National leaders share their plans to advance the digital nursing agenda
Working with data and technology must now become “business as usual” for nurses in the wake of the coronavirus pandemic, according to figures leading the National Digital Nursing Agenda. The response to Covid-19 has meant that more nurses than ever have become involved in digital transformation, and Nursing schedules was informed that it is planned to build on these foundations.
When Dr Natasha Phillips took over as England’s first National Director of Nursing Information (CNIO) in April 2020, the pandemic was just beginning and at that time ‘very few’ people knew what was a CNIO. However, just two years later, a growing network of CNIOs is in place at local and regional suppliers across the country.
It’s Dr. Phillips’ ambition to make sure every healthcare organization has a CNIO, which she says could happen soon. “I think we’ll see a significant change and come to a point in the not too distant future where every organization will have a senior nurse like that,” she said, though she noted that she doesn’t was not “married” to the CNIO title. , which is common in the United States.
Dr Phillips said that since the start of the pandemic, “many” head nurses had contacted her asking for help in recruiting a CNIO, and nurses in the field had adopted new ways of working digital. “We still have a way to go, but what I would say is that during the pandemic, many, many more nurses are working with digital technology all the time,” she said, citing the increased nurse-led virtual services and consultations.
Until last month, Dr Phillips was based at NHSX, a national body set up in 2019 to lead NHS technology, digital and data. At the start of February, however, NHSX was merged into NHS England as part of a wider merger which also involves NHS Digital and Health Education England (HEE). Her title remains CNIO for England, but she now sits on the ‘transformation directorate’ of NHS England. She said the move would mean “bringing the digital and the non-digital together,” which she saw as a positive step.
Looking ahead, Dr. Phillips pointed to two major publications she had planned that would support the advancement of digital nursing. The first is a nurse-specific version of NHSX’s What Good Looks Like framework, which would be aimed at executive-level nurses. It would provide a “cookbook” for digital transformation of their organization and address areas such as whether they have a CNIO and whether their electronic patient records include nursing content. It is expected to launch in the coming months and Dr Phillips suggested that the ‘cumulative effect’ of each trusted chief nurse implementing such measures ‘would see a massive shift in nurses feeling supported by digital technologies’ .
Additionally, she commissioned a major study of the HEE workforce, looking at how all nurses and midwives are prepared to work digitally. Scheduled to be published in 2023, the review, she said, “will be pretty crucial in getting a collective understanding of what we need to do, getting that investment, and really starting to move forward on the more strategic things that we need to do. . around undergraduate education [and] post-graduate education”.
Dr. Phillips also pointed out that work is underway around the “professionalization of nursing informatics”.
Asked about the remaining obstacles to transformation, Dr Phillips cited the shortage of nurses and the fact that staff were “exhausted” by the pandemic. However, she said digital “could be the opportunity that really helps with this”, for example by reducing the burden of paperwork and time spent on other administrative tasks.
Meanwhile, in Wales, significant progress has also been made. Fran Beadle, national clinical informatics manager for nursing at Digital Health and Care Wales, said that when she started in 2016 she was the country’s only nursing informatics specialist. There is now a nursing IT lead in each health board and trust, along with other digital specialist nurse roles.
The nursing informatics core roles were introduced in 2018 to support the roll-out of the Welsh Nursing Care Record (WNCR) – a digital documentation system with standardized nursing language – which is now available across five health boards. The roles were later made permanent in 2020 after being identified as a “key enabler for the digital transformation of health and care”, Ms Beadle said.
She said the WNCR project has been a “huge success” so far. While previous inquiries into care failures in Wales had raised concerns about nursing records, Ms Beadle, with the WNCR, said “nurses tell us they are really proud of their documentation”.
In terms of developing future digital nurses, she said there is now a ‘career path’ in Wales for health and care staff to become digital specialists, with courses ranging from certificate to mastery. Her organization is also working with Health Education and Improvement Wales on a digital capability framework, which was informed by the landmark digital health capability framework for nursing and midwifery in Ireland, launched in November 2021.
Compared to the US, Ms Beadle said the UK was “probably behind” in terms of nursing informatics. But she believed that was changing now, attributing the success to the collaborative approach taken between England, Wales, Scotland, Northern Ireland and the Republic of Ireland.
Dr Geraldine Shaw, director of nursing and midwifery at the Health Service Executive of Ireland, said an all-Ireland framework had been developed in response to the increasing use of digital technologies to deliver care to patients at both in the Republic of Ireland and Northern Ireland, and in recognition of the ‘important’ role of nurses and midwives.
She said it was intended to be a “guide” for individuals, employers and educators, rather than a “rigid set of skills” or a “professional standard”.
“The framework and its intended uses will support and enable nurses and midwives to develop and strengthen the care they provide, and to be in a strong position to advocate on behalf of the people who use our services in order to ensuring optimal access to, and use of, digital technology to improve health and well-being,” said Dr Shaw.
The Florence Nightingale Foundation (FNF) is helping to develop the pipeline of future CNIOs, offering digital leadership scholarships and fellowships, supported by sponsorship from Dr Phillips, Chief Nursing Officer for England Ruth May, and the Welsh Government.
The nursing charity will launch its third cohort this year. FNF chief executive Professor Greta Westwood said nurses and midwives had always been ‘absent’ when discussing digital transformation, and the aim of the scholarships was to give them a ‘voice’ .
“It’s really important that the things that make a difference or affect nursing [and] midwifery care, especially around digital care, digital innovations, are discussed and decided by nurses and midwives,” Professor Westwood stressed. She believed the emphasis on this program meant “we’re starting to see a sea change in the way nurses are heard” and, post-pandemic, there could be “no turning back”.
The College of Healthcare Information Management Executives (CHIME) also supports the program by offering digital leadership academics and masterclasses for nurses, including existing FNF digital academics and CNIOs.
Jane Dwelly, CHIME’s international vice-president, helped Dr Phillips conduct a ‘digital maturity assessment’ last year, which surveyed NHS acute trusts in England about their digital nursing staff. She said one of the “shocking” findings was the discrepancy between CNIO ranks, which ranged from band 7 to very senior. “What we got out of it was the feeling that the role of the CNIO is not very well defined, because I don’t think you would have [chief information officers] to group 7 – they would definitely be 8, 9 and up,” Ms Dwelly noted.
In the future, she wanted to see more emphasis on digital health when training nursing students. She said nurses were “particularly well placed to drive digital health transformation” due to their large numbers and “many, many patient touch points”.
Ms Dwelly believed that a ‘really positive and unintended consequence’ of the pandemic was to raise the profile of nurses in digital terms, as they were the ones who made sure that patients who had to stay at home still received support via digital means. “Nurses have been invited into multidisciplinary teams to talk about how they will manage patients in this emergency and their opinion has been sought to reach out to patients,” she said. “Hopefully, now that the emergency is almost over, they will continue to be brought into these discussions at the highest level.”
NMC Professional Requirements
The latest competency standards for registered nurses, updated by the Nursing and Midwifery Council (NMC) in 2018, include requirements related to digital literacy. They state that all nurses should, at the time of registration, possess the “technological competencies required to meet the needs of those in their care to ensure safe and effective nursing practice.”
Dr Geraldine Walters, executive director of professional practice at the NMC, said the code also clarifies “the professional requirement for people to continue to learn and keep abreast of new and emerging innovations in all aspects of their scope of practice throughout their careers”.
“We ask professionals to confirm that they achieve this every three years, during revalidation,” she added. “Overall, this ensures that nurses, midwives and nurse associates can provide the most effective care using both current technologies and emerging new technologies available to them.
This story is featured in the March 2022 Nursing schedules print magazine, focused on digital nursing. Read more content from the issue: