Talking nursing informatics with Brittney Wilson also known online as “The Nerdy Nurse.” Brittney is a community manager for Next Wave Connect and has a background in clinical informatics. Brittney is also the author of The Nerdy Nurse’s Guide to Technology and she blogs about nursing, technology, healthcare, parenting and various lifestyle topics on thenerdynurse.com. Here’s that interview.
Jamie Davis: Hi, Brittney, welcome to Nursing Notes Live. It’s great to have you here joining us as our Get-to-Know nurse this month. We’re talking nursing informatics and we’ll get all into that in just a second. But I always ask our nurses the first question, which is why did you, Brittney, want to become a nurse?
Brittney Wilson: First of all, thank you so much for having me. The second of all is why did I want to become a nurse? My story for this is a little bit funny. It’s not the traditional I used to put Band-Aids on my baby dolls and would be the first to help when I was a little kid. I would love to be able to tell that story. The real truth is that I wanted to get into a profession that helps people and make people happy. When I was a kid, I wanted to be a country star. In fact, I just published a video on my Facebook channel that I may or may not regret that shows me winning a talent show when I was about 15 years old by yodeling to a LeAnn Rimes song. When I grew up and realized that not everybody can hit the lottery again the music industry, because that’s pretty much like hitting the lottery, I decided I wanted to be a plastic surgeon because, just like country stars, they make people happy and they bring quality of life rather than just quantity of life. At the time, I was naïve and thought that the only area of healthcare or medicine that dealt with quality of life was plastic surgery and how wrong I was. However, I wasn’t exactly sure that I wanted to get myself into 12 years of medical school and mountains and mountains of debt. That’s something I wasn’t 100% convinced that would be up for, I mean, do you really know you can handle blood in surgery and breaking bones and all that kind of stuff until you’ve actually done it or, at least, had some hand in the medical field? So I stopped off along the way to nursing school to see if I could cut it with all this healthcare stuff. It was very interesting. I didn’t realize that I wanted to be a nurse until at least six months after I was a nurse. But that was when I quickly discovered that nursing was truly the area of healthcare that dealt with body, mind and soul, and holistically the quality of life. It wasn’t about diagnosing somebody or stitching somebody up. It was about making sure that their pain was managed and that if they were dying, they did so with dignity and with the comfort of their family. So that story is a little bit complexed. But in short, I didn’t know I wanted to be a nurse until six months after I was a nurse and then it just kind of stuck.
Jamie: Awesome. It’s interesting. Everybody that is online and maybe knows you through your online persona as The Nerdy Nurse knows that you’re heavily involved with nursing informatics. But what was your career path like to get into nursing informatics? You didn’t just jump right for nursing school into that. You had some clinical application time at the bedside too, correct?
Brittney: Absolutely. In fact, it’s almost unheard of to go directly into informatics. Typically, the career path requires at least three to five years of clinical experience and even then it’s a real challenge. Mostly, informatics nurses you’ll meet are in their mid-40s because they want people who have a dynamic clinical skill set. However, I think we are starting to see that slowly shift because the clinical experience is fantastic. However, having a strong technical attitude is really something that the emerging informatics nurses need. I’ve noticed a lot of younger people coming into the forefront because they innately have those technology skills; whereas, some of the people who ran the profession before maybe just wanted to escape from the bedside. Informatics is very much a specialty where I filled a lot of questions. That people assume that since they’re tired of working on the floor they can just go there and it will be a rest. What I found is that the people who have tried to do that, who do get an opportunity and get their foot on the door, which is really hard especially if you’re really passionate about it, they often hate every moment of it. It is not an opportunity to rest. It is not a desk job where you can turn your brain off and not have to walk the halls anymore. It’s some pretty intense work. I probably did some of my most robust critical thinking in informatics. The basic way to get there without a degree - you can do it with a degree, without a degree - is to have three to five years of clinical experience with a strong technical aptitude and really know the name-of-the-game, know the talk and know the walk. So that means you’re doing a lot of research on your own, reading a lot of job descriptions, reading a lot of blogs. I read books. I read blogs. I read pretty much everything I could so that when I did my interview that even though I wasn’t an experienced clinical informatics nurse that I could speak like one and that they knew that I had the passion and put in the effort to send it home, to hit the ground running. In fact, my boss told me that they historically don’t hire people (A) as young as me or people who had the level of clinical experience I had three years. Really, at that point, they had stopped wanting to hire anyone that didn’t have any informatics experience because they had such bad luck. But the passion I did was what got me there and I’m confident that anyone who does the same sort of thing, they did that passionate, can do as well. The other path, the more traditional path, the more expensive path, is to get a Master’s degree. I am fully confident that the Master’s degree prepares you to be an informatics nurse. I have seen the course where I was actually investigating that for myself when I decided to give it a go without going back to school. I simply didn’t want to pay $20,000.00 for something that - what if I hated it? I was sure I wouldn’t but what if I did, right? So the Master’s degree will prepare you but they also a lot of times have job placement and it gives you such an edge over people like me, for example, who really have probably minimal clinical experience and don’t have anything on paper that says they’re certified or have any aptitude to do the informatics work. So those are the two ways you can get into it.
Jamie: We should probably clarify what nursing informatics is because there’s a lot of misconceptions out there about what is informatics. So how do you define “informatics” and what are some of the common myths you run into?
Brittney: Sure thing. Informatics is kind of funny because it lies in different areas of the hospital, in different organizations. It goes by about a thousand names – “clinical applications”, “clinical analyst”, “informatics nurse”, “informatics specialist”. I have been called about six different names even at one hospital. For a little while, they were calling me “clinical applications engineer”. And I was thrilled because “Wow, I’m an engineer. I don’t have to go to a tech school. I’ve become an engineer.” But the actual job work is pretty similar but varied. It depends on which department you live in and how your hospital treats you. So technically you could live in the Nursing department. You could live in the Administrative department. You could live in the Education department or you could live in the IT department, or the IS department depending on what your hospital call things. Most of them live in the IT Department and those that do actually function more as analyst than they do true informatics nurses - I’ll get on to the distinction in just a second - but a lot of what the people who work in IT departments, the nurses who work in IT departments do is computer analyst work. They troubleshoot issues. They run reports. They review applications. They plan upgrades and installs and make sure that everybody has what they need. A lot of what I did - and my role was actually, I took care of an entire home care department. I made sure all their nurses had all their devices, and so on and so forth. Depending on the size of your facility, different things lie with an informatics nurse that would normally be for somebody else. Now if they belong to that Nursing department or the Education department, which I have also seen, informatics nurses served more as educators. So they would be educating on these things in the system. They would be educating on new procedures. If there is a new type of documentation, they would be educating on that. They also probably heavily involved with some project management and planning implementation. But they wouldn’t actually do a lot of the software work behind it as far as actually getting the server ready, doing anything with the files that belong in the actual software. They may do testing but it’s a little less involved. I would say the same thing probably this for people who are in the administrative department as well. When you shift between those departments it really has a big difference on what level of technical hands-on skills you get to use. IT departments in most hospitals have gotten very funny about what they said IT departments do. Ten years ago you would have saw a lot of the work that is shifted to IT being done by nurse on the floor. She’d be called a “system administrator.” She’d still have her normal workload but she’d also be responsible for testing things and doing things within the system. Because of the regulations involved in healthcare IT, that work has shifted to an IT department with change control and change management, clear documentation around how things are done. So you see that work shift inside. So in a nutshell that’s kind of what they do. They essentially make sure the IT systems that are in place are running while they test the new upgrades. They implement changes to current systems. They project managed the whole darn thing which is probably where the most difficult parts of the job.
Jamie: One of the things I’ve heard a lot about – I actually had the pleasure to attend the recent American Nurse Informatics Association, the ANIA conference, and while I was there I heard all of the experts there that I interviewed talking about how all nurses really need to have a solid basis in informatics. Do you see that as something that is coming into the basic nursing programs or is this something that still really needed out there?
Brittney: Well, I can’t speak for exactly what their curriculum looks like today. It’s been a little while since I have been in nursing school, but it’s not been that long. I actually graduated in 2008. We had absolutely no informatics training. We literally document - we were taught the document on paper and we’re told, “Your facility probably hadn’t documented it sufficiently.” We didn’t really practice any of that. In fact, most of my clinical experience I didn’t get any of that. It wasn’t until you’re actually on the floor. I would assume that a lot of hospitals have upgraded that a little bit. At least students get to document on computer systems, but I would imagine beyond the actual hands-on of the documentation, there’s probably not a lot of training in the world of informatics and just technology in general. I saw that and I actually wrote a book about it. In the book, it’s actually targeted at two dynamically different skill sets at the same time which is kind of funny. It’s targeted at the over-50 nurse who has not grown up with this technology, who may be struggling with it and is not getting the type of training and education that they need at their facilities. Hospitals just don’t provide this sort of thing. And it also has targeted the students in schools who may have a really good grasp of technology but may not get the big picture. Because nurses in general don’t understand all that goes on behind the HER. They’re often told to do things without a great explanation of why - why it benefits their patients, why it helps the hospital get reimbursed, which is important as much as we all – I did get around subject of money. If the hospital doesn’t get paid, the nurses don’t get paid. I know we love our jobs, but we all have to get paid, we can’t feed our families otherwise. So I think if we improve that level of education as far as the why and the how and this is what matters, nurses are less likely to fight it because if they know it benefits their job and their patient and the overall care they provide, they’re more game to do it. Unfortunately, I’m sure that most nursing schools do not have that in their curriculum. Frankly, they have so much to stuff in there I don’t know where they put it. Sometimes the supplemental education – the books, the website, so on and so forth – are the things that nurses need to do that. I would say in the future I would hope it’s there but I still see this as something that the nursing schools are assuming people just kind of know at this point. But the sad fact of the matter is that even the ones that are using them today probably they don’t have the big picture knowledge of why we’re using the EHRs other than the fact that it’s the latest thing to begin with.
Jamie: Yes, I’ve read your book. It’s awesome. It’s one of those go-to things I point to the other people in the nursing field and beyond in healthcare as a way to really get your feet wet in technology and healthcare. One of the things I’m curious about is what you think the future holds. As a nurse journalist, I’m constantly seeing just amazing new breakthroughs in health technology, in apps for smart devices. I know you’ve attended Consumer Electronics Show in their digital health arena. What do you see the future holding for using technology to advance and improve healthcare?
Brittney: First of all, thank you so much for reading the book. It’s always an honor, a privilege to hear that somebody read anything I write especially the book. So thank you for that. As far as what’s on the horizon for technology in healthcare, it had gotten to the point where I don’t even try to imagine anymore because people think of things that are way beyond my grasp. We’re living in a time where technology is not something where you hope that when - 20 years from now you’ll see it. It’s literally six months from now there could be a Kickstarter and a year from that you could have it in your pocket. It is amazing and it blows my mind every day. For instance, somebody sent me an email the other day, a company I believe they’re called Echo and they have a new stethoscope, a digital stethoscope that uses Shazam technology. They partnered with the company that can detect what song is playing on the radio - to detect what heart sounds that you hear when you put a stethoscope on somebody’s chest. And it blew my mind. It’s not even super-expensive. A Littman Cardiology is $200.00 to $300.00. Instead this thing it’s $1.99 for the digital attachment and it’s $200.00 if you buy the whole kit and caboodle. And that is exhilarating because for me one of the hardest things was to detect heart sounds. I’m sure that a lot of the people that are going to be listening to this still have trouble detecting. Even if they work in cardiology, it’s difficult. If you have that one extra digital tool that kind of solidifies what your opinion is in the first place, it’s mind blowing. I really look forward to see the things that we could potentially do with technologies like Google Glass or the Apple watch. Not only for nurses at the bedside but actually patients. A company called the Sierra has an app that integrates with the EHR system that reminds nurse when to get medications. I believe Walgreens actually has an app for the Apple watch that reminds patients when to take their medications once they get home and they can verify that they’ve taken it so that they can have a clear record of compliance. We hear this all the time and we’ve said it two years ago, we said it 20 years ago but the future really is now. It’s absolutely mind-blowing the things that were coming out with. In fact, my husband just ordered – well, I ordered for him - something called a two-wheel self-balancing scooter which is essentially a Segway without a handlebar that you lean forward on this little two-wheel device that would you know we paid $300.00 for the thing. But it’s a propelling mobility solution that I could literally see nurses 10 years from now using to get up and down the hall. It’s so small and not invasive and doesn’t pick up a footprint. So this is the way that nurses can get from one end of the hospital to the other more quickly without running as we were. So little things like that can really add up to add a better value to patient care. I hate to predict where technology is going to go but it’s going to outdo me ten-fold.
Jamie: Yes, it’s funny. I just did an episode of one of my other shows that focuses on health technology. I was looking at a study out of Northwestern University that had used the data that every smartphone collects - GPS and data usage and different times spent on different apps. Using that collection of data, it was able to come up with an app that accurately predicted the presence of depression in the person using the phone. When they compared it to clinical diagnosis from a clinician, they were 90% to 95% accurate in the patient population they tested it was. That’s just incredible. Like you said, I never would’ve thought of something like that but there are people out there coming up with solutions to questions I didn’t even know to ask.
Brittney: Yes, absolutely. That’s the thing, like, that’s mind blowing. And you should be super-surprised. It should like blow our minds like we never would have imagined but although I wouldn’t have found out when you say it to me it makes total sense that kind of technology we have it and that is exactly the type of things that people do that with. You can see the patterns and what they look at to look at expression. It’s just a matter of creating algorithms and measuring things accurately. The fact that somebody was able to bring that together and the fact that we have the technology just here. They just have to add an – like an add-on app. They had that structure already in place. It’s amazing. It’s a beautiful time to be alive especially for technology innovators.
Jamie: So my final question for you actually is – it’s kind of a pitch for nurse bloggers out there and you don’t have to be a nurse informaticist to be a nurse blogger but I know you’re very active over at thenerdynurse.com. I just wonder what advice you would offer to maybe a nurse or a student nurse listen to this program that maybe – they’re not a nursing informaticist. Maybe they aren’t even really comfortable with technology but they feel like they might have a voice to share and why nurse blogging is so important.
Brittney: Absolutely. I would preface by saying I think all blogs are important. Nurse blogging is exceptionally important because it gives you an opportunity to put a voice in your profession. I used to be the nurse at the nurses station who would say, “Why is it like this? Why are we doing things like this? Why do we struggle? Why are we not given the staff that we need? Why are we not giving XYZ?” What I realized is that if you take the issues that define present healthcare and stop complaining about them and instead offer potential solutions as well as provide your honest feedback on situations that people will appreciate and respect you a lot more than if you just complain at the nurses station all day long. The other simple fact of the matter is that it is no longer as easy to get a job as nurses it once was. It’s become very competitive. Even if you have years of experience, you really need to do something you set yourself apart from the crowd. Blogging is something that gives you a personal brand. Now when I started about six years ago, I was really apprehensive that it would make me unhireable. In fact, I found that to be completely opposite. People are really impressed when I see that I’ve done something that propelled the nursing profession forward and I put something positive out there. So I will say that it can do excellent things for your career and, in fact, I’ve used it to triple my salary in the last three to five years, primarily through the blog and through opportunities I’ve gotten. In time that I earned from it. You can actually earn a living either part-time or full-time. So I think there’s a lot of excellent reasons to do it. I will say that if you’re going to blog you have to make a choice on whether or not you’re going to do so anonymously or you’re going to own your words. I don’t believe in doing it anonymously simply for the fact the matter that it makes you really easy to be negative and paint a very negative picture. While I don’t want to sugarcoat and pretend that negative things don’t go on in nursing, that sort of negativity online does not help anybody. In fact, it’s pretty easy even if you think they’re anonymous to figure out who you are. That sort of behavior can get you in trouble. So just word to the wise there. So I recommend owning your words and just being aware of what you say. Just like you would post on any social network. Not that anyone at any time could potentially read it even if you think that your words are private and paint a pretty picture. In doing so, you’re probably going to find that you’re going to see the world in a much brighter way and you’re also going to be able to add that to your resume that you’re an online thought leader and a collaborator and that you write works related to nursing issues and you solve problems. You’re really going to give yourself an edge over other people who are competing for the same top-role that you are. You may find that you get into a community that’s absolutely awesome. Nurse bloggers are some of the most supportive people that I’ve ever had the opportunity to be involved with. I see almost - once somebody say how thankful they are that they found this community because while other people support each other, we really help each other grow and we help each other evolve as not only online platforms but as businesses. These people are taking these tools and evolving and doing something off the beaten path and it’s really amazing. It’s something wonderful that I would encourage other nurses to at least investigate because I think they’ll love it.
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Make sure you check out the entire September 2015 issue of Nursing Notes where we take a look at the specialty of Nursing Informatics. You can read the entire issue online at www.discovernursing.com and don’t miss the other Nursing Notes Live episode this month where I sit down with Daniel Gracie, DNP, RN-BC. Gracie is a Senior Clinical Analyst Team Leader for Medical University of South Carolina and the current President-Elect for American Nursing Informatics Association. You’ll find this and other episodes of Nursing Notes Live in the podcast area on iTunes as well as our new podcast player on DiscoverNursing.com!