexamination. Practice 

responsibilitiesfocus on assessment, diagnosis,outcome 

identification,planning, implementation, and evaluation 

of informationsystems and technologies. Professional 

performance standards for informatics nurses include 

statements about the following: maintaining quality of 

informatics practice, appraising performance, keeping 

knowledge current, developing professional colleagues, 

using ethical principles, collaborating with other nurses 

and other disciplines, participating in research, and 

utilizing appropriate resources. A third group of 

standards describesspecific domain responsibilities for 

NI. They include applying the information systems’ life 

cycle, using informatics knowledge and principles from 

supporting disciplines, gaining proficiency in using 

information technologies,communicatingwith other 

disciplines, and supporting databases that represent 

nursing language. 

The standards for informatics nurses described above 

focus primarily on information systems and technologies 

rather than on data structures or interactions between 

humans and machines. A more advanced level of 

informatics practice is needed to deal with complex 

issues of human-computer interface, data representation, 

linguistic analysis, information processing, use of 

information, decision support systems, and system 

design. Development of standards for more advanced 

informatics practice is a future project. 

Educational Preparation in Nursing Informatics 

Early preparation in NI was availableonly through 

work-relatedexperiences and a limited number of 

continuingeducation conferences and programs. Later a 

handful of facultyprovided informatics education to 

graduate students through independent study focused on 

informatics concepts. More recently five informatics 

education models, ranging from continuing education to 

specialization,have been identified. Additional detail 

about the educational models is found in Section III . 

The appropriate model for an educationalinstitution is 

dependent on the levels of informaticscompetency 

desired as an outcome for students. 

In 1988, the InternationalMedical Informatics 

Association’s(IMIA ) Nursing Informatics Work Group 

met in Sweden to identify informatics competence 

required for nurses at three different levels of 

expertise.36 Information about expected competencies 

for each of the levels has served as a framework for 

informatics programs, including specialized informatics 

education at the University of Maryland at Baltimore.37 

According to the IMIA work group, level one 

competencies prepare nurses to be users of information 

technology. Nurses are expected to know, understand, 

use, and interact with computer applications and 

information systems. Level one nurses are also prepared 

to collect relevant data for patient care, access 

information needed to provide nursing services, and 

implementpoliciesthat assure the privacy, 

confidentiality and security of data. This preparation is 

expected to occur in baccalaureate nursing programs. 

The scope of practice document

7 suggests almost 

identical competencies for all RNs completing their 

basic nursingprograms. 

Level two nurses are described by the IMIA work group 

as information system and technology modifiers. At this 

level nurses are prepared to analyze, manage, critique, 

develop,modify, and evaluatetfie technology by 

applying theoretical knowledge from nursing, 

information science, computer science, and business. To 

achieve the desired competencies of level two, nurses 

10 National Advisory Council on Nurse Education and Practice 
need at least specialized informatics courses and perhaps 

graduate specialty programs of study in NI. 

Level three nurses are labeled information technology 

innovators. Nurses who perform at this level design and 

develop research-based information technology; analyze, 

define and develop the structure of nursing’s language; 

and define the decision-making processes used for 

clinical nursing (individual level) and administrative 

policy (aggregate level) decision-making. According to 

the IMIA work group, nurses must be prepared at the 

doctoral level to become informatics innovators. 

Certification 

Although many different organizations certify nurses38, 

informatics certification is granted only through the 

American Nurses Credentialing Center (ANCC), a 

subsidiary of ANA. Current certification recognizes 

informatics generalists and calls them informatics 

nurses. This is a basic level of certification in 

informatics. Nurses who hold a baccalaureate or higher 

degree in nursing may apply for the certification test 

after they have practiced as a registered nurse for a 

minimum of 2 years and have practiced in informatics 

nursing for 2,000 hours within the past 5 years. If the 

applicant has 12 semester hours of academic credit in 

informatics in a graduate program, the number of 

practice hours is reduced to l,000.39 The examination is 

administered by computerized testing and is given 

continuously. 

The certification test was developed from informatics 

standards written by the ANA’s Task Force to Develop 

Measurement Criteria for Standards for Nursing 

Informatics. The content outline is as follows: systems 

analysis and design, system implementation and support, 

system testing and evaluation, human factors, computer 

technology, information/databasemanagement, 

professional practice trends and issues, and basic 

theories impacting NI. In 1997more than 120 nurses are 

certified as informatics nurses. 

Organizational Support 

To qualify as a specialty, a practice area must be 

represented by at least one organized body. Three 

national organizations, the ANA, National League for 

Nursing (NLN), and American Medical Informatics 

Association (AMIA), and one international organization, 

IMIA, have councils, work groups, or special interest 

groups that represent NI. In addition, there are several 

regional or local special interest groups in NI. (See 

Appendix A) 

Research Program 

The final attribute required of specialties is a defined 

research program. The National Center for Nursing 

Research (NCNR), now the National Institute for 

Nursing Research (NINR), released a 1992-1996 

national nursing research agenda for NI.

40 The report 

was developed by a panel of experts in NI. Their 

recommended priorities are as follows: 

1. Using data, information, and knowledge to 

deliver and manage patient care. 

2. Defining and describing data and information for 

patient care. 

3. Acquiring and delivering knowledge from and for 

patient care. 

4. Investigating new technologies to create tools for 

patient care. 

5. Applying patient care ergonomics to the patientnurse-machine interaction. 

6. Integrating systems for better patient care. 

7. Evaluating the effects of nursing information 

systems. 

The report noted that most of the recommendations will 

be impacted by the development of nursing language. 

Although the research agenda was defined, moneys for 

conducting NI research are difficult to obtain. 

Informatics researchers successful in obtaining funding 

generally have linked projects to clinical priorities. 

Some informatics researchers have questioned whether 

grant reviewers fully appreciate the role of informatics 

as an infrastructure for addressing language and 

technology issues. Informatics researchers also question 

whether some of the delay in innovative and new 

technologies reaching health care is tied to the 

skepticism of the reviewers. 

National Advisory Council on Nurse Education and Practice 11 
SECTION NURSING INFORMATICS IN 

EDUCATION AND PRACTICE 

To define the state of NI in education and practice, an 

extensivereview was conducted of literaturepublished 

from 1990 to early 1997. The review focused on 

determining 1) the information and technology skills of 

nursing students,nursing faculty, and practicing nurses; 

2) the informatics education needs of students, faculty 

and practicing nurses; 3) the use of computers by 

students,faculty, and practicing nurses; and 4) the 

availabilityof computers and applications in education 

and practice. Literature was reviewed from many media, 

including written and electronic publications. 

A preliminary step was to informallypoll experts in NI 

to determine if there were sentinel documents or fugitive 

literaturethat should be reviewed. None were 

discovered. An electronic literature search for NI was 

undertaken on CINAHL, then repeated through Medline 

Express, as a cross-check. Attempts to increase the 

specificity and limit the search were unsuccessful. 

Surveys of schools of nursing and other relevant articles 

were found through Internet lists and on Web pages. 

Those articles were obtained, and their bibliographies 

were checked to locate any additional relevant articles. 

Nurse educators who were known to have conducted 

surveys were interviewed by telephone to obtain their 

Division of Nursing Informatics Funding 

findings. Finally, non-infonnatics specialty nursing 

journals, such as nursing administration or public health 

nursing, that have published articles on NI were 

scrutinized for relevant articles not located through other 

search mechanisms. 

Fewer than 300 articles published since 1990 were 

located through the electronic searches. Published 

research on the general topic of NI was more scarce. 

This result is not surprising sincemost NI literature is 

retrieved under specific topics of interest such as 

decision support,telecommunications, telemedicineor 

telehealth, and nursing language. Abstracts of articles 

indicated that only 38 reported research findings. Two 

informal, unpublished surveys were also located. The 

40 studies examined computer literacy, use, 

competencies, attitudes, or preferences of practicing 

nurses, nursing students, and faculty. 

Generally, samples were small, convenience samples of 

individuals within the institutionbeing surveyed,such as 

nursing students enrolled in a specific course at one 

point in time. Such articles seldomreported results of 

repeating the survey at a later time in the academic year 

or with a different sample. There seemed to be no 

attempt to replicate studies or to use instruments with 

established records of reliability or validity. In most 

cases, the instrument was developed for each study 

setting, 

The DN has recognized the importance of NI for a number of years, funding projects early in the development of the 

specialty. A summary of funded projects and initiatives is presented in Table 1.

1972 

1973 

DN funded Community Nursing Services of Philadelphia to develop a computerized record system 

for planning, administrating,and evaluating nursing services. 

DN and NLN sponsored a 3-day national conference to exchange and evaluate knowledge of 

computerized information systems for nursing and health care management. 

1974 

1975 

1977 

1984 

DN and NLN sponsored four regional conferences (Omaha, Boston, San Francisco, and Atlanta) to 

stimulate development of management information systems. 

DN funded Visiting Nurse Association (VNA) of Omaha to develop a patient problem classification 

scheme; this is one of five nursing vocabularies recognized by the ANA. 

DN funded VNA of Omaha to develop outcomes and an outcome classification scheme to be 

adapted for computerized information systems for public health nursing.24,41-42 

DN funded St. Louis University to expand a nursing management graduate program that included 

computer technology as an integral part of the program.43 

12 National Advisory Council on Nurse Education and Practice 
1987 

1988 

1990 

1991 

1991 

1992 

1994 

1994 

1995 

1996 

1996 

1997 

DN funded American Journal of Nursing (AJN) Company to develop, implement, and evaluate the 

effectiveness of interactive videodiscs (IVDs) on clinical decision making Three IVDs were 

developed: Nursing Care of the Elderly Patient with Chronic Obstructive Pulmonary Disease, 

Nursing Care of Elderly Patients with Acute Cardiac Disorders, and Ethical Dilemmas and Legal 

Issues in Care of the Elderly.44-48 

DN funded University of Maryland at Baltimore to start the Nation's first graduate program in NI; it 

was positioned within the nursing administration track.49 

DN funded University of Utah to start the second graduate program in NI; it was positioned within 

the clinical nursing track. 50 

DN funded University of Maryland at Baltimore to start a doctoral specialty in NI. 

51 

DN funded Rutgers University to revise the graduate community health nursing program to include 

NI.52 

Legislation eliminated the support of graduate programs in nursing administration thus eliminating 

support for NI programs. DN support for such programs was terminated. 

DN awarded a special projects grant to the AJN Company to develop a national information service 

to provide continuing education through an electronic network to nurses in medically underserved 

communitie.53 

DN supported 25 distance education grants: 9 Nursing Special Projects; 6 Advanced Nurse 

Education; 10 Nurse Practitioner and Nurse-Midwifery. 

DN awarded cooperative agreements to three regional nursing compacts to provide introductory NI 

continuing education for faculty at sites across the Nation. 

DN entered collaboration with the National Library of Medicine (NLM)to support NI fellows in 

developing expertise that can be applied to nursing education and practice. 

DN convened NNIWG to advise NACNEP on establishing a National Informatics Agenda for 

Nursing Education and Practice. 

Informatics Education Models 

In 1996, Lange conducted an informalsurvey to compile 

a list of schools offeringeducation in NI.54 The 

researcher talked with informatics colleagues, broadcast 

messages on a NI listserv, posted an announcement on 

the Web page of AMIA Nursing Informatics Work 

Group, and contacted faculty at schools of nursing either 

known or rumored to have informaticsprograms. Lange 

divided responses into three categories or models of NI 

education. Two additional categories were added to 

accommodate integrated models and continuing 

education models described in the literature. The 

listings are included to provide examplesof NI 

education models, not to provide an exhaustive list of 

programs. 

Category I GraduatePrograms with a 

Specialty Nursing Informatics Focus 

Two master's programs fit within this category; the 

University of Maryland and University of Utah 

programs. Implemented in 1988,Maryland's program 

prepares graduates to analyze information requirements 

for nursing, design system alternatives, manage 

information technology, identify and implement user 

training strategies, and evaluate effectivenessof clinical 

and management information systems in patient care? 

Courses are required in management, finance, and 

theories of organizations. The program uses an 

interdisciplinaryapproach to informatics,requiring NI 

students to take at least nine credits of information 

systems management courses with information 

majors. Suggestedcourses include systems analysis and 

design, databases, decision support systems, data 

security, project management, and networks. Informatics 

principles are then applied in nine credits of NI. 

Included in the NI courses are: 1) a field experience in 

National Advisory Council on Nurse Education and Practice 13
which students work with clients to identify system 

requirements or plan system implementation, and 2) a 

practicum experience in which students are assigned to 

work with NI specialists in health care agencies (acute 

care, long-term, or home health), consultingfirms, 

vendor corporations, or administrative offices setting 

informatics policies (e.g., ANA or Department of 

Defense). 

Utah’s program opened in 1990and prepares graduates 

to practice and conduct research in nursing and health 

care informatics. The program was placed within the 

Parent, Child, and Adult Nursing Division. Students 

need 26 quarter credits of specialty coursework in 

structured programming, analysis and design of clinical 

nursing and health care systems, database theory and 

design,design of decision support systems, and 

implementationof systems. Field experienceis included 

in each informatics course, and a practicum is included.50 

Together these two NI programs have prepared 

successfully over 100 informatics nurse specialistsfor 

the marketplace. To be successful, master’s programs in 

NI should meet the following guidelines: 

1.Build on nursing science coursework 

2. Use interdisciplinarycoursework to build 

informatics and technology competencies 

3. Have available state-of-the-arttechnology 

4. Provide adequate faculty and technology support, 

and 

5. Have available a variety of settingsfor practicum 

experiences. 

The supply of graduates produced by these two 

programs, however, is inadequateto meet the demand 

for specialists in NI. Because of the need for informatics 

nurses, graduates of the two programs have multiple 

opportunities for employment. 

Category 2 Models: Graduate and Undergraduate 

Programs and Courses in Nursing Informatics: 

Concentrations and Minors 

Lange found six programs that offer a concentration or 

minor in informatics.54 Case Western Reserve 

University implemented a program that offers four NI 

courses (totaling seven credits) to prepare undergraduate 

baccalaureate students to be sophisticated users of 

information and information technology. The courses 

are spread out over 3 years and focus on the content, 

flow, and processing of patient information;information 

and the clinical care process; use of information 

technologies; and hands-on experiencein NI.

55 

Since January 1997,Duke University School of Nursing 

has offered a NI option within the nursing 

administration program. Graduate students take between 

8 and 14credit hours of informaticscourses. The 

program includes a post-master’s certificate option for 

nurses who have earned an MSN. The unique feature of 

Duke’s program is that courses are designed for distance 

learners who are able to commute to Duke on a limited 

basis and take the rest of the classes through a virtual 

classroom experience.54 

Saint Louis University, University of Iowa, and 

University of Arizona offer programs that allow 

graduate students to select an informaticsoption within 

their nursing administration programs. The Iowa 

program allows students to take elective courses from 

the departments of management and organizations, 

management sciences, hospital and health 

administration, computer science, and library and 

information science.Lawless56 describes Northeastern 

University’s program that includes three NI courses 

required as part of the nursing administration program. 

Category 3Models: Individual Courses in Nursing


Informatics Within


Programs


While much attention has been focused on potential uses 

of information technology, schools of nursing have been

slow to include informatics in their curricula. Carty and

Rosenfeld57found that less than half of 190accredited

schools of nursing reported the availability of

informatics education either through integrated or

freestandingcourses offered as part of the curriculum.

Lange compiled information about several graduate

programs that offer courses in informatics.54 The list 

has been expanded to include information about 

graduate and undergraduate NI courses found in the

literature. To help students understand the nature of

courses offered, developers need to differentiate

between offerings that focus only on computer literacy

and those that teach additional informatics concepts.

Currently the NI title is used for both types of courses.

Examples of entries follow.

School:Lewis University, Collegeof Nursing

CourseTitle: GraduateProgram in Nursing Applications

in Multimedia.

Description: The course introduces the use of

computerizedmultimedia presentationsfor advanced

practice nurses.

Intended Audience: Graduate students

School: Loyola University at Chicago

Course Title: Introduction to Information Systems for

Health Care Management.

Description: The course presents an overview of

14 National Advisory Council on Nurse Education and Practice 
information systems and related concepts in a hands-on

format. Emphasis is on evaluation,analysis, and use of

clinical, administrative,financial, home health, and

integrated information systems. The roles of the

computer-based patient record, standydized nursing

languages, and electronic networks in health care are

also discussed. 

Intended Audience: RN to MS students

School:Oregon Health SciencesUniversity

Course Title: Information Management and

Technologies.

Description:Thecourseisofferedwithinthecommunity

nursingmaster’sprogramandprovidesaintroductiontoNI.

Intended Audience: Master’s students

School: University of North Carolina - Chapel Hill

Course Title: Health Care Informatics.

Description; The course focuses on developing an

understanding of concepts relevant to health care

informatics and the use of computerized information

systems in health care organizations.

Intended Audience: Graduate students

School: Georgia College and State University

Course Title: Health ScienceInformatics.

Description: The course is an overview of health science

informatics and the skills needed to access information. 

The focus is the use of computer and technology based

health applications.

Intended Audience: Undergraduate and graduate

students

School:Wichita State University, College of Health

Professions, School of Nursing

Course Title: Health Care Information Systems. 

Description: The Internet-based course examines

information systems as they relate to health care;

analyzes information systems in clinical management,

administration, education and research; and emphasizes

issues surroundinginformation systems. 

Intended audience: Graduate students

School: Hunter College,Hunter-Bellevue School of

Nursing

Course Title: Nursing Informatics. 

Description: The course emphasizes the integration and

use of computer/information technology. Class 

experiences include mastering of basic computer

competencies, evaluating trends in electronic

information processing, and establishingconnections

through electronic networks.58

Intended audience: Graduate students

Category 4 Models: Nursing Informatics Integrated 

into the Curriculum 

Some schools have elected to integrate computer

competency and informatics concepts into the 

curriculum rather than offeringseparate courses. 

School: Saint Louis University

Graduate students in administration use information

technologies as they develop their skills in forecasting

and budgeting (spreadsheets),managingprojects

(projectmanagement software), presenting (presentation

graphics), manipulating databases, and negotiating (idea 

generation software).43

School:Rutgers University, College of Nursing

Revised its graduate community health nursing 

curriculum to include NI. A 2-day orientation workshop

prepares incoming students to use computer technology. 

Informatics concepts and experiences are incorporated

into subsequent courses.52

School: Miami University, Department of Nursing

Integrated information technology into the

undergraduate curriculum. The focus is on preparing

studentsto use technology devices.59

Category 5 Models: Continuing Education and 

Professional Development in Nursing Informatics 

The mainstay of education for nurses in informatics has

been continuing education through workshops,

conferences,institutes,fellowships,and literature selfstudy. Programs in this category range from traditional

2- or 3-day conferencesto intensive fellowships lasting

up to 3 years. All are focused on NI.

Workshops or Conferences:

For 15 years Rutgers University, College of Nursing, has

offered an international NI conference. The conference

is held in the spring and has focused primarily on

educational application of NI.

For many years New York University Medical Center 

held a spring NI conferenceunder the direction of Patsy

Marr. In 1996NYU’s nursing education department

partnered with the Medical Center to present the

conference.

Numerous informatics programs are available through 

informatics professional organizations. Each year

AMIA holds spring and fall congresses that focus on

informatics issues. Every three years IMIA presents 

MedInfo, an international conference that rotates to

different countries. In 1998MedInfo will be held in

South Korea. IMIA’s NI Special Interest Group

National Advisory Council on Nurse Education and Practice 15
sponsors an international conference every third year. 

The 1997 meeting was held in Sweden; the 2000 

meeting will be in New Zealand. One of the largest 

conferences in terms of attendance is presented each 

year in February by the Healthcare Information 

Management Systems Society (HIMSS). It rotates to 

differentparts of the United States each year. 

A few nursing organizations have added informatics 

continuing education to their programs. The NLN’s 

Council on Nursing Informatics holds a conference each 

year. The ANA included informatics in general 

education sessionsfor the first time at the 1996biennial 

meeting. 

Even though an increasing number of conferewes and 

workshops in informatics are available to help nurses 

learn about NI and technology issues, nurses continually 

expressthe need for more accessible educational 

programs to help them perform better within the field of 

informatics. 

Institutes and Fellowships: 

Institutes and fellowships are designed to provide an 

intensive learning experience for participants. A 

summer institute in NI has been held every July since 

1991 at the University of Maryland at Baltimore, School 

of Nursing.60 The institute has attracted international 

nurses and other health care providers who practice in 

informatics. Using a faculty of informatics experts, 

participants have received information about basic 

processes such as system selection and implementation, 

informatics issues, and future trends in informatics. 

Hands-on opportunity to interface with information 

technologies has been provided. To maximize 

opportunity for networking with faculty, host site staff, 

and other participants, the enrollment has been limited to 

100. The institute is completely subscribedeach year, 

indicating the interest in continuing of this 

kind. 

Another model of an informatics institute is the HBO 

Scholars Program held from 1989-1995. A healthcare 

information systems vendor, HBO and Company, 

partnered with the University of Coloradoand the State 

University of New York at Buffalo to provide a unique 

opportunity for nurse educators to learn about 

informatics.61 Through a competitive process, a small 

number of scholars were brought to HBO’s corporate 

headquarters each spring for an intensive 1-week 

emersion in informatics. A faculty of NI experts helped 

the HBO scholars learn informatics concepts they could 

share with the nursing community of students, faculty, 

practitioners,and administrators. This cadre of scholars 

(about 75 nurse educators)has impacted NI 

tremendously through its subsequentresearch and 

education efforts. 

Since 1993,the MassachusettsGeneral Hospital, and 

now its parent Partners Healthcare Corporation, has 

sponsored a NI fellow. The competitive 1-year 

fellowship is open to nurses who have completed a 

graduateinformatics program of study. The intent is to 

provide a rich informatics environment where fellows 

can begin informatics practice with guidance available as 

needed. The fellowshiphas been very successful in 

launching NI specialists on their career trajectories. 

Informatics fellowshipsare also available to nurses 

through the NLM Medical InformaticsFellowship 

Program. Post-master’sand post-doctoral informatics 

fellowship programs accept both nurse and physician 

applicants. 

StudentPreparation in Nursing Informatics 

More than 10years ago, Ronald and Skiba wrote 

Guidelinesfor Basic Computer Education in Nursing.62 

The publication offered very helpful information about 

the purchase of computers and adding computer 

education to nursing curricula. Even though information 

was available, many nursing educators pay little, if any, 

attention to students’computerskills and their ability to 

use information technologies in practice. More recently, 

Division of Nursing staff explored the literature to 

confirm the availability of computers to students. 

Rossel63conducted a national survey of baccalaureate 

nursing computer labs in 1994, focusing on the 

administration, funding, and use of those labs. The 

sample of 297 baccalaureate schools (62 percent 

responded) was included in the State-Approved Schools 

of Nursing listing from NLN. Respondents were 

divided into four regions, Northeast (60 percent), 

northern Midwest (64 percent), southern Midwest (58 

percent), and Western plus Alaska and Hawaii (62 

percent). Rossel found that almost all schools have 

access to computers, printers, and library searches. The 

researcher concluded that connecting to a network for 

Internet and Web access is more likely in large schools, 

public schools, and the Western region. In this study, 

grant funds provided half of the computer hardware and 

one-third of all the software available in the schools. 

In 1997,Carty and Rosenfeld57 reported on the extent of 

NI in nursing curricula and how students are being 

prepared in the area of informatics. The sample 

consisted of 190of the 347(55 percent) NLN approved 

diploma, associate, and baccalaureate schools of nursing. 

Many of Rossel’s findings were confirmed by Carty and 

16 National Advisory Council on Nurse Education and Practice 
Rosenfeld. In assessing the availability of computer 

technology, the researchers found that computers are 

available to students in more than 97 percent of schools 

responding. Further technology analysis shows nearly 

68 percent of the schools have Internet access, 56 

percent of schools have Web access, 51percent have a 

local area network, and 20 percent have distance 

learning access. 

Examining the technology infrastructureof schools of 

nursing in terms of allocation of technology personnel 

and financial resources, as well as the existenceof a 

network manager and a technology planning committee 

produced quite different results. Half of the schools 

allocated no moneys for the technology infrastructure. 

Those that did have allocated resources depended mainly 

on grants and institutionsfor funding. Fifty percent of 

schools with technology budgets allocated $7,000 or less 

per year. The most common amount allocated was 

$1,000. The limited funding for information technology 

raisesthe question if nursing students receive adequate 

support to use the technology effectively. With such 

small budgets, upgrading hardware and softwareto 

accommodate changes in technology is a problem in 

schools of nursing. 

Carty and Rosenfeld were also interested in the 

availability of NI education in the surveyed schools. In 

their sample only 38 percent of nursing schoolshave 

included M in the curriculum. Fifty-one (28 percent) 

programs indicated they had integrated NI into the 

curriculum. Another 19schools(10percent)said they 

have specific NI courses. The researchers concluded that 

NI needs to be recognized as essential to the curriculum. 

Johnson64 examined curriculartrends in nursing 

programs to determine the presence or absence of 

current health care emphases, and of essential nursing 

knowledge and skills in nursing curricula. The sample 

for the study was 113 NLN accredited generic 

baccalaureate programs (61 percent responded). Current 

health care emphases were: computerization, critical 

care, geriatric health care, economics, health 

maintenance, home health care, legal issues, long-term 

health care, and rehabilitativehealth care. Respondents 

represented 22-24 percent of baccalaureate programs 

accredited by the NLN between 1986and 1990in each 

of four regiohs. Johnson looked at computer literacy, a 

skillrequired before more sophisticatedactivities of NI 

can be performed and found that computer literacy was 

the only health care emphasis the majority of 

respondents did not address through a required course. 

Thirty-nine percent of schoolsin the study addressed 

computer literacy by a specific course or program 

objectives,and 27 percent integrated computer literacy 

in one or more courses. About 27 percent also reported 

that computer literacy was addressed in an elective 

course outside of the nursing school or through an 

entrance requirement. Johnson states that since computer 

literacy is not required, it is not yet considered an 

important element for nursing curricula. 

Faculty do not always use the term computer literacy to 

mean the same set of skills. Bryson65investigatedthe 

perceptions of nursing educators concerning the amount 

and kinds of computer education that would make 

students computer literate. A panel of two computer 

educators, one software developer,and nine nursing 

educators used the seven domains of computer literacy 

defined by the Minnesota Educational Computer 

Consortiumto identify instructional objectivesthat 

delineate computer literacy forstudents completing2- or 

4-year nursing programs. To validate the objectives, a 

questionnaire was administered to 87 faculty from 2-year 

programs and 93 faculty from 4-year programs. From 

the NLN list of state-approved nursing programs 

published in 1987, faculty were randomly chosen to 

participatein the survey. Of the 74 objectivespresented, 

57 received scores of 3.5 or greater on a 5-point Likert 

scale and were retained to identify computer literacy. As 

a result of Bryson's study, a computer literate nurse is 

defined as one who has knowledge about computers,is 

able to learn by using computers, and is able to use the 

computer as an effective tool in nursing. Bryson 

observed that only 20 percent of the nursing schools 

represented by study subjects require a computer course. 

Educators have speculated that with the increased use of 

technology throughout primary and secondary education, 

nursing schools would not have to be concerned about 

the computer skills of incoming students. Data are 

needed to either confirmor refute that thinking. Birx, 

Castleberry,and Perry66report a study that included selfreported measures of computer skills. Laptop 

computers were issued to 20 senior nursing students for 

transmitting weekly assignments to faculty. To evaluate 

their own computer skills, the students also completed 

three check lists. Students who used the Iaptops 

showed significantimprovement in computer skills 

related to e-mail, word processing, and computerized 

library database searchingskills. The level of computer 

literacy of these students at the start of the study is not 

indicated, only that their self-reported skills improved by 

using the laptop computers. 

Jacobs and dela Cruz67determined the informatics 

curriculum needs of graduate nursing students. The 

study actually looked at the computer literacy of 67 

studentsin one school of nursing(74 percent 

responded). Eighty-two percent of the students had 

word processing experience,but half of these were at the 

beginning level. Other skills were as follows: 24 percent 

National Advisory Council on Nurse Education and Practice 17 
had used spreadsheets,21 percent had used learning 

modules, 3 percent had used computers for decision 

analysis, 33 percent had performed statistical analysis, 

and 30 percent had done a literature search using a 

database. Most of the students had access to a computer 

either at home, at work, or at school. 

Two unpublished studies give additional information 

about computer literacy, but reach different conclusions. 

Saba68 has administered an 8-itemcomputerliteracy 

survey to incoming undergraduate and graduate nursing 

studentsfor the past 10years. Computer literacy is 

defined by this researcher as the ability to use a 

keyboard to prepare a paper, conduct a literature search, 

send e-mail, access the Internet, and operate computerassisted instruction (CAI)programs. Scoring for the 

survey is unclear. Saba reports the computer literacy 

rate increased from 20 percent in 1986to 99.9 percent in 

1996. In the second unpublished study, results were not 

as encouraging. Gassert and McDowel

69 administered a 

survey instrument consisting of 15 items with a 4-point 

Likert scale to determine students’ perception of their 

ability to use computers and software. Factor analysis of 

the survey items identified three factors: connectivity, 

applications, and hardware. A total of 394 students, 

most of themjuniors, completed the survey in 1994and 

1995. The modal age of students was 20 years. Sixty 

percent of the students owned a computer, and 60 

percent had some computer instruction. Surprisingly, 

when looking at connectivity,over half of the students 

had never used e-mail or the Internet and over 80 percent 

had never accessed the Web. Scores were also low for 

the applications factor. More than 50 percent of 

studentshad no experiencewith databases, spreadsheets, 

presentation graphics, bibliographic databases, or 

statistical software. Students scored higher on the 

hardware factor. Mean scores for keyboard skills and 

word processing indicated students had moderate skills 

in this area. These data indicate that students know how 

to word process, but cannot use other applications to 

access, process, and transmit data using the NII. The 

researchers concluded that faculty needed to continue 

teaching computer literacy to nursing students. 

In summary, many nursing students have access to 

computers, but have limited or no ability to use them 

except for word processing. The level of computer 

literacy is dependent on how it is defined. To identify 

computer education needs, more schools of nursing must 

evaluate the computer literacy of incoming students by 

means of valid and reliable instruments. 

Faculty Preparationin Nursing Informatics 

There is a need to know if faculty are prepared 

adequately to use information technology so they can 

teach students to use computers. In 1994the Southern 

Council on CollegiateEducation for Nursing (SCCEN) 

surveyed institutionsin the southern States to determine 

how nurse educators were using educational 

technologies.70 Surveys were sent to 440 institutions and 

174responded (40percent). Sixty-six percent of 

responding schools had access to the Internet, but 

interestingly,33 percent of those said that less than five 

faculty members had access. Information access through 

bibliographic databases showed more favorable results. 

On-line library catalogs were accessible to 77 percent of 

schools, and 48 percent said off-campus users could 

accessthe electronic catalog. The survey also asked 

about the availability of continuingeducation to help 

faculty incorporate information technology into the 

curriculum. Sixty-five percent of responding schools 

offer orientation to technology, but most often by 

individual troubleshootingrather than through organized 

training or workshops. 

In the SCCEN survey, many respondents indicated their 

interest in distance learning activities: 81 percent of 

schools receive or are planning to receive educational 

programs; 70 percent deliver or plan to deliver 

educational programs to off-campus sites; and 36 

percent produce educationalprogramsto be delivered by 

this technology. Of the responding schools, 85 percent 

plan to offer distance education by technology in the 

future; but only 47 percent of the schools stated interest 

in working through a consortiumto share educational 

offerings. 

In 1996,another interestingsurvey identified the NI 

educational needs of faculty and practicing informatics 

nurses, and the computer applicationsthey used.” A 

total of 497 nurses who were on a computer conference 

list responded to the survey (33 percent). More than half 

of the respondents were prepared at the master’s level. 

The sample was composed of 172informatics nurses, 

140nurse educators, and 131 nurse managers. Fiftyfour responses could not be used. Access to computers 

was no problem for this sample; more than 80 percent 

had computer access at home and more than 90 percent 

had access at work. Softwareusage for the sample was 

as follows: word processing, 73 percent; e-mail 50 

percent; database,spreadsheetand hospital information 

systems, 40 percent; presentation graphics, 38 percent; 

and Internet, 29 percent. 

Arnold asked participants if they were interested in 

obtainingformal NI education. More than 80percent of 

informatics nurses were interested in certification, and 70 

percent were interested in an informatics degree. Nurse 

managers were also quite interested in informatics 

education. About 80percent were interestedin certificate 

education, and more than 60 percent expressedinterestin 

18 National Advisory Council on Nurse Education and Practice 
an informatics degree. In this survey nurse educators 

were less interested in informatics education. Sixty 

percent of nurse educators wanted a certificate in 

informatics, and only 40 percent expressed interest in an 

informatics degree. Acquiring nurse faculty prepared in 

informatics has been difficult, so a lower interest in 

obtaining informatics knowledge is of concern. 

Arnold examined the desired knowledge related to 

informatics content areas and again found differences 

among the three groups of respondents. Informatics 

nurses chose decision support, advanced informatics 

knowledge, and integration of NI as their first three 

priorities. Nurse managers wanted knowledge of 

graphical presentations, clinical data analysis, and 

electronic communication. Nurse educators also chose 

graphical presentation as a first priority, but selected 

computer assisted instruction critique, and decision 

support as their next two preferences. The researcher 

concluded that informatics nurses had more differences 

than similarities with the other two groups in terms of 

desired knowledge of informatics content. Findings of 

the study support the need for specialized courses, 

certificate programs, and degree programs in NI. 

Practicing Clinicians’ Preparation in Nursing 

Informatics 

The number of nurses prepared to work in the specialty 

of informatics is unknown. Nurses hired to fill 

informatics positions in health care agencies use many 

different titles and are placed within administration, 

nursing, or information system departments. Berends

72 

found that 39 informatics nurses reported 34 different 

job titles. The informaticsjobs could be classified into 

eight categories. Carty73 likewise found that the titles of 

89 informatics nurses fell within 10 different informatics 

job categories. A majority of respondents in Carty’s 

sample worked in hospitals (63 percent). Another 10 

percent worked in community agencies, home health 

agencies, or schools of nursing. Although not included 

as respondents in Carty’s study, informatics nurses 

employed by software vendors and consulting firms 

work in a variety of positions and are often assigned 

different titles for jobs having similar responsibilities. 

The variety of settings,job titles, and categories speaks 

to the diversity of informatics nurses’ roles, but makes it 

very difficult to determine the number of nurses actually 

employed in the field. 

What is known is that most informatics nurses have 

prepared themselves to work in the field through job 

experiences, continuing education, and self-study.74 In a 

1993 study of role activities of informatics nurses, 

Berends found that 53 percent of 43 informatics nurses 

had master’s degrees, but only 2 percent of these were in 

NI.72 Twenty-one percent had master’s degrees from 

specialties other than nursing. In 1994, Carty reported 

similar data for a sample of 97 nursing information 

specialists from 37 states and Canada who also 

demonstrated diverse entry routes into NI.73 Although 

63 percent of Carty’s sample had master’s degrees, only 

6 percent held a master’s degree in NI and 19 percent 

had master’s degrees from specialties other than nursing, 

including management, business, and computer science. 

Carty concluded that the diversity in educational 

specialization for informatics nurses emphasizes the 

scarcity of formal graduate courses in NI. Carty lists the 

University of Maryland and the University of Utah as 

the only two graduate programs awarding master’s 

degrees in NI. Both of these programs received initial 

funding from the Division of Nursing (see Table 1). 

Only a few studies reported on the informatics 

preparation of practicing nurse clinicians. Staggers75 

included a measure of computer experience (computer 

use and knowledge) in a larger study of the effect of 

screen density on detecting critical on-line information. 

The study sample of 110clinical nurses from 145 

randomly selected nurses (76 percent response rate) in a 

large eastern academic health center completed the 

Staggers Nursing Computer Experience Questionnaire 

(NCEQ).76 The NCEQ is comprised of 4 subscales: 

overall computer use, overall computer knowledge, role 

participation, and role knowledge; it has a possible score 

of 292. The mean score for the NCEQ for this sample 

was 29.27. The mean subscale score for computer use 

was 14.56 (of a possible 128) and the mean subscale 

score for computer knowledge was 12.79 (of a possible 

124). A hospital-wide information system was not in 

place in the study setting. The study findings have 

tremendous implications for educating clinical nurses to 

use information systems. 

In an earlier study,Burkes77examined the satisfaction, 

motivation, and beliefs of 52 ICU staff nurses related to 

computer use in an environment that had computerized 

nursing programs in place since 1982. Computer 

experience was measured as one of the nursing 

characteristics and was recorded as length of time using 

computers. Forty-two percent of the sample had used 

computers more than 2 years, 32 percent had used 

computers 1 to 2 years, and 25 percent had used 

computers less than 1 year. At the same time 85 percent 

of the ICU nurses had worked as a nurse for 4 or more 

years. The data indicate that the ICU nurses had worked 

much of their careers without using computers. This is 

not surprising, given the fairly recent interest in 

installing information systems in acute care 

environments. In Burkes’ study, computer knowledge 

scores were almost equally distributed in five categories 

from very low to very high. Interestingly, length of 

National Advisory Council on Nurse Education and Practice 19
computer experienceand nursing experience related 

negatively to nurses’ computer-use satisfaction. More 

computer experience was expected to correlate 

positively with satisfaction. Burkes states the finding 

may indicate the nurses were able to critically evaluate 

existing computer programs and were dissatisfied with 

their inadequacies. This view is supported by findings 

that increased computer knowledge correlated positively 

with beliefs. The researcher postulates that knowing 

more about computers motivates nurses to use 

computerized nursing programs. Findings from this 

study also imply a need to educate nurses about 

computers prior to system implementation. 

Computer use was included as a variable by Patterson 

and collegues78 when they investigated the information 

exchange required for continuity of care across patient 

units. The researchers assessed the information 

exchange problems and preferencesof staff RNs, as well 

as their database needs, when faced with 3,750patient 

transfers a month between 21 different nursing units. A 

sample of 197 staff nurses in all 21 clinical units 

participated in the survey (responserate 45 percent). 

Methodsfor receivinginformation about incoming 

patients were studied. Results show the telephone was 

used by 82percent of nurses, the medical record was 

used by 81percent, an interunit transfer form was used 

by 64 percent of nurses, and the medical center computer 

was used by 55percent of the nurses. Nearly half of the 

nurses preferred the telephone for receiving information, 

while only 10percent preferred the computer. When 

asked whether computer use would improve conveyance 

and timeliness of clinical information exchanges, 56 

percent of the nurses thought it would improve care 

continuity. Thirty-fivepercent also said that if data 

entry were simple,they would use the computerto report 

patient transfers in the future. Since it was not the focus 

of the study, the ability of clinical nurses to use 

computers was not addressed. 

Summary 

In summary, several implications can be drawn from the 

studies reviewed. First, the nursing culture needs to be 

changed to promote acceptanceand use of computer 

technologie as basic tools for information management 

and exchange by nurses. Second, technology is 

available in the schools of nursing that have been 

studied; however, infrastructuresupport in terms of 

personnel,planning, and budgeting is often not present. 

Technology that is available in many schools is not fully 

utilized. Third, information technology needs to 

facilitate, not hinder information exchange; therefore, 

informatics nurses who understand nursing, information, 

and information technology need to be included in the 

design and development of systems that work for nurses 

as well as other care providers. Fourth, more NI 

educational programs are needed. There are needs for 

computer education courses, informatics courses, and 

specialty informatics programs to prepare nurses as 

specialists in informatics. Fifth, practicing nurses are 

not necessarily computer competent. They need 

increased educational opportunities through continuing 

education programs so they are ready to interface with 

information technology in their work environments. 

20 National Advisory Council on Nurse Education and Practice 
SECTION III: NATIONAL NURSING 

INFORMATICSWORK GROUP 

Descriptionof Members 

In January 1997,NNIWG was convened to make 

recommendationsto NACNEP in setting the Nation's 

informatics agenda for nursing education and practice. 

NNIWG identified and prioritized informatics needs and 

initiatives that will prepare the nursing workforce to use 

information technology and apply informatics concepts 

to manage patient care information. 

The 19members comprising NNIWG (see AppendixB) 

are recognized for their outstandingcontributions to NI 

in a variety of work settings. Six members work in 

patient care settings,two in commercialbusiness, three 

in government service, and nine in nursing education. In 

addition,one is a nurse practitioner and one is not a 

nurse, thus broadening the panel's health care and 

informatics perspectives. Members are recognized for 

their expertise in one or more of six keys areas of 

informatics practice and education. The distribution of 

expertiseof the panel is as follows: 

1. Decision support 3 members 

2. Distance education 3 members 

3.Informaticseducatiordcompetencies 3members 

4. Information systems 6 members 

5. Language and taxonomies 5 members 

6. Telecommunications 4 members 

Contextfor Identifying Informatics Needs and 

Initiatives 

To provide adequate governmentalcontextfor setting 

the NI agenda, the NNIWG members were briefed on 

the mission, authorization,and strategicdirectionsof the 

DN and the national priorities of the Health Resources 

and ServicesAdministration (HRSA). The DNs critical 

foci are: (a) enhancingnursing's contribution to primary 

health care and public health; (b) developing and 

promoting innovative practice models for improved and 

expanded nursing services; (c) enhancing racial and 

ethnic diversity and cultural competency in the nursing 

workforce; (d) promoting improved and expanded 

linkages between education and practice; (e) improving 

and expanding nursing services to high-risk and 

underserved populations; (f) enhancing nursing's 

contributionsto achieving the Healthy People 2000 

objectives and health systems change; and (g) capacitybuilding for meeting the nursing service needs of the 

nation. 

HRSA has identified eight priorities that will help put 

primary health care providers and servicesin places they 

are needed most. The four priorities most pertinent for 

informatics are: (a) forming academic and community 

partnerships to move clinical education into 

neighborhood sites and to empower communities to meet 

their unique health care needs; (b) using advanced 

information technology systems, such as telemedicine, to 

solve servicedelivery problems; (c) building state and 

community relationships to better serve populations; and 

(d) safeguardingadolescent health by providing primary 

care to children and teenagers. 

Five NNIWG panel members presented position papers 

that challenged their colleagues to consider the current 

status, future directions, major issues, and the barriers to 

reaching full use of specific informatics languages and 

technologies. Topics presented were cutting edge 

information technologies, telecommunications, distance 

learning, data sets, and information systems. Data from 

the literatureon faculty's informatics needs, students' 

computer competencies, and availability of computers in 

public health settings were presented to review further 

the status of NI. The final phase of sharing information 

with NNIWG members was to present an update on 

informatics projects funded by the DN. 

Method for Identifying Informatics Needs and 

Initiatives 

Nominal group technique, a group process method, was 

used to assist members in identifyingand prioritizing 

informatics needs. First, NNIWG members were 

randomly assigned to one of two subgroups. Subgroup 

facilitatorshelped participantscomplete their assigned 

tasks within the designated time period. Second, 

subgroup members in turn each stated one NI need that 

was recorded without discussion. Rounds continued 

until members had no further ideas to list or time had 

expired. Third, ideas were explored through discussion 

in the subgroups;and items were expanded, combined, 

rephrased, or eliminated with consent of the originatorof 

that idea. Fourth, subgroup members prioritized the 

needs by placing one of five colored dots that 

represented a weighted value from 5 (firstpriority) to 1 

(fifth priority) beside each chosen item. This process 

allowed overall scores to be determined for each item on 

the list, thus prioritizingthe items. 

Nursing InformaticsNeeds 

In identifying NI needs, NNIWGmembers agreed on 

five assumptions foundational to all further discussion of 

informatics: 

1) Learners are students, faculty, and clinicians. 

2) Nursing informatics must be considered within 

an interdisciplinary context of partnerships and 

collaboration. 

3) Efforts should target disadvantaged and 

National Advisory Council on Nurse Education and Practice 21
underserved populations. 

4) Initiatives should be responsive to other 

government funding priorities. 

5) Collaboration among Federal agencies and 

between Federal and private entities is necessary. 

Based on identified assumptions,informatics expertise, 

and information presented, the subgroups named a total 

of 81 informatics needs for nursing education and 

practice. Group One initially listed 48 informatics 

needs. After discussion its list was reduced to 21 items. 

In prioritizing the items, only 8 of the 21 needs received 

a score. Group Two initially identified 33 informatics 

needs. Following discussion its list was reduced to 15 

items. As Group Two members prioritized their needs, 

13of the 15 itemsreceived votes. 

Eight focal areas of NI needs emerged from the two lists. 

1) Education and curriculum 

a) Identify and incorporate informatics skills 

and competencies for all levels of education 

(basic, graduate, post-graduate, continuing 

education, and informatics specialization). 

b) Teach information seeking and evaluation 

behaviors that consider age, learning styles, and 

motivation. 

c) Integrate nursing science with NI education 

and practice to encourage innovations in 

nursing practice. 

2) Demonstration projects for telenursing, patient 

education in the community, patient-specific clinical 

decision support systems, virtual courses, and 

consumer education about the nurse as a broker of 

information. 

3) Development of models of nurse-patient 

encounters using technology including shared 

decision-making, consumer health 

acquisition,multiproviders, and optimal ways to 

interact with systems. 

4) Preparation of faculty in informatics including 

Internet skills, effective distance education schemes, 

and benchmarking strategies for technology 

education. 

5) Collaboration on informatics initiatives with 

partnerships 

a) Collaborate at Federal, academic,industry, 

and community levels. 

b) Form partnerships among these groups. 

c) Develop technology supported models of 

community development to identify new roles 

and to maximize use of technologies. 

6) Integration of nursing informatics into practice 

a) Include informatics in nurse-managed 

clinics. 

b) Link nurse-managedclinics and practices. 

c) Identify barriers to using technology. 

7)Additional informatics programs 

a) Develop innovativeprograms that share 

expertise and resources. 

b) Link regions to deliver informatics 

education. 

8) Interdisciplinaryfocus in informatics 

a) Determine if informatics can be used as a 

model for interdisciplinaryeducation. 

b) Develop interdisciplinary partnerships within 

universities and colleges to support informatics 

research and development. 

Proposed Nursing Informatics Initiatives 

The second phase of the NNIWG project was to produce

informatics initiativesfor nursing education and practice 

from the prioritized needs. Seven NI initiatives and

actions were identified by Group One. Members of this

group considered the need for an interdisciplinaryfocus

in informatics to be one of the assumptions and did not

develop a separate initiative for it. Using broader 

language, Group Two members wrote four general NI

initiatives. Each of these initiativeslinked to several of

their prioritized needs. In a final session, all 11

initiatives were presented and clarified. Two sets of

initiativeswere combined, leaving nine initiativesto be

prioritized by assigning weighted values to them.

The nine initiatives developed by NNIWG addressed the 

following topics in descending order of

priority:

1) Core informatics education 

2) Advanced informatics preparation 

3) Demonstration projects 

4) Enhancement of clinical practice 

5) Faculty preparation 

6) Enhancement of community partnerships 

7) Collaborative initiatives 

8) Competencies for practicing nurses 

9) Interdisciplinary academic-industrypartnerships 

Results of the prioritization were distributed to NNIWG 

members for feedback and comments. Based on input 

received, two additional sets of initiatives were 

combined and items were reworded. A list of five 

initiatives were submitted by the NNIWG to the 

NACNEP. 

NACNEP reviewed the initiativesin April 1997 and 

approved them with minor changes. The National 

Agenda for Informatics in Nursing Education and 

Practice is presented in Section IV. 

22 National Advisory Council on Nurse Education and Practice 
SECTION IV: POLICY, ISSUES, GOALS, 

AND OPTIONS 

The National Advisory Council on Nurse Education and 

Practice accepts the assumptions and initiatives 

proposed byNNIWG and recommends five informatics 

goals for nursing education and practice to the Secretary 

of Health and Human Services. 

Educate Nursing Students and Practicing Nurses in 

Core Informatics Content 

Issue: The first priority in educatingthe nursing 

workforce is to include basic informatics skills and 

content in undergraduate, graduate, and continuing 

education nursing programs. Basic computing skills 

include the ability to use word processing, E-mail, 

spreadsheets,databases, bibliographic retrieval, the 

Internet,World Wide Web, and presentation graphics 

software. In addition, all nurses need to be competentin 

collecting and recording data, analyzing and interpreting 

information needed for patient care, using clinical 

information systems, and in implementing policies 

related to privacy, confidentiality,and security of 

information? Informaticscontentsuch as decisionmaking, information management, standard 

nomenclatures for nursing’s language, and informatics 

roles should be integrated in nursing curricula. This 

knowledge will prepare nurses more adequately to 

collect and process health care information to make 

appropriate clinical and administrative decisions. 

Curricula content must reflect emerging information 

technologies. 

Policy Goal: Federal resources should promote the 

inclusion of core informatics skills and knowledge 

leading to competency in nursing undergraduate, 

graduate, and continuingeducation programs. 

Policy Options: 

1) Provide funds to develop models to identify core 

informatics competencies, including those for 

emerging technologies. 

2) Provide funds to disseminateinformation 

regarding core informatics knowledge and 

competencies appropriatefor different levels of 

education through model curricula, identification of 

centers of excellencein informatics,and 

establishment of a clearinghouse. 

3) Supportstrategiesto create demand for including 

core informatics content in nursing education and 

practice. 

4) Fund creativecontinuingeducation models, 

including partnerships among academia, corporations, 

and professional organizations, to provide core 

informatics content to practicing nurses. 

5) Support employers in rewarding nurses for 

attending NI educationalprograms. 

Prepare Nurses with Specialized Skills in Informatics 

Issue: The number of post-baccalaureateand postmaster’s certificate, master’s and doctoral educational 

programs that prepare nurses with specialized 

informatics skills is limited. Most nurses who practice 

in NI have prepared themselves to work in the field 

throughjob experience,self-study,and continuing 

education programs. Although they have learned how to 

perform needed tasks, many lack the knowledge of 

informatics theory and principles required to develop 

technology solutions. More programs are needed to 

meet the demand for nurses with specialized informatics 

skills. Increasingthe cadre of nurses with specialized 

informatics skills will facilitate the development of 

information technologies that can help improve patients’ 

access to health care, involve patients in care decisions, 

and monitor the quality of care delivered, especially to 

underserved populations. 

Policy Goal: Federal funds should support innovative 

nursing and health informatics programs that teach the 

specialized informatics skills needed to develop 

information technology supporting the Nation’s health 

goals of providing accessible, high quality, and costeffective care. Nursing informatics contentshould 

address competencies expected for the different levels of 

education, and across practice settings and disciplines. 

Policy Options: 

1) Support specialized areas within informatics programs 

such as language nomenclatures, consumer health 

informatics, tools for shared decision-making,distance 

learning strategies,and human computer interface 

design. 

2) Encourage partnering with the health care industry to 

obtain information technology equipment, software, and 

technical support. 

3) Support use of information technologies to develop 

regional consortiathat teach NI specialtyskills. 

Develop within these consortia sites of excellence for 

teaching specific content. 

4) Support nurse participation in NLM informatics 

fellowships. 

5) Support development of interdisciplinaryprograms 

that teach nurses informatics specialty skills. 

Enhance Nursing Practice and Education Through 

Informatics Projects 

Issue: Informatics principles and technologies can 

significantly impact patients and providers in 

underserved areas. Technologies requiring further 

National Advisory Council on Nurse Education and Practice 23 
analysisinclude: (1)telenursinghelehealth, (2) patientspecific clinical decision support systems, (3) electronic 

global health conferences, (4) virtual courses, (5) health 

information networks, (6) and devices. Information 

technologies are used increasingly to deliver care to 

underserved areas, but knowledge of their impact on 

care processes involving nurses is obscure. New models 

should be developed to describe patient-provider 

communications using electronicmedia, to determine 

optimal ways of presenting electronic information to 

patients, to demonstrate nursing's role in shared 

decision-making, to develop community centers as hubs 

for health education,to calculate the cost-effectiveness 

of various technologies,and to help disadvantaged 

populations connect to providers electronically. 

Policy Goal: The Federal government should fund 

innovative, collaborativetelecommunicationprojects 

that would enhance the quality of clinical practice for 

populations at risk and contributeto the education of 

health care providers. 

Policy Options: 

1) Fund the design, implementation, and evaluation 

of NI innovations that support community 

partnerships. Innovations include information 

technologies, devices, models, and processes. 

Partnerships could embrace communities, industries, 

schools,human serviceorganizations,and care 

delivery systems. 

2) Fund collaboratory NI laboratories within an 

interdisciplinary and regional environment for 

providing simulated learningexperiences to the 

underserved. 

3) Support nurse-managed clinics and relevant 

interest groups to streamline information 

management across the patient's continuum of care. 

4) Encourage collaborationamong interdisciplinary 

professional organizations such as AMIA and 

HIMSS to identify centers of excellencethat could 

be included in site visitation programs. 

5) Support dissemination of information to 

consumers to educate them about the role of nurses 

as partners, facilitators, and information managers 

in the current health care environment. 

6)Collaboratewith the NLM and other Federal 

agencies to fund innovative informatics projects. 

7) Fund national conferencesfor recipients of 

informatics grants to share successfulprojects, 

identify common problems, and provide mentorship. 

Within the conferencesprovide instruction in using 

technology to support ongoing electronic 

communicationamong the recipients,mentors, and 

DN. 

Prepare Nursing Faculty in Informatics 

Issue: The number of nursing faculty who are prepared 

sufficientlyto teach core informatics content to students 

and cliniciansis inadequate. Inadequate faculty 

preparation is slowing the adoption of information 

technology as a basic nursing tool. Although exposure 

of the population as a whole to computers has increased 

dramatically, many nursing faculty continue to use 

computers only as word processors and fail to realize the 

potential of this technology to assist clinicians with 

information management. The changing academic 

environment and the teaching/learning paradigm shift to 

faculty facilitatinginformation access requiresfaculty 

knowledge of telehealth, distance learning, and other 

information technologies. 

Policy Goal: Federal resources should support 

increased nursing faculty preparation in informatics 

through the use of collaborativeprograms and 

technology. 

Policy Options: 

Support institutional collaborativestrategies 

between the dean and faculty to share knowledge of 

core informatics content and development of 

information technology skills. 

2) Target funds to explore use of collaborative 

agreements and other partnership mechanisms to 

determine best practices for facultypreparation in 

NI. 

3) Fund consultations and demonstrationsof 

informatics skills at meetings sponsored by the DN. 

4) Fund collaborative efforts among schools of 

nursing to provide adequatecomputer supportto 

each other. 

Increase Collaborative Efforts in Nursing 

Informatics 

Issue: Collaborative efforts among health care 

providers are needed to provide resources for 

informatics in nursing education and practice. Although 

NI research priority areas were identified by NINR, 

funding in this area has been limited. To increase 

resources, funding agencies should be educated about 

the potential of NI to improve the access, cost, and 

effectivenessof care. Funding also can be increased by 

integrating NI into existingFederal programs, such as 

telehealth, managed care, and school health programs. 

Collaboration can help informatics nurses link with 

Federal and non-Federal programs that are funding 

resources. After funding sources are identified, 

collaborative efforts also are needed to help informatics 

nurses write successful grants. 

24 National Advisory Council on Nurse Education and Practice 
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28 National Advisory Council on Nurse Education and Practice 
APPENDIX A 

Nursing Informatics Organizations 

UNITED STATES NATIONAL ORGANIZATIONS 

REPRESENTING NURSING INFORMATICS 

American Medical InformaticsAssociation 

Nursing Informatics Working Group 

Area: United States

Contact: American Medical Informatics Association 

4915 St. Elmo Avenue

Suite 401, Bethesda, MD 20814

291

mail@amia2.amia.org; 

http://www.gl.umbc.edu/-abbott/nurseinfo.html 

Carole Gassert, Chair, cgassert@hrsa.dhhs.gov 

American Nurses Association Council on Nursing 

Services and Informatics 

Area: United States

Contact: American Nurses Association 

600 Maryland Avenue 

Suite 100West, SW

Washington, DC 20024-2571

202-65 1-7000

chelmlin@ana.org;http://www.ana.org 

Jacqueline Dienemann, Chair, 

jdienema@welchlink.we1ch.jhu.edu 

National League for Nursing Council on Nursing 

Informatics 

Area: United States

Contact: National League for Nursing 

350 Hudson Street, New York, NY 10014

800-669-1656,212-989-9393

nlninform@nln.org;http://www.nln.org 

Ramona Nelson, Chair, ren@sruvm.sru.edu 

National Advisory Council on Nurse Education and Practice 29
REGIONAL AND LOCAL NURSING 

INFORMATICSSPECIALINTERESTGROUPS 

IN THE UNITED STATES 

American Nursing Informatics Association (ANIA) 

Area: Southern California

Contact: Karen Lookabaugh,President,

lookabaughk@csmc.edu

Peggy Wetsch, President-Elect

Roseanne Sullivan,Membership Chair

Boston Area Nursing Informatics Consortium 

(BANIC) 

Area: Boston, MA and Vicinity 

Contact: Mimi Hassett (Chair), mhassett@world.std.com

Capital Area Roundtable on Informatios in Nursing 

(CARING) 

Area: Maryland, Virginia, Washington,DC

Contact: Sue Newbold (Subscriptions),410-531-9244(tel

& fax), snewbold@umabnet.ab.umd.edu

Kathleen Smith (NewsletterEditor), 703-998-4813,

ksl963@erols.com

KellyWenner (Treasurer),301-564-1170,

kwenner@fcgnet.com

Computersin Healthcare Interfacing with Nursing 

(CHIN)

Area: Connecticut

Contact: Ann Bello (President),nk-bello@commnet.edu

Delaware Valley Nursing Computer Network 

(DVNCN) 

Area: Delaware, New Jersey, and Pennsylvania 

Contact:Mary Ellen Sweeny (ExecutiveOfficer), 302-

994-2511 x 4194, msweeny580@aol.com 

Anne M. Bird (CorrespondenceOfficer), 609-384-2959 

James Cannon (Membership& Newsletter), 

610-566-8061, cannon2@aol.com 

Healthcare Informatics Forum of Eastern Virginia 

Area: Eastern Virginia and Northeast North Carolina 

Contact: Dana Hlusko, 757-594-3591, 

dhlusko@series2000.com 

Health Informatics of New Jersey (HINJ) 

Area: New Jersey

Contact: Sharon Majarowitz (President), 201-268-2530

Houston Area Nursing Informatics Group (HANIG) 

Area: Houston, Texas

Contact: Brigid Lattner, tippytoo@flash.net

Maryland Society for Healthcare Information 

SystemsManagement(MSHISM)

Area: Maryland and surrounding area 

Contact: Joan Duke, 717-637-6392,

joanduke@sunlink.com

Michigan Nursing Informatics Network (MNIN) 

Area: Michigan, includingSaginawBay Cityhiidland 

Contact:Lori Girard,RN, Saginaw GeneralHospital, 

517-771-4830, girardl@aol.com 

Midwest Alliance for Nursing Informatics (MANI) 

Area: Illinois

Contact:Joyce Sensmeier(President),708-923-4531,

maniernail@aol.com

Midwest Nursing Research Society (MNRS)Nursing 

Informatics Research Section 

Area: Midwest 

Contact: Katy Karpiuk, Sioux Valley Hospital, Sioux

Falls, SD, 605-333-7073

Connie Delaney, 319-541-3600, Conniedelaney@uiowa.edu

Amy Coenen,MNRS Office, 847-375-4711

Minnesota Nursing Informatics Group (MINING) 

Area: Minneapolis and St. Paul, Minnesota and vicinity 

Contact: Martha Bergren, bergren@uninternet.com 

Tess Settergren,tsettergren @smmcduluth.com 

Mobile Area Nursing Informatics 

Area: Mobile, Alabama 

Contact: Marianne McCrory, marianne@iar.net

New Jersey State Nurses Association Computer 

Forum on Nursing Informatics 

Area: New Jersey

Contact: Mary Ann Cavallaro, Chair, 

mcavallaro@otis.state.nj.us

North Carolina State Nurses Association Council on 

Nursing Informatics (CONI) 

Area: North Carolina

Contact: Berit Jasion, jasio00l@mc.duke.edu

SheilaEnglebardt, 919-966-5440,

Sheila-englebardt@unc.edu

Northern California Nursing Informatics Association 

(NCNIA) 

Area: Northern California

Contact: Michael Moore, 415-638-3140,

mmoore@drai.com

30 National Advisory Council on Nurse Education and Practice 
Nursing Information Systems Council of New 

England (NISCNE) 

Area: New England

Contact:Ms Ginny Poulin, 508-537-3552(fax),

geegee950@aol.com

Texas Nursing and Healthcare Informatics 

Association 

Area: DallasFort Worth

Contact: Toni Sartori, 972-402-4773, tonis@imncorp.com 

Tri-StateNursing Computer Network (TNCN) 

Area: Pennsylvania, Ohio, West Virginia

Contact: Ramona Nelson, 412-738-2325,

ren@sruvm.sru.edu

Mary Lou Zemaitis, zemaitis.mary@pittsburgh.va.gov

Utah Nursing Information Network (UNIN) 

Area: Utah

Contact: Lauka Heerman, Co-chair

Donna Tomky, Co-chair

Diana Willson,Co-chair

Perry Gee, Co-chair

email: not available

Western New York Nursing InformaticsGroup 

(WNYNIG) 

Area: Buffalo, New York

Contact: Moira Haley, mhaley@falls.net

Wisconsin Computers in Nursing (WICAN) 

Area: Wisconsin

Contact: Judy Murphy, 414-647-3244,

jamurphy @execpc.com

National Advisory Council on Nurse Education and Practice 31
APPENDIX B 

National Nursing Informatics Work Group Members 

MEMBERS OFTHE NATIONAL NURSING 

INFORMATICS WORK GROUP 

PROJECT COORDINATOR 

Carole A. Gassert, PhD, RN


Nurse Consultant - Informatics

Division of Nursing

Bureau of Health Professions 

Health Resources and Services Administration 

MEMBERS 

Carol J. Bickford, MS, RN 

Doctoral Candidate, Nursing Informatics 

University of Maryland at Baltimore 

Diane M. Billings, EdD, RN 

Associate Dean for Teaching 

Learning and Information Resources 

Indiana University School of Nursing 

Patricia F. Brennan, PhD,RN, MIE 

Moehlman Bascom Professor 

School of Nursing and College of Engineering

University of Wisconsin-Madison

Betty Chang,DNSc., RN, FNP-C 

Professor of Nursing

School of Nursing

University of California, Los Angeles

Christine Curran, MS, RN 

Doctoral Candidate, Nursing Informatics 

University of Maryland at Baltimore 

Susan J. Grobe, PhD,RN 

LaQuinta Professor of Nursing

School of Nursing

University of Texas at Austin 

William Holzemer,PhD,RN 

Chairperson and Professor

Community Health Systems 

School of Nursing

University of California, San Francisco 

Alice K. Kuramoto,PhD,RN 

Professor and Director

School of Nursing

University of Wisconsin-Milwaukee

Tereceita VernaLaidlow,MS, RN 

Senior Application Analyst 

Integrated Health Services 

Nancy Meehan,PhD,RN 

Associate Professor 

School of Nursing 

Clemson University 

Judy Ozbolt,PhD, RN 

Professor

School of Nursing

University of Virginia

Mary Ann Rizzolo,EdD,RN 

Director, Interactive Technologies 

American Journal of Nursing Company 

Carol Romano,PhD,RN 

Director, Clinical Systems and

Research Support, Nursing 

Clinical Center 

National Institutes Health 

Virginia Saba, EdD,RN 

School of Nursing 

Georgetown University 

Diane Skiba, PhD 

Director of Informatics 

Professor, School of Nursing 

University of Colorado 

Susan Sparks,EdD,RN 

Senior Educational Specialist 

Extramural Programs 

National Library of Medicine 

Nancy Staggers,PhD,RN 

Colonel, US. Army

Nurse Staff Officer for U.S. Army Office of the Surgeon 

General

Cathy Wasem, MN, RN 

Director, Information Services and Policy Development

Office of Rural Health Policy 

Health Resources and Services Administration 

Rita Zielstorff, MS, RN 

Corporate Manager, Clinical Information Systems

Research and Development

Partners HealthCare System, Inc.

32 National Advisory Council on Nurse Education and Practice