This reflective essay examines how a practicing emergency room nurse applies a systematic, evidence-based decision-making framework to evaluate a career transition into nursing informatics. Drawing on Karl Albrecht's concept of conscious living and Harris's definition of decision-making, the author walks through an eleven-step scientific process — from curious observation and problem definition to hypothesis formation and conclusion — to justify the move toward a specialty that integrates nursing, computer science, and information technology. The paper demonstrates how clinical reasoning skills can be transferred to major personal and professional decisions, ultimately affirming nursing informatics as a well-suited and forward-looking career choice.
In Brain Power: Learn to Improve Your Thinking Skills (1980), Karl Albrecht writes: "The typical human life seems to be quite unplanned, undirected, unlived, and unsavored. Only those who consciously think about the adventure of living as a matter of making choices among options, which they have found for themselves, ever establish real self-control and live their lives fully." Nurses are faced with decisions every minute of the day during their work. This is why learning how to make clinically based decisions is so important. It is necessary to make choices from an empirical perspective rather than from an emotional or personal one — being objective versus subjective.
Applying this concept to personal decisions is much more difficult, yet just as important. Making a choice about one's life without considering all the evidence would be unsound, especially when that choice is as significant as deciding on a future career. I made the right choice to enter the field of nursing several years ago. Over the past five years, I have experienced much personal and occupational growth in my position in the emergency room. Now, however, I believe it is time for a change into another nursing specialty. There are many choices, and I want to ensure that I make the right decision in pursuing nursing informatics. To do so, I applied a scientific approach to my personal decision similar to the one I use for clinical decisions.
In the decision-making process, alternative choices must be considered. It is necessary to identify and research as many alternatives as possible and to choose the one that has the highest probability of success or effectiveness and best fits with one's personal lifestyle and values. Harris (2002) defines decision-making as "the process of sufficiently reducing uncertainty and doubt about alternatives to allow a reasonable choice to be made from among them." With this definition, it is necessary to gather information to reduce — not totally eliminate — uncertainty. That, unfortunately, is the best that humans can do in most cases. Admittedly, risk is always involved in every decision, but that risk needs to be minimized as much as is feasible.
When I first considered changing careers, I entered the first stage of my career decision-making: Curious Observation — looking at my personal interests and identifying what I had liked best about my work experience and found most challenging. I began researching different careers by reading articles and talking with people in other nursing areas. In the second stage of decision-making, I defined my problem: "What career should I choose?" I began to examine my own skills and abilities and consider how I could apply them to other healthcare areas. I have always been interested in caring for others, which is why I chose a nursing career. However, underlying that interest was another ability and passion: computers and technology, which also go hand-in-hand with healthcare.
Thus, in the third stage — establishing goals and making plans — I researched nursing areas that involved technology and health information technology. Naturally, the list was very long; it included all the most advanced technologies nurses use on a regular basis, ranging from computerized patient information systems and ultrasound technology to virtual patient care. In steps four, five, and six of this eleven-step process, I continued gathering relevant information, began to eliminate choices that required too much additional education, were not practical for my current situation, or did not spark genuine personal interest. By the sixth stage — evaluating the evidence — I had narrowed down my choices to a few alternatives and began rating them on various criteria, such as degree of personal interest, educational parameters (length of study, cost, and degree offerings).
By this point, I also realized that I wanted to enter a newer specialty area for several reasons. First, newer areas tend to have a greater need for practitioners and offer more positions and opportunities. Second, I have always enjoyed challenges and the experience of something new. Third, I wanted to find an area that would sustain my interest over the long term — one that would continue to evolve so that I could grow along with it.
I was ready for step seven: making an educated guess or, as in the scientific approach, forming a hypothesis. I hypothesized that nursing informatics would meet the criteria I had established in the previous stage. According to the American Nursing Informatics Association, this field combines computer science, information science, and nursing science to support the management and processing of nursing data, information, and knowledge in order to maximize the efficiency of nursing care delivery. It appeared that in this specialty I could draw on my past experience, incorporate my interest in computers and technology, and continue to help others — both healthcare professionals and patients. The need for nurses with information technology experience is definitely growing, as is the broader field of informatics, which would keep me challenged and engaged for many years to come.
"Researching informatics and forming a hypothesis"
"Conversations, evidence gathering, and conclusion"
By going through this step-by-step process, I felt very confident in the decision I made from both a professional and personal standpoint. I definitely look forward to moving ahead with this decision and embracing the opportunities that nursing informatics has to offer.
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