Margaret Ann Kennedy

As I pause to reflect on my journey in Nursing Informatics (NI), I am filled with a profound gratitude for the wonderful challenges, opportunities, and colleagues that I’ve encountered. NI has come so far since I, and many others, started on this path, and yet we still have countless opportunities and accomplishments to pursue. Starting out, most colleagues didn’t understand my focus in NI, dismissing it as “something to do with computers”, but I’ve witnessed the growth of our NI community and shared passion - which has emerged as an essential element in contemporary nursing practice. Great strides have been made in establishing NI competencies, positioning nurses with advanced NI skills to support implementation of health information systems, and nursing voices have helped shape the healthcare industry and the practice of NI. My journey is one that reflects four distinct experiences: 1) the rapid growth of a discipline, and emergence of a unique body of knowledge, 2) strength in the shared belief that nursing must be systematically documented and included in all healthcare discussions, all decision making forums, and in all national evaluations of healthcare, 3) finding a community of like-minded nurses, irrespective of jurisdictional or international borders, who share my passion and are committed to authentic innovation, and 4) an enduring belief that fostering relationships among nurse infomaticians empowers the very profession of nursing.

I began my nursing career at a time when paper records were the sole mechanism of documentation in healthcare. Despite my initial fascination with the range of health care technologies, it quickly became apparent to me that technologies of every type were merely tools to support professional practice, generating data to support clinical decisions. As I gained experience, clinical documentation became a primary source of interest, including the language and terminology used to represent nursing care and patient outcomes, the diversity of completeness, and the tools used to communicate key elements of care. Being able to aggregate patient data and quality care metrics was also a source of interest to me as a unit manager, informing leadership decisions and preparing for organizational activities such as unit reporting and accreditation.

My graduate education at the Dalhousie University School of Nursing provided a rich environment supporting my interest in innovative data utilization. The availability of data previously collected in a national survey was serendipitously available and I took the opportunity to conduct the School’s first “secondary data” thesis. After completing my graduate studies, I followed a path in academia and explored the emerging use of technology to support “just in time training” and to generate clinical skills testing. These early commercial tools were Disk Operating System (DOS) products and although they were frustratingly primitive, they prompted me to perform gap fit analyses and evaluate not only functionality, but also the actual pedagogy of digital education tools. This eventually led me to distance education and leading the development of dynamic online courseware. For the next decade, I focused on contributing to my local and regional nursing informatics networks, serving a term as President of my provincial nursing informatics group, and supporting the provincial health information system implementation. Throughout my academic journey, I taught undergraduate courses in nursing informatics, promoted nursing data and documentation standards, and consulted on health and nursing informatics.

Mentorship is a critical factor in many career trajectories, including my own. The single most influential person in my informatics career was, and continues to be Dr. Kathryn Hannah. In the late 1990’s Dr. Hannah’s leadership in nursing informatics was featured in the Canadian Nurse, the professional journal of the Canadian Nurses Association. I promptly emailed Dr. Hannah about my interest in nursing language and the International Classification for Nursing Practice (ICNP^®), and she immediately responded and arranged to meet with me in person. Dr. Hannah provided key support and mentorship as I evolved my preliminary PhD research topic to focus on ICNP’s representational capacity. Over the years, she has been a critical mentor, PhD Supervisor, co-author, co-editor, colleague, and cherished friend.

Since completing my PhD, my commitment to nursing informatics has been targeted at the national and international levels. The Canadian Outcomes forBetter Information and Care (C-HOBIC) was a landmark project that proposed to document patient outcome data related to nursing care and was a career highlight. I mapped the original indicators for this project into ICNP^® Versions 1 and 2, and subsequently led an international group of nurse experts through a validation process and making recommendations to the International Council of Nurses (ICN). Ultimately we published the C-HOBIC work through ICN as the Nursing Outcomes Indicators Catalogue, which is currently being mapped to SNOMED CT. This suite of patient outcome data elements is the first nursing standard ever designated as a Canadian Approved Standard, and is formally approved by both the Canadian Nurses Association and Canadian Nursing Informatics Association.

My nursing informatics journey has led me to roles in health information standards in Canada and internationally at standards development organizations (SDOs), to educational roles including invited faculty at the National Institute of Nursing Informatics at the University of Toronto Bloomberg School of Nursing under the direction of Dr. Lynn Nagle, and sessional faculty at Athabasca University Master of Nursing program, to leadership roles including President of the Canadian Nursing Informatics Association, International Board member of the Health Information Society of Ireland (HISI), and the Technology Informatics Guiding Educational Reform (TIGER), and roles in Scientific Committees for ACENDIO, IMIA-NI, CNI and COACH. My role at Global Village Consulting is quite possibly the most rewarding of my career, in that it allows me to leverage the full scope of my interests and skills – directly supporting clients in their journey to implement health information solutions, developing talented health information consulting teams, mentoring students and new generations of health informaticians, and provoking the evolution of our discipline through leadership roles in our professional associations.

My enduring interest and priorities for nursing informatics continue to be the accurate and effective representation of nursing data, promoting nursing representation in interprofessional health informatics discussions, fostering the establishment of nursing informatics networks, and advocating for senior nursing informatics roles to ensure that the clinical component in informatics continues to inform decisions, strategic directions, and values well into the future.

My journey thus far has been filled with the excitement of key nursing informatics accomplishments, moments of discouragement that provide lessons and inevitably turn into momentum builders, opportunities to contribute to Canada’s electronic health record and informatics community, and the delight of colleagues who bring such a rich tapestry of passion, expertise, and commitment to a domain that we all hold dear. This informatics career path has been incredibly rewarding and inspirational, and as always, I’m excited to see where the next bend in the road will take me.