Lynn Nagle

A Journey to Becoming a Nurse Informatician

My journey to becoming a nurse informatician began in the mid-80's while working as an instructor in a School of Nursing on the east coast of Canada. In this role, I had the opportunity to work in a newly constructed acute care centre which opened with a fully functional first generation hospital information system. Unknown to me at the time, there were only a handful of other such facilities operating with this new technology in all of Canada. The system was monochrome (black and white) with data entry supported by a tethered light pen pointing-selecting device, and supported the functions of: ADT, order entry (physician entered), results review, nursing care planning and all documentation including eMAR except for clinician progress notes. Although all online documentation was printed either on demand or q24h for all updates and maintained as the patient record in 3-ring binders for general access, it was readable, legible and accessible to all clinicians with authorized access. Spending 2 years working with this system, I came to realize the benefits and yes, also some of the clinician frustrations with the system, in my view it still beat the paper record hands down. The use of this system pre-dated personal computing and any computerization that existed in the rest of the hospital and nursing school setting was limited to the use of early word processing devices. Handwriting, copying machines, typewriters and overhead projectors remained the most pervasive document producing and reviewing methods of the day.

Shortly thereafter, I began my first foray into graduate studies, moving to Toronto to begin my Masters of Science in Nursing. While doing so, I found part-time employment as a staff nurse in one of the city's most prestigious academic health science centres. When arriving for my first shift, I was surprised to discover that the use of computerized hospital information systems was not common. Indeed I had expected that an large, urban centre such as Toronto would be much further advanced in this regard than the small cities of the Maritime provinces. This was definitely not the case and I found myself reverting to the paper, hand-written documentation that had been the basis of my formative nursing years. This reversal of function left me lamenting the loss of accessibility, legibility, readability and consistency of patient charts.

Nonetheless my interest in making more nurses/clinicians aware of the possibilities for computerization in healthcare was shared by a colleague who encouraged my pursuit of further networking and knowledge development in informatics. At the time, most opportunities to connect with like minded individuals were serendipitous but also purposeful in my attendance and participation in relevant conferences and meetings. I subsequently pursued my PhD in nursing at the University of Rochester; PhD options for nurses in Canada were limited at the time and there were no nursing doctoral programs. I had the fortune to find a supportive chair who enabled me to pursue my interests within the context of a program that was not specifically informatics oriented. I was able to construct my coursework and assignments to meet my interest and informatics learning needs. Upon completion of my doctoral work, I returned to Toronto and assumed a Director of Nursing role which in addition to having clinical unit oversight responsibilities, held me accountable for creating an Informatics Program within nursing. I was among a small handful of nurses in Canada who had any such designation related to informatics. The work was challenging, but required much political and professional maneuvering to achieve any credibility, perceived relevance and value to nurses and non-nurses alike; what was this thing called informatics anyway and what did it have to do with clinical practice.

In the years that followed, I began to teach a graduate course in Nursing Informatics at the University of Toronto. Although an unknown entity to a majority, the course quickly became popular through word of mouth was always filled to capacity; and while less of a foreign concept it remains tremendously popular today. My teaching was an opportunity to advance nurses' awareness and understanding of informatics, but I have always kept my foot in the practice world. I eventually assumed the role of Chief Information Officer in an organization in the years prior to Y2K and continued through the following decade. I subsequently left this position to establish my own health informatics consulting practice and to this day, have no shortage of work.

Over the course of almost two decades, my expertise and reputation had grown significantly, I had arrived.

While the journey has been long and by times painstakingly slow and frustrating, I have absolutely no regrets about my chosen path. My career has been rich and challenging and afforded me incredible opportunities to work with colleagues locally, nationally and internationally. To this day my work remains extremely gratifying both as an educator and as a consultant in health informatics. To those uncertain of possible professional paths in informatics, there are many practice, education and research gaps yet to be addressed - without a doubt there are enough opportunities to fill the careers of many nurses for many years to come.