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Clinical Informatics

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Analysis of the Clinical Informatics Job Description
Ann Miller
American Sentinel University

Analysis of the Clinical Informatics Job Description
What is an Informatics Nurse, an Nurse Informaticist? When people ask me what job that I do and I reply “Informatics”, they get an interesting look on their face. The look is of concern and of that is not what a nurse does. The public is not educated in what this position’s importance really is and that is too bad.
What is a typical day like for an informatics nurse like myself? That question is easy. There are no typical days! I can honestly say that this is what I like about my job position. Some days I am going to staff meetings where I am educating on a new process to a page from the floor that a provider needs my help. I have many computer classes to teach for staff, nursing students, providers, and soon 80 or so high school students who will be joining us for the next seven months to learn patient basic care and documentation. In my spare time- I do get some from time to time, I have many projects that I am working on to optimize the electronic medical record. The projects can be getting rid of any paper processes that remain and doing whatever it takes to get them all electronic from the development of provider order sets (Powerplans), to nursing processes, and education. You cannot forget about the education. Education has to come in many formats, including group settings (staff meetings), one-on-one, on-line Healthstream sessions (where staff can view Powerpoints that are assigned), and e-mail. You have to be creative in education of staff are just not going to remember what you teach them. Once a new process is rolled out, you have to monitor, monitor, and monitor. It usually takes time to get staff compliant with new initiatives. Continued e-mail and one-on-one reminders can reinforce the education and get staff in the habit of adding just one more thing to their workflow. What can a nursing informaticist do that a patient nurse cannot do? I can improve patient care on a high level than when I am one-on-one with a patient. With the power of the electronic medical record, I can provide information that might improve the care for all of our Congestive Heart Failure patients, not just the one or two that I might be taking care of that day. I am a facilitator of technology, where as a clinical nurse may be the end user. I am always looking at ways to make improvements to the technology that is available into our current practice/processes. I pretty much run my own shop. I pick a lot of my own projects and prioritize my work day based on what will bring about the best changes to clinical practice. To be in my role, you have to be a self-starter and not all people can do that. My position is in its infancy and to a great extent, I am creating my own job description. I work at all levels of my organization so it never seems to get boring. With that said, have you got the idea that I do not have a job description. I have been in my role since June of 2011 and I still do not officially have a job description. I went on the Internet and researched Clinical Nursing Informatics job descriptions. They vary in substance, but are pretty much a canvas in which to practice. I think the opportunities for nurse who develop these clinical technical skills and clinical expertise have not boundaries. Ten years ago, we would have never thought that a registered nurse would be delving into the information field as the clinical experts that are so highly desired in these positions. There were not MSN degrees in informatics ten years ago. Universities are quickly jumping on the bandwagon to offer programs in informatics. Here I am, enrolled in the Informatics track at American Sentinel University. American Sentinel joined several other universities, such as the University of Phoenix, to have solid nursing graduate programs in informatics. The clinical factor is so important because it provides the opportunity to improve patient care. Any data analyst can work wonders with technology, but they lack the clinical piece of why the data is important. There is also the communicating with the providers and nursing staff. It is easier for a nurse to translate the technical problem to the providers because they can translate it into something that the providers will understand. The Nurse Informaticist at Cadillac Mercy Hospital is a new position that started in August of 2011 because of a missing and highly desired clinical nursing liaison position between the Cerner computer system and the analysts that build and modify the system. The position was presented as a job in which the job description would essentially be written by analyzing the work and tasks that the person who accepted the position was involved in. Because there is not an existing job description, it is impossible to fully be able to determine if the nursing informatics nurse is fully satisfying all elements of the position in which they were chosen to perform. There have not been any complaints from clinicians as to the job the nurse informaticist is providing, which can be a sign that the nurse is a self starting change agent, that has taken the needs of the organization and has began to implement change and adequately supports the clinicians in a manner that is satisfying to their needs. The job description that would be created by the nurse informaticist after a year and a half in the position is presented later on in the paper after clearly defining what encompasses a well thought out job description. The job description should clearly define the minimum amount of education that is required for the role in which needs to be filled. The essential job functions of a position are often kept in a document called a job analysis, which included general information about a position, a job description, essential functions, working conditions, and other information. Specifically, the job analysis should contain the title of the position, the department within the organization, the employer address and phone number, work location, if different form organization location, title of direct supervisor, name of job contact person, contact person’s address and phone number, hour of work, shift or rotation requirements, flexibility expected, overtime requirements, and on-call duties, breaks, vacation, education certification, or licensure required or preferred, work experience knowledge, and skills required or preferred, and travel requirements. The job description found in a job analysis should include a general explanation of duties and the work environment (Wegman et al., 2004).
The Cadillac Mercy Hospital job description for the Clinical Informatics Nurse position:
Description Summary:
Responsible for planning, coordinating and facilitating education for all computer applications and computer software for all clinical nursing groups to include clinician providers, nurses, patient care assistants, nursing students and other workforce members as directed for Cadillac Mercy Hospital. Develops and trains all user groups on clinical computer applications, and on-line documentation processes.
Qualifications:
Required: Licensed Registered Nurse; BSN Nursing; Minimum 5 years healthcare experience; Knowledge of Cerner Powerchart/FirstNet system; Computer knowledge; Must have experience with computer software including Word, Excel, and Powerpoint; Patient Safety knowledge; Working knowledge of clinical performance improvement; Proven verbal and written communication skills; Experience or formal training in adult education; Able to communicate effectively with all levels of personnel within the organization; Demonstrated presentation skills; Demonstrated leadership in change management; Able to integrate goals, mission, and vision or organization into educational problems; Demonstrate creativity and self-directive manner; Can work independently with minimal supervision; Able to work effectively as a team member and team leader; Desired: Master of Science in Nursing, Informatics, or related health care field.

Reports to:
Director of Information Systems
Professionally accountable to the managers, Director of Nursing, and the Chief Nursing Officer.

Essential Functions: Job Duties and Responsibilities; The Clinical Informatics Registered Nurse is an expert in human factors, patient safety, and the use of technology to optimize care delivery processes and effectively communicate patient care activity. The Clinical Informatics RN specializes in patient care processes and clinician workflow and leads initiatives to promote effective process design, development, and implementation of the electronic medical record (eMR) and other technologies. The Clinical Informatics RN conducts and facilitates clinical computer applicaotns training and non clinical computer training for all staff. Provides computer orientation training and information system updates for current and ongoing personnel, providers, and others as directed. Assesses, plans, develops, and implements educational programs for staff based on an annual needs survey new computer applications, system updates, and other organization goals and changes. The Clinical Informatics RN is responsible for maintain up-to-date knowledge of trends and advances in their clinical field and in health care informatics assuring clinician involvement in evaluation of new technology design and function. This role supports physicians, other providers, nurses, pharmacists, dieticians, case management, cardiopulmonary, radiology, and other clinicians as the resource for requests related to technology changes. The Clinical Informatics RN demonstrates independent decision making as appropriate in evaluation of requests for system improvements and determines feasibility and advisability of system changes. The Clinical Informatics RN works closely with clinicians, departmental leadership, Quality, Patient Safety and Accreditation and Licensure Departments and Information Systems staff to clarify needs, prioritize requests, recommend technology design, workflow and execute change and adaptation to the eMR and other technology. Participates in planning related to future direction of information systems that involve end-user and end-user feedback. Responsible for order set management: o Development and maintenance of overall principles for safe design and use of order sets, with a focus on workflow design; o Development and maintenance of standard order set clinical content; o Identified leader as resource for requests for changes, additional orders and order sets; o Collaborates with provider specialty groups to develop order sets based on order set standards, patient safety principles, and evidence based practice guidelines. Responsible as a thought leader for maximizing technology design to achieve the best clinical outcomes and leads the organization’s approach process outlines by the IS Steering Team. Works with clinicians to optimize MR documentation and the use of the eMR as a communication tool. Participates in improvement projects and on assigned committees to provider content expertise on the literature related to the use of the eMR, Bar Coding medication administration, and other technology to meet patient safety goals, support clinician workflow, and achieve care improvements. Thought leader and resource for clinicians on the clinical information system and patient care processes to promote optimal care, reduce errors, and achieve organizational goals. Participates in development, monitoring and evaluation of technology and decision support (barcode point of care, rules, order sets, etc.) for continuous improvement. Partners with the informatics pharmacist to facilitate advanced clinical decision support implementation within the electronic medical record in order to meet medication clinical goals. Collaborates with the education department for safe and effective use of the eMR. Coordinates, facilitates, and evaluates clinician functional testing for human factors issues before and after system upgrades and improvements. Problem solves application and workflow issues and works through barriers to achieve results by collaborating effectively with users and the IT staff. Communicates effectively with all members of the healthcare delivery team, leadership, informatics committee members, and the Powerchart implementation team. Accountable for measurable improvements in clinician satisfaction with technology, and in the use of technology as a facilitator of best practices, patient safety, and error avoidance. Participates on the Management of Information committee and assigned functional team(s) and committees as directed. Accountable for maintaining the order and security of the computer room. Coordinates the use of the computer room with other departments. Serves as a change agent in the organization through the delivery of new ideas, through leading projects and teams, and by acting as a role model in order to build a culture of excellence with Cadillac Mercy Hospital.
Physical Demands: Job involves sitting for extended periods of time at a computer; Requires standing, walking, bending, stooping, and reaching; Frequently lifts and carries light to moderate heavy objects; Requires consistent use of motor skills and visual effort; May stand and speak for long periods during educational classes.

Working Hours and Overtime Status: Works 40 hours per week; Must remain flexible with schedule to meet the needs of clinical staff on various shifts; Classified as exempt for purposes of overtime.
Working Environment: Classroom, departmental, and office settings with temperature controlled environment. Requires travel to other locations within the Cadillac Mercy Hospital healthcare system.

Technical Proficiencies and Work Aids: Computer applications appropriate to clinical areas; Microsoft Office Suite, Fax; Office Aids: Computer, Copy Machine, Printer, Telephone; Classroom Aids: Overhead projector, LCD projector, laptop computer and some medical equipment; Reference Materials: Manuals, Books, Videos, etc.

Hiring the right employee can be a very challenging process. Hiring the wrong employee can be very expensive, costly to the work environment, and time consuming. Hiring the right employee, on the other hand, pays you back in employee productivity, a successful employment relationship, and a positive impact on your total work environment. There is not a perfect answer to how you select the right person for the job, but the interview process can be a tremendous help if you use it effectively. In other words, you must have completed all the other steps in the hiring process in order to get the most out of the interview process. Interviewing candidates for a position within the organization is one of the final steps in the hiring process. The following steps are best practices when hiring an employee: A clear definition of the job staring with a job analysis and job description. Determining the need to hire a new employee. Conducting a thorough job analysis. Writing a job description and job specification for the position based on the job analysis. Determining the salary for the position, based on internal and external equity. Deciding where and how to find qualified applicants. Collecting and reviewing a fair amount of applications and resumes and then selecting the most qualified candidates for further consideration. Interviewing the most qualified candidates for the position, based on the job’s description and specifications Checking references. Hiring the best person for the job.

Promoting the wrong employee is like quitting smoking: It is easy to do, a million times. Promoting the right person at the right time takes more diligence. Because Cadillac Mercy Hospital is a unionized hospital representing the RNs under SEIU, promotion of staff is bound by the employee contract. As set forth in the Agreement Between Mercy Hospital- Cadillac, Michigan and Professional Employees Division of Service Employees International Union Healthcare- Michigan, performance evaluations are handled in the following manner. In order to assess nursing staff competency to perform assigned responsibilities, a competency assessment process will be maintained. This assessment process shall include competency assessment during the initial employment and orientation process, maintenance of competency through a combination of ongoing assessment and educational activities, and an annual performance evaluation system. The performance evaluation system shall include self-assessment, a peer review process, and a review by the employee’s immediate supervisor. The self-assessment shall be based on objective criteria that is reviewed and validated by the Director of Information Services. Increases in wages are set by a wage schedule set forth in the union contract.
The staffing of this position is a 36-40 hour per week flextime schedule with full benefits. If there is not an adequate amount of workload, the informatics nurse may pick up allotted hours on the inpatient units doing patient care if desired, take census time that can be paid using Paid Time Off (PTO), or taking unpaid census.

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