[00:04]Preparing the next generation of nurses
[00:08]Since the 1970s, several authors and organizations recommended
[00:14]that health care professionals develop knowledge and skills
[00:18]in computer literacy, information literacy,
[00:21]and the use of information technologies.
[00:24]In addition, it has been recommended
[00:27]that these competencies be integrated into nursing curricula.
[00:33]Though 30 years have passed,
[00:35]there is minimal implementation of the recommendations despite the fact
[00:40]that ours is an increasingly technological society,
[00:44]health care technology has expanded,
[00:47]and the amount of access to information continues to grow at a rapid rate.
[00:53]Federal initiatives are pushing the adoption of electronic health records (EHRs)
[01:00]throughout all health care institutions by the year 2014,
[01:05]an initiative that will dramatically change how nursing is practiced.
[01:11]Graduates of today's nursing programs should know how to interact
[01:16]with the important informatics tools to ensure safe and quality care.
[01:22]In addition, there is a growing consumer movement wanting to
[01:27]interact with health care professionals through personal health records
[01:32]and various electronic communication devices.
[01:35]Nurses should acquire the necessary
[01:38]"21st century knowledge and skills for practice
[01:42]in an emerging technologically sophisticated, consumer-centric environment".
[01:49]A call for reform
[01:51]The intent of this position paper
[01:54]is to support the reform of nursing education
[01:58]that prepares a workforce capable of practicing in a health care environment,
[02:03]where technology continues to increase in amount and sophistication.
[02:09]The National League of Nursing (NLN),
[02:13]as a leader in the preparation of a diverse workforce,
[02:17]advocates for support of faculty development
[02:20]initiatives and innovative educational programs.
[02:24]The call for reform is relevant to all nursing education programs
[02:29]as the informatics revolution will impact all of nursing practice.
[02:35]Numerous forces are catalysts to incorporating
[02:39]information and communication technologies
[02:42]throughout the health care delivery system.
[02:46]Institute of Medicine
[02:48]Since 2000, interdisciplinary teams of scientists, practitioners,
[02:55]and administrations convened by the Institute of Medicine
[02:59]have advocated the use of health information technologies,
[03:04]including electronic health records, as one solution for ensuring safe,
[03:09]quality health care. Greiner and Knebel summarized the problem
[03:14]with health professions' education in 2003:
[03:19]"Clinical education simply has not kept pace with
[03:23]or been responsive enough to shifting patient demographics and desires,
[03:29]changing health system expectations,
[03:32]evolving practice requirements and staffing arrangements,
[03:36]new information, a focus on improving quality or new technologies".
[03:41]Decade of Health Information Technology
[03:45]Another driving factor is the establishment of the Office of
[03:48]the National Coordinator of Health Information Technology
[03:53]and the Decade of Health Information Technology in 2004.
[03:58]The agenda included a strategic plan that set four major goals
[04:03]to be accomplished by 2014: Encourage the widespread adoption of
[04:09]electronic health records; Interconnect clinicians
[04:13]so that data and information can be more easily shared;
[04:17]Personalize care through the use of personal health records
[04:21]and telehealth; Improve public health through accessible information.
[04:27]In response, some agencies held summits
[04:30]that focused on building a workforce for health information transformation.
[04:36]Numerous recommendations were posed, including the following:
[04:40]Collaborate to ensure that informatics educational competencies
[04:45]are embedded in curricula;
[04:48]Promote faculty development in electronic information technologies;
[04:53]Support the passage of legislation to strengthen programs
[04:57]and increase funding for health informatics education programs,
[05:01]student recruitment and retention, and faculty development.
[05:06]Technology Informatics Guiding Education Reform (TIGER) Initiative
[05:13]The TIGER Initiative responded to the lack of nursing involvement in
[05:17]meeting federal initiatives by convening
[05:20]more than 40 nursing professional organizations to create a vision
[05:25]and a three-year action plan. The TIGER Initiative
[05:29]"aims to enable practicing nurses and nursing students to fully
[05:34]engage in the unfolding digital era of health care".
[05:39]To reach its goals, TIGER established the following recommendations
[05:44]for schools of nursing: Adopt informatics competencies for all levels of
[05:50]nursing education (undergraduate/graduate) and practice (generalist/specialist);
[05:57]Encourage faculty to participate in development programs in informatics;
[06:03]Develop a task force to examine the integration of informatics
[06:08]through out the curriculum; Collaborate with industry
[06:12]and service partners to support faculty creativity
[06:16]in the informatics technology; Develop strategies to recruit, retain,
[06:22]and educate nurses in the areas of informatics education, practice, and research.
[06:29]Robert Wood Johnson Foundation
[06:32]The Robert Wood Johnson Foundation (RWJ) funded several initiatives
[06:38]related to health care delivery transformation, workforce,
[06:43]and patient safety and quality.
[06:45]The Quality and Safety Education for Nurses (QSEN) project's goal
[06:51]is to "reshape professional identity formation in nursing to
[06:56]include commitment to quality and safety competencies
[07:00]recommended by the Institute of Medicine". To accomplish this goal,
[07:05]six competencies were defined - patient-centered care,
[07:09]teamwork and collaboration, evidence-based practice, quality improvement,
[07:15]and informatics plus safety.
[07:18]Pilot schools are integrating them in their nursing programs
[07:22]and sharing the work on the website.
[07:25]Nursing Education and Informatics
[07:29]With multiple initiatives from government and organizations,
[07:33]the question arises about where nursing education is going. Specifically,
[07:39]are educators preparing nurses who can use informatics tools to provide safe,
[07:44]patient-centered, quality care based upon evidence? The simple answer is no.
[07:52]In March 2006, a task group sent email surveys to some people.
[07:57]The emails asked for input about how the education community
[08:02]is preparing the next generation of nurses to practice in the new environment,
[08:07]and asked respondents to identify both exemplars and gaps in the curricula.
[08:14]Five hundred forty deans or directors and 1,557 faculty responded.
[08:22]Results revealed that about 60 percent of programs
[08:26]had a computer literacy requirement
[08:29]and 40 percent had an information literacy requirement.
[08:33]Only 50 to 60 percent of respondents said informatics
[08:38]was integrated into the curriculum.
[08:41]The critical conclusion is that while most schools of nursing
[08:44]focused on computer and information literacy,
[08:48]there was considerable confusion as to what nursing informatics entails
[08:53]and what constitutes the necessary knowledge to practice
[08:57]in an informatics rich environment.
[09:01]There are no other recent studies that document either similar
[09:05]or different findings. When this information was presented
[09:10]at conferences and meetings,
[09:12]the audience of nurse educators was not surprised.
[09:16]It is, therefore, imperative that people call for action
[09:21]to prepare the next generation of nurses
[09:24]with the necessary informatics competencies to provide safe and quality care.
[09:30]Information technology (IT) is not a panacea,
[09:34]and will not fulfill its promise
[09:37]unless it is harnessed in support of foundational values.
[09:41]That is why every nurse cannot afford to be unconnected
[09:45]to this transformation, but must take an active role in ensuring
[09:50]that IT is used in service to profession's values. After all,
[09:56]nurses are knowledge workers.