Nursing Competencies: Evidence-Based Practice and Informatics

Introduction to QSEN Nursing Competencies

The American Association of Colleges of Nursing and the Quality and Safety Education for Nurses (QSEN) have produced a joint document outlining six competencies associated with nursing practice (QSEN, 2012). These six competencies are quality improvement, safety, teamwork and collaboration, patient-centered care, evidence-based practice, and informatics. Quality improvement is associated with using data "to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems" (QSEN, 2012).

Safety refers to minimizing the risk of harm to patients. Teamwork reflects the ability to "function effectively within nursing and interprofessional teams, fostering open communication" (QSEN, 2012). Patient-centered care recognizes the patient as the source of control and a full partner in care. Evidence-based practice integrates the best current evidence, and informatics reflects the use of information and technology to "communicate, manage knowledge, mitigate error, and support decision-making" (QSEN, 2012).

The two competencies selected for this analysis are evidence-based practice and informatics. Together, they represent the most forward-looking dimensions of modern nursing and have the greatest potential to shape career trajectories in the 21st century.

Evidence-Based Practice and Informatics Defined

Evidence-based practice refers specifically to the reliance on hard scientific evidence in making nursing decisions. This may seem self-evident, but it stands in contrast to traditional nursing approaches that are grounded in various grand, mid-range, and practice-level nursing theories. Evidence-based practice as an approach demands that healthcare professionals maintain a high level of awareness about the evidence relevant to each clinical situation, and about what the best nursing approaches are based on that evidence (McKibbon, 1998). Nurses therefore need a grounding not only in how to acquire evidence, but in how to apply that evidence to their daily practice (Wood & Haber, 2005).

The theoretical basis for evidence-based practice is that facts are preferable to guesswork and untested theory. Evidence is gathered through hypothesis testing, and over time a significant body of knowledge accumulates to support certain interventions while disproving the value of others. Using what can be demonstrated to work is a principle that guides virtually every other discipline, and it follows that nursing should operate on the same foundation.

Informatics is a means of gathering, storing, and retrieving knowledge. It aligns closely with evidence-based practice, particularly where clinical decision-making systems are used. There are, however, other important dimensions to informatics — including the use of electronic health records to store and transfer patient information. Staggers and Thompson (2002) note that multiple definitions of nursing informatics have evolved over the years, tending to emphasize either the application of information technology to nursing or the performance of nursing tasks using information technology. At its core, informatics is the application of information technology to nursing practice; anything beyond that basic definition risks unnecessary complexity.

Since HIPAA established the expectation of electronic medical records as standard practice in healthcare, informatics has grown steadily more important. While virtually every other industry has been transformed by information technology, healthcare has lagged behind and remains one of the few fields where electronic record keeping is not yet universal. This trajectory makes clear that electronic health records and electronic decision-making systems will become standard across healthcare. The implication is straightforward: informatics will no longer be a specialty within nursing, but a foundational skill that every nurse and every healthcare practitioner must use daily. The theoretical basis for informatics competency, therefore, is that information technology will be a defining feature of healthcare going forward, and nurses with strong informatics skills will be best positioned to excel in that environment.

Factors Shaping These Competencies

The nurse must take responsibility for his or her development in both of these competencies. That begins with recognizing that evidence-based practice and informatics are among the most important competencies in the profession for the 21st century. The current environment — both technological and social — is well suited to support nurses who pursue these competencies. Informatics today is driven by the availability of mass data storage, high-speed retrieval, and powerful analytics systems. Nursing informatics a decade ago was considerably less capable, and two decades ago would be largely unrecognizable by today's standards. Given what is now possible, the profession must pursue the full potential of modern information systems to improve nursing practice.

The social and political environments reinforce this imperative. Electronic health records are mandated by law, and patient expectations are shifting accordingly. Younger patients in particular tend to expect their care providers to work from current evidence and to use information systems competently. If that is what the healthcare market demands, the nursing profession will need to meet it.

Other paradigms of nursing continue to be used, but the shift toward evidence-based practice and informatics has been underway for some time. In many other fields, evidence-based methods and information systems are already the primary tools for learning and decision-making, and healthcare is increasingly expected to follow the same path.

Conclusion

Two of the most important nursing competencies in the 21st century are informatics and evidence-based practice. These fit with the paradigm of the information age and the technology available today. In essence, evidence-based practice means making decisions based on what has been proven to work — ideally through scientific investigation. Informatics encompasses the information systems used in healthcare, with nursing informatics referring specifically to those applications relevant to nursing practice.

For nurses today, developing competency in both areas is essential. Most nurses enter the profession having studied various nursing theories and aspects of patient care through their undergraduate programs. Many schools devote limited time to either informatics or EBP, yet both deserve sustained attention. Many practicing nurses would benefit from committing to lifelong learning and a spirit of inquiry, returning for a master's degree to strengthen their knowledge in both areas. The reality is that patients will increasingly expect the nursing profession to be grounded in empirical evidence and to leverage informatics effectively to manage information and improve patient outcomes.

A master's-level nurse is expected to hold multiple competencies and will be regarded as a leader in the workplace. It is therefore important for nurses at this level to develop expertise in the areas that are most current and innovative within the profession. Ideally, such knowledge and skill will be acquired not only through formal education, but through ongoing training and learning — and that is how a meaningful nursing career, one committed to excellence and continuous improvement, will unfold.

References

Buysse, V., Winton, P., Rous, B., Epstein, D., & Inglim, C. (2012). Evidence-based practice. Zero to Three, March 2012.

Kitson, A., Harvey, G., & McCormack, B. (1998). Enabling the implementation of evidence-based practice: A conceptual framework. Quality in Health Care, 7, 149–158.

McKibbon, K. (1998). Evidence-based practice. Bulletin of the Medical Library Association, 86(3), 396–401.

McNeil, B., Elfrink, V., Pierce, S., Beyea, S., Bickford, C., & Averill, C. (2005). Nursing informatics knowledge and competencies: A national survey of nursing education programs in the United States. International Journal of Medical Informatics, 74, 1021–1030.

QSEN. (2012). Graduate level QSEN competencies. American Association of Colleges of Nursing.

Staggers, N., & Thompson, C. (2002). The evolution of the definition of nursing informatics. Journal of the American Medical Informatics Association, 9(3), 255–261.

Wood, G., & Haber, J. (2005). Methods and critical appraisal for evidence-based practice. Nursing Research.