Are you a clinical nurse interested in health information technologies (HIT)? Are you a new nurse informaticist who someday would like to lead a large HIT-related quality improvement project? If you answered yes to these questions, then you might be a future nursing informatics leader. And we need you!

...nurse leaders need to gain informatics knowledge and experience.As integration of health informatics solutions continues in all aspects of healthcare, and the use of big data becomes widespread, nurse leaders need to gain informatics knowledge and experience (Englebright & Caspers, 2016). Given the continued advancement of HIT in healthcare, “…nurse leaders now have an opportunity to advance innovation within nursing through informatics expertise and HIT solutions that address the emerging quality needs of the health care team” (Kelley, 2019, p. 531).

Nursing Informatics and Nursing Leadership

The American Nurses Association (ANA) Nursing Informatics Scope and Standards of Practice (2015) defines nursing informatics (NI) as “…the specialty that integrates nursing science with multiple information and analytical sciences to identify, define, manage, and communicate data, information, knowledge, and wisdom in nursing practice” (“Definition of Nursing Informatics” section, paragraph 1). To be a nursing leader is to be in a role to inspire and motivate effective performance from others through the development and diffusion of shared values and expectations that support the overall organization (Almost et al., 2016; Giltinane, 2013). Combining these two concepts, NI leadership involves engaging in leadership activities that involve effective use of HIT to support the organization.

How you become an NI leader depends on where you are in your career and your personal experience with HIT. We can look at potential roles in NI leadership development in research by Staggers and colleagues (Staggers et al., 2001) and Benner’s Novice to Expert leadership development model (1984), as listed here:

• If you are new to NI, but have experience or proficiency with electronic health records (EHRs), you could be an EHR super user (Boffa & Pawola, 2006). Super users train and support nurses to use EHRs; they also collaborate with the organizational information technology (IT) department to address issues with the EHRs their nurses use.
• If you have some experience within NI, but have not yet fully matured as a leader, you might consider becoming an informatics nurse specialist. Nurses in this position may be in charge of managing HIT solutions, educating novice nurses, or holding an executive or analyst position (Cummins et al., 2016).
• If you are an advanced leader, there are formalized high-position roles, such as chief nurse informatics officer (CNIO), that are growing in number within many healthcare organizations and systems (Kirby, 2015). In a CNIO role, nurses might engage in typical leadership activities, such as developing a vision and associated action plan for implementation, but with a focus on informatics (American Nursing Informatics Association [ANIA], 2018; Healthcare Information and Management Systems Society [HIMSS], 2020; Jackson & Ross, 2020; Scottsdale Institute, 2018).

...it is important to assess the maturity of your knowledge base and determine additional skills and/or experiences required.Overall, there are various roles that emerging NI leaders can hold depending on their level of experience. However, previous research has suggested that emerging leaders, especially early in their careers, face many challenges when trying to advance leadership skills and experiences (Dyess et al., 2016). To fill these NI leadership roles, it is important to assess the maturity of your knowledge base and determine additional skills and/or experiences required. Staggers and colleagues have done foundational work to understand which informatics competencies are needed at different levels of practice (Staggers et al., 2001). Additional research in this area is needed to identify actionable steps that nurses can take to meet those competencies and to mature as NI leaders.

With that in mind, we conducted a study to provide emerging NI leaders with strategies to reach maturity. The aims of this study were to gather recommendations from NI leaders about specific steps/strategies nurses can take to achieve NI leadership positions and to identify ways in which emerging leaders can participate in professional organizations to gain relevant training and experience. The purpose of this article is to describe our study methods and findings, and to offer specific recommendations for new and emerging NI leaders.

Methods

We conducted a mixed-methods, cross-sectional descriptive study in the Unites States from November 2018 - September 2019. First, a website scan was conducted for eight national and international professional organizations within nursing (organizations 1, 7, and 8), nursing informatics (organization 2), nursing leadership (organization 3), and informatics (organizations 4-6) to identify informatics and/or leadership maturity activities available through each organization. Second, we conducted interviews and surveys with NI leaders involved in each of the eight professional organizations. The purpose was to gather information about NI leaders’ leadership journeys and their recommendations for emerging NI leaders.

Lastly, we received feedback from current NI leaders who were not part of the interview group regarding our synthesized findings from the website scan, interviews, and surveys. These NI leaders had been actively involved in developing and supporting NI leadership, and they provided insights on various topics including ways that emerging NI leaders can enter and be engaged in NI leadership development. All interviews were audio recorded and the interviewers took handwritten notes. Recordings were then transcribed for analysis. Our study was approved by the University of Washington Human Subjects Division. See Backonja and colleagues (2021) for additional details about the study methods.

To identify themes across data sources, we applied directed content analysis (Hsieh & Shannon, 2005). Directed content analysis, compared to other types of qualitative analyses such as conventional or summative, is a structured approach guided by prior theory or research. We chose this approach to extend previous research on leadership development and competencies (Benner, 1984; Collins et al., 2017; Dermenchyan & Jeffery, 2018; McBride, et al., 2017; Phillips et al., 2017). We initially developed coding themes that were guided by previous research and used them to classify the information we received from participants regarding educational and training opportunities that could be taken to indicate their maturity as leaders. We also calculated descriptive statistics for the quantitative data collected from the surveys.

Findings

Sample
We recruited eight NI leaders from eight different professional organizations for the initial interviews and survey. Seven completed the survey, and among them they had an average 37.6 years of nursing experience (SD = 10.6) and 24.3 years of leadership experience (SD = 12.1). We also recruited two NI leaders to review our findings from the interviews and surveys. We use “P” and a number that corresponds to their organization (e.g., P4 was the participant who spoke about organization 4) when reporting the findings from interviews and surveys. NI leader reviewers are indicated within as “NIRa” or “NIRb.” Below, we present the findings synthesized across the three data sources.

...there is no single prescriptive way to become an NI leader.Interview, Survey, and NI Leader Review Findings
Ways for Emerging NI Leaders to Mature. As indicated in the participant interviews and explicitly stated by NIRb, there is no single prescriptive way to become an NI leader. Most participants stated that they came to NI through exposure to informatics during their nursing practice, whereas others knew coming into their nursing careers that they wanted to use informatics. Their accounts of how they came to their NI leadership positions also varied, with responses that ranged from being a new nurse “in the right place at the right time,” to being asked to be part of an informatics project (e.g., implementation of a new electronic health record), to intentionally seeking leadership building opportunities. Drawing on their experiences, participants gave general suggestions that could be implemented in different ways depending on individual career goals and needs.

Participants recommended seeking formal training or education...Get Formal Training or Education. Participants recommended seeking formal training or education appropriate for an aspiring NI leader’s professional role or career goals including taking relevant courses, completing a degree program (master’s degree, PhD, Doctor of Nursing Practice [DNP]), or completing a certificate program (e.g., nursing informatics). In our website scan, we found that some professional organizations have information on their website about informatics educational programs for those interested in university/college-based training. Participants stated that formal training and education provide foundational knowledge and allow for more opportunities for mentoring and networking by instructors and advisors. P7 and P8 noted the value of seeking educational opportunities that provide a foundational knowledge and involve hands-on experience; P8 recommended seeking “good internship opportunities so that you can get some work experience [in] real-life…outside of the classroom.” Formal training could also expose emerging NI leaders to important leadership theories and models. As described by NIRb, knowing Benner’s (1984) novice to expert model could help emerging leaders understand how to mature as NI leaders.

There was some disagreement between participants about the necessity of graduate education or certificates to becoming an NI leader. Some noted that advanced education or certification was important to gain a foundation in informatics. As P1 stated, “the theory behind informatics, of core competencies that are needed to practice at the highest level you won’t get in an on the job… Whether it’s a certificate in health informatics, or it’s a class, go do something [to advance your informatics knowledge].” However, P6 noted that advanced degrees and certifications are not requirements to be an NI leader, providing examples of current successful NI leaders who do not have PhDs or DNPs; this participant emphasized that one’s professional goals should be a factor in deciding whether formal education or certification will be helpful, and that a combination of factors, not education alone, make an NI leader.

...it is important to find several mentors within the disciplinary community to guide and support professional growth and engagement.Build a Support System by Getting Mentorship and Building a Network. Many participants and both NI leader reviewers stated that it is important to find several mentors within the disciplinary community to guide and support professional growth and engagement. Participants suggested finding NI mentors and mentors within a person’s practice domain, as recommended by P1. NIRb suggested that a practice domain mentor could be an administrative leader because it is important to have feedback about how to improve on the leadership qualities and organizational considerations that contribute to being an effective leader (e.g., internal politics, system complexities). NIRb stated that professional organizations are a mechanism by which new networks can be built and emerging leaders can connect with and learn from peers and mentors. If a formal mentorship program does not exist in the professional organization in which an emerging NI leader is a member, then participants recommend reaching out to leaders and asking them to be mentors.

Participants discussed the importance of building and maintaining a professional network.Participants discussed the importance of building and maintaining a professional network. The benefits of networks include helping to find mentors and opportunities for personal and professional growth. For example, P6 noted from personal organizational experience, “that if I hadn’t joined and contributed [to an NI committee], I don’t think I ever would have met [NI leaders who became my mentors] or maybe I would have met them but I wouldn’t’ve had the relationship with them where they would have been able to mentor me.” NIRb stated that building a network also provides opportunities to learn from peers. Participants also said that becoming known within the professional organization is a benefit of networking. NIRa stated that name recognition is important because many of the more senior positions within professional organizations are elected and require name recognition.

Cultivate Confidence. Several participants noted that it is important for emerging NI leaders to cultivate and build confidence, to have “the willingness to get out there” (P6) and “have curiosity” (P4) to find mentors, build a network, collaborate with others, and take and find growth opportunities. Part of this comes from self-assessment of current competencies and reflection about one’s future, as suggested by P7. One way a practicing nurse in a hospital could build NI competencies, said P8, is to volunteer to be a super user for the hospital IT department; this could also have the added benefit of strengthening a network within a professional organization that includes informatics leaders. P4 suggested that confidence can not only support an emerging leader but also help them support other emerging leaders in turn: “have that basic ‘you’re ok with yourself,’ [then] you can reach out and help raise others as well.”

...going outside one’s healthcare system and being actively engaged in professional organizations is critical for leadership and career development.Be Active in Professional Organizations. Participants recommended actively engaging in professional organizations, including one related to the nursing discipline and another related to leadership or informatics. For example, as stated by NIRb, going outside one’s healthcare system and being actively engaged in professional organizations is critical for leadership and career development. Engagement may include becoming a member of a committee and then being elected or selected to be in a leadership position within the committee or professional organization. There are opportunities at the national/international level (e.g., membership in a nursing informatics group/committee or an organization’s board) or a local level (e.g., leadership within a city/state/regional chapter or organization). Involvement in leadership positions or development programs is on a volunteer or unpaid basis for most but not all professional organizations.

...the best way to get value from outreach opportunities and to bring value to the professional organization is active engagement.Participants stressed that the best way to get value from outreach opportunities and to bring value to the professional organization is active engagement. As P6 stated, “I would encourage [those interested in NI leadership] to join committees, to be active – not just join them and show up to the meeting once a year when it happens, but to actually get involved.” Active participation can include participating in or holding a leadership position within a committee or group. NIRa suggested active involvement including serving on committees, being active on interest group listservs, and commenting on policies when there are calls for feedback from professional organizations. NIRb stated that professional organizations can help emerging NI leaders see and learn about possibilities for NI careers and educational opportunities.

National and regional meetings provide opportunities to learn about nursing informatics and leadership...Conference presentations were mentioned as a way to be actively involved in a professional organization. P6 discussed submitting posters, papers, or panels. Panels provide a networking opportunity for emerging leaders to reach out to potential mentors and invite leaders to be panelists. As indicated in the website scan and interviews, most professional organizations host annual national conferences. Throughout the year, many professional organizations hold smaller meetings on specific relevant topic areas, or regional/chapter meetings for members. National and regional meetings provide opportunities to learn about nursing informatics and leadership through viewing talks or attending workshops. Participants noted that presenting at a conference, either through posters or podium presentations, was a way to help gain name recognition too, which, as noted above, is helpful when running for an elected position within that professional organization.

Participants also discussed the importance of engaging in more than one professional organization. They suggested joining informatics-related organizations as well as ones related to nursing and areas of specialized practice (e.g., critical care, oncology, public health). Joining multiple professional organizations allows an emerging leader to gain benefits from the informatics professional organization regarding NI leadership development. Engagement in a nursing or practice-based organization can also help emerging NI leaders gain additional mentorship and leadership opportunities that are important for professional development. It can also facilitate opportunities to raise awareness about NI within non-informatics professional organizations. As shown in the Table, there are various options for emerging NI leaders who want to participate in professional organizations that relate to nursing, nursing leadership, informatics, or nursing informatics.

Several participants described a professional organization leadership structure that allows members to move through a leadership pipeline. For example, one might, first start as a member of a committee or local chapter, then assume a leadership role on the committee or local chapter, and finally become elected to the board of the professional organization.

Discussion and Recommendations

In this study, we identified ways to pursue maturity as an emerging NI leader. These include obtaining training or education, seeking mentorship, building a network, cultivating confidence, and being active in professional organizations. The Table presents a checklist of strategies to determine actionable ways to mature as an NI leader.

Table. Checklist of Strategies for Emerging Nursing Informatics (NI) Leaders to Enter and Mature

The findings from our study align with a recent publication by HIMSS (2019) titled “Five Ways to Become an Influential Woman in Health IT.” Female leaders in HIT suggested that emerging leaders “Be the Team Member Who Always Takes Initiative” (section 2), echoing what we found regarding the importance of building confidence. Our participants also discussed the importance of networking and mentorship; this, too, echoes the HIMSS (2019) piece and is supported by work by McBride et al. (2017) that advocates having multiple mentors.

...emerging leaders should be purposeful when seeking informatics or leadership opportunities that match their needs and career goals.Based on our findings, we recommend that emerging leaders look for training and education opportunities within professional organizations that match their career goals and interests. Given the limited time that emerging leaders have to engage in these opportunities, the cost of joining professional organizations, and the voluntary nature of these opportunities, emerging leaders should be purposeful when seeking informatics or leadership opportunities that match their needs and career goals. For example, emerging leaders interested in policy could consider joining a Policy committee within a nursing informatics organization as a career building strategy to gain experience and network. Emerging leaders could also join the local chapter of an organization that supports leadership development and educational opportunities. These emerging leaders can use self-assessment tools (e.g., the leadership self-assessments we list in the Table) and competencies to strategically identify areas for improvement and growth.

Conclusion

We need more NI leaders to meet current and emerging demands in healthcare.We need more NI leaders to meet current and emerging demands in healthcare. In our study, we identified ways that emerging NI leaders can self-support their entry into and maturity in NI. Emerging NI leaders can grow through mentorship, engagement in professional organizations, and formal training and education. Individual needs will determine the most beneficial experiences and training for emerging leaders. The recommendations we have provided can help emerging NI leaders identify the best opportunities.

Acknowledgement

This study was completed as part of the Alliance for Nursing Informatics (ANI) Emerging Leaders Program supported by the American Medical Informatics Association (AMIA) and the Healthcare Information and Management Systems Society (HIMSS). We would like to thank study participants for their insights and ANI members for their support. Thanks to Dr. Amanda Menking and Liz Gloor for their editorial support on this manuscript. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors

Uba Backonja, PhD, MS, RN
Email: backonja@uw.edu

Dr. Backonja is an Emerging Nursing Informatics Leader, selected to be part of the Alliance of Nursing Informatics 2018-202 cohort. She discovered the power of leadership and its intersection with health while in New Orleans after Hurricane Katrina as Red Cross volunteer leader working with community health nurses to support survivors with their health and medical needs. She has held various leadership positions including Secretary for the Public Health Informatics Working Group of the American Medical Informatics Association. Currently she is Chair of two faculty-based committees within her School and was Secretary for the Public Health Informatics Working Group of the American Medical Informatics Association. Dr. Backonja is currently co-PI on a large federally-funded project to develop a website for rural public health partitioners to identify and address health disparities (https://sharenw.nwcphp.org/). Dr. Backonja has published in peer-reviewed journals and presented at local, national, and international conferences.

Patricia Mook, MSN, RN, NEA-BC, CAHIMS
Email: patricia.mook@atriumhealth.org

Ms. Mook is recognized as a dynamic nurse leader with executive health care experience and speaks regularly at the national level. She has served as a Board member of AONL and is presently on the AONL Foundation Board and the Development Chair. She represents AONL as a member of the Board of Governors for the Alliance for Nursing informatics and was previously the Chair of the HIMSS Nursing Informatics Committee. She presently serves on the Credentialing Committee for HIMSS and has participated in multiple taskforces to represent the voice of Nursing leaders for both HIMSS and AONL. She has over 40 presentations and publications, many on the topic of leadership and informatics, and has received 14 awards, many for leadership.

Laura Heermann Langford, PhD, RN
Email: laura.heermann@imial.org

Dr. Heermann Langford is a Nurse Informaticist at Intermountain Healthcare and the Chief Operating Officer for the non-profit Logica, Inc. Dr. Heermann-Langford has a clinical background of nursing in adult emergency care and pediatric intensive care units and burn care. Her informatics work has focused on clinical decision support and workflow, clinical engagement, standards and interoperability. She is a co-chair of the HL7 Emergency Care Workgroup (ECWG), HL7 Healthcare Clinical Interoperability Council Working Group (CIC), and the HL7 Patient Care Workgroup (PCWG) where she co-leads the HL7 PCWG Care Plan Initiative and is a founding member of the leadership of Clinicians on FHIR (Fast Healthcare Interoperability Resources). These roles at HL7 allow her to have a tight connection between clinical domains and the application of HL7 standards, specifically FHIR in clinical application development and implementation.