Digital and informatics competencies: Requirements for nursing leaders in Canada

Introduction

Over the last decade, the use of health information technologies (eg, electronic health records) and innovative services and tools (eg, mobile apps) have increased across Canadian healthcare to support the delivery of digital health. ¹ Digital health has been defined as:

The field of knowledge and practice associated with the development and use of digital technologies to improve health. Digital health expands the concept of eHealth to include digital consumers, with a wider range of smart-devices and connected equipment. It also encompasses other uses of digital technologies for health such as the Internet of things, artificial intelligence, big data and robotics. ²

The global COVID-19 pandemic and restrictions on in-person care ³ have accelerated the adoption of digital health tools such as virtual consultations. However, a recent survey of Canadian nurses on using digital health technologies in practice revealed many ongoing challenges. ⁴ For example, issues of usability, redundant data collection, and inadequate support and training are persistent problems for nurses. ⁴ Nurse leaders play an important role in ensuring nurses are involved in planning, design, implementation, and evaluation of digital health solutions; however, their ability to strategically lead digital health initiatives has been limited, largely due to limited knowledge and a lack of clear guidelines outlining digital health competency expectations for this group in Canada.

There is a need for competencies specific to nursing, given the unique demands and practice environment of the profession. One of the main differentiators is that nurses typically care for individuals over the duration of a shift (eg, 12 hours) as opposed to encounter-based care found in other professions. ⁵ This has unique implications for how nurses use electronic health record systems versus other provider groups. In addition, nurses have unique workflows, needs, and requirements (eg, shift handover, ⁶ closed loop medication administration ⁷ ). As nurses become a key user group, their needs have not been well represented which have led to suboptimal user experience and burnout. ⁴ Thus, harnessing the power of EHR for nursing care requires a comprehensive leadership approach that is considerate of the specific nuances and diverse scope of nursing practice.

Purpose

The purpose of this article is to reflect on progress to date on the delineation of digital health competencies for nurse leaders in the Canadian context and offer our perspectives on how the competencies can enhance current and future nurse leaders’ readiness for participation in digital health initiatives. In particular, the implications of advancing these competencies across nursing practice domains ⁸ (eg, administration, clinical care) are discussed. Ensuring Canadian nurse leaders are prepared with informatics knowledge is a critical first step toward supporting use of health information technologies in achieving the quadruple aim of healthcare. ⁹

Identifying digital and informatics competencies for Canadian nurse leaders

Although the digital health skills and knowledge required of registered nurses are outlined in the Canadian Association of Schools of Nursing’s ¹⁰ entry-to-practice nursing informatics competencies, ¹⁰ there remains a lack of consensus on informatics competencies at the level of nurse leaders. Nurse leaders play an important role in advocating and supporting the needs of direct care nurses at decision-making tables and have different roles and responsibilities than those who use health information technology in direct care or educator roles. ¹¹ However, contrary to other countries such as United States and Australia,^12,13 the informatics requirements for Canadian nurse leaders were not specified until recently. As other countries advocate for increased leadership in nursing and informatics,^12,13 there is an opportunity to maximize the value of digital health to nursing by establishing and ensuring uptake of informatics competencies by Canadian nurse leaders.

In response, our research team of nurse leaders from several Canadian jurisdictions led several studies to identify informatics competencies for Canadian nurse leaders (Figure 1).^14,15 Informed by approaches conducted in the United States, ¹⁶ this began with a scoping review of the literature and followed by a Delphi study to engage key stakeholders on validating competences that are important to Canadian nurse leaders. These findings are now used to inform the development of a self-assessment tool that can be used by Canadian nurse leaders. These studies are summarized below.

OPEN IN VIEWER

Figure 1.

Overview of work to date on delineating informatics competencies for Canadian nurse leaders.

Advancing digital health competencies for nurse leaders in all domains of practice

At the current juncture of expansive digital health integration, there is a need to support the dissemination and adoption of entry-to-practice informatics competencies and advanced competencies for nurse leaders. ²⁰ In particular, integrating nurse leader informatics competencies across the practice domains defined by the Canadian Nurses Association ⁸ can support effective integration and implementation of existing (eg, electronic health record) and emerging (eg, robotics) digital health technologies. Moreover, it can maximize the value and benefits of advances in health information technologies for patients, caregivers, and clinical staff across practice. In this regard, our research team collectively identified several possible approaches to disseminate and integrate these informatics competencies across the five practice domains (Table 1). This list is not intended to be exhaustive but serves as a starting point for enabling the potential impact of these competencies.

OPEN IN VIEWER

Table 1.

Examples of digital health competencies ¹⁴ applied across practice domains

Practice domain 8	Examples
Administration	Advocate for and support the role of nursing in the development and implementation of a digital health strategic plan  Promote and celebrate the achievements arising from the use of informatics for better quality care
Clinical care	Explore how emerging technologies (eg, virtual care, robotics) can support better nursing practice  Explore how the use of data analytics and existing data can be used to provide personalized and tailored care
Education	Identify and explore bottlenecks and unintended consequences that hinder effective use of digital health solutions and clinician wellness  Deliver appropriate training and support for effective adoption and use of information and communication technologies in healthcare, and other digital solutions supporting clinical care delivery
Policy	Promote and advocate for investments and infrastructure to support the use of digital health and analytics in nursing environments  Form interprofessional collaborations to support the use of digital health tools throughout the care journey
Research	Promote the use of standardized clinical data standards to enable large-scale analysis of clinical data  Support the use of research and research approaches to addressing complex challenges with using digital health tools in nursing care

As the number and variety of digital health technologies continue to grow, there is diversity in how they can support existing and emerging health system challenges. ²¹ To reap the benefits of these tools, there is a need to examine which technologies may be appropriate and conducive to addressing unmet healthcare needs. This may involve considering the maturity of digital health tools ²² and exploring opportunities to integrate them into existing nursing practice environments. In addition to selecting appropriate digital health tools and solutions, nurse leaders can identify and advocate for resources (eg, funds, human resources) required to ensure successful acquisition and safe implementation of these tools. As integrated ²³ and collaborative care ²⁴ models are adopted, nurse leaders can work together with other healthcare professionals and nurse superusers to develop or adapt workflows in a way that maximizes value for patients and families and contributes to addressing health system challenges, such as timely access to health services.

Nurse leaders with informatics competencies can also be positioned to mitigate unintended consequences that hinder the use of digital health to improve care. With growing concerns about administrative burden and its impact on patient safety,^25,26 strategies that nurse leaders can take to optimize the use of digital health tools include (1) actively participating in the implementation of health information technologies (design and workflow), and (2) identifying appropriate interventions (eg, training) to mitigate challenges that nurses encounter as they provide care at the bedside. ²⁷ Moreover, with increased emphasis on data analytics to understand digital health use,^28,29 nurse leaders can be well positioned to determine relevant indicators to evaluate and measure system performance. This information can inform actions to address bottlenecks and challenges in a timely manner to avoid detrimental impacts on patient care, clinician well-being, and productivity. ²⁷

Nurse leaders with informatics competencies can also facilitate meaningful use of large-scale clinical data generated by digital health tools. For example, applying machine learning to electronic health record data provides opportunities for personalized care and enhanced point of care clinical decision-making. ³⁰ Currently, much of these data remain underutilized due to concerns related to privacy, ethics, bias, and data quality.^31,32 By acquiring informatics competencies, nurse leaders can be better informed about the scope of digital health and critical issues that need to be addressed to optimize digital health in Canadian healthcare. Additionally, nurse leaders will be better prepared to advocate for the implementation of clinical data standards for nursing documentation (eg, admission, discharge) to enable the use of clinical outcomes for informing health policy-makers and funders, public health, and research directions. ³³ More importantly, nurse leaders with knowledge of data quality, privacy, and ethical implications can critically examine challenges and influence current policy decisions as it relates to the investment, implementation, and use of these tools in practice.

Moreover, with nurses being front and centre in virtually all aspects of care, nurse leaders can advocate for and identify indicators that can inform optimal nursing care and resource management. Based on the needs of patient care and these indicators, nurse leaders can collaborate with stakeholders to develop workflows and models of care that enable patients and families to receive the necessary care in a safe, timely, and effective manner. ³⁴ In addition, the availability of clinical and administrative data has proven critical in informing decision-making and resource allocation during large-scale, unpredictable events. ³⁵ Worldwide, healthcare organizations have implemented “command centres” to enable restructuring of operations to meet evolving healthcare needs and coordinate surge demands (eg, ventilators, critical care beds).^35–37 The abrupt transition to virtual delivery of health services during the pandemic also underscores the importance of enhancing nurse leaders’ informatics competencies. This knowledge will enable nurse leaders to view these new ways of care delivery as opportunities for transformative change and to strategically lead data informed initiatives within their healthcare organizations in a more informed manner.

Empowering nurse leaders to lead healthcare transformation

Nurse leaders across all practice domains are uniquely positioned to shape the future of Canadian healthcare through digital health. For this to happen, it is crucial that nurse leader informatics competencies (Supplementary Appendix 1 of Strudwick et al. ¹⁴ ) are embraced and integrated into their role functions. Several approaches are recommended to support the implementation of these competencies. For healthcare organizations, embedding these competencies as part of relevant position description and responsibilities may help nurse leaders, such as Chief Nursing Informatics Officers, exhibit and apply these skills and knowledge as they oversee and manage digital health investments within their organization. If the nurse leader informatics competency scale is validated, organizations may also support nurse leaders in using this instrument to identify opportunities for improvement to acquire and maintain these informatics competencies. ¹⁹ Organizations may also implement this scale to identify learning needs and inform the development of professional development programs (eg, courses, workshops, etc) for their current nurse leaders as well as for orientating and/or preparing future nurse leaders to work effectively with digital health solutions.

Nursing organizations can support and advocate for the adoption of these informatics competencies by embedding these competencies in current nursing leadership frameworks, such as that developed by the Registered Nurses’ Association of Ontario. ³⁸ Additionally, the Canadian Nurses’ Association can play a useful role in disseminating these competencies by developing supportive documents such as a position statement and/or delineating them within the defined scope of practice relevant to nurse leaders’ roles.

To ensure future graduates of nursing programs are prepared for digital health practice and leadership, it may be important to embed these informatics competencies in the graduate nursing curricula. Furthermore, nursing schools may consider developing specialty education programs in digital health. To date, there is no standardized curriculum for nursing administration and informatics. Although graduate-level informatics and nursing administration programs are growing, it is unclear whether curricula address nurse leader informatics competencies. The competency statements can provide a comprehensive framework to guide integration of informatics as well as the development of specialized program in digital health for nurse leaders. Such an undertaking is timely and crucial to ensure future nurse leaders are well prepared to champion and lead healthcare transformation through digital health and innovation. ³⁹

Conclusion

Adoption of the nurse leader informatics competencies is a critical step to empower nurse leaders and enable them to (a) contribute to a future vision for Canadian healthcare, (b) mitigate current challenges related to digital health solutions, and (c) advocate and advance digital health that enables the quadruple aim of healthcare. ⁹ Therefore, nurse leaders in all domains are called upon to embrace informatics as part of their day-to-day role responsibilities. To enhance awareness and continued learning about these competencies, the nurse leader informatics competencies scale is currently being validated and will soon be widely disseminated. As digital health technologies transform the way nurses provide care, nurse leaders can be instrumental in ensuring that nurses are active participants in the design, planning, implementation, and evaluation of these technologies to ensure optimal utilization and value to patients, families, and health systems.

Supplemental material