Richard Rees-Jones, lead nurse for informatics at Airedale NHS Foundation Trust
My journey into clinical informatics began almost ten years ago, when I was seconded as clinical implementer for the emergency department IT system at Leeds Teaching Hospitals NHS Trust.
I helped to get the system into the trust's two inner city emergency departments and two minor injury units. The role opened up a whole different world in which I could use my nursing knowledge, and gave me the challenge of helping non-clinicians understand how clinicians use IT systems.
I spent nearly two years in the role and was left as the only person in the trust who could manage the system and continue to tailor it to clinical need. I was also offered a job by the software suppliers as one of their clinical project staff.
All of this was great ego boost and affirmation of my value in the role. However, I decided that I wasn't ready to give up a patient-facing role, so I returned to life as an ED charge nurse for a few more years.
I also completed a Master’s degree in psychotherapy and counselling – which proved very useful when I returned to an informatics post six months ago! I’ve realised that a key part of the work is understanding people’s behaviours and knowing how to support them.
Other important skills for the job include:
- Fluency in different languages. That includes the language of nursing and wider healthcare disciplines, and also technology, projects and systems.
- Change management. It’s all about understanding people’s varying reactions to change, managing those reactions, and supporting individuals and groups to adopt systems and take ownership. Many people are anxious about change, so supporting staff to appreciate their ability to learn and adapt is really helpful.
- An ability and willingness to making unpopular decisions. A thick skin is essential: being the public face of change means that I am – on the whole – unpopular, until the dust settles and the benefits are visible.
One of the downsides of all this is that working in clinical informatics can be fairly insular, and you can sometimes feel a bit isolated. So I think my top tip for nurses who are thinking of taking up an informatics role would be to seek reliable and trustworthy support – make sure you think about your own resilience and self-care.
The challenges of securing formal roles
When I saw a six month secondment position of ‘lead nurse for informatics’ advertised at my trust, I knew I wanted to apply. But it’s never quite that simple.
Airedale NHS Foundation Trust has a high vacancy rate, and so I was told a six month secondment could not be supported. Bitterly disappointed, as I believed I would be valuable to the Digital Care Programme, I registered my interest and prepared to move on.
Then I received a phone call from my manager to say that they would support my application but not my secondment. If I wanted the post, and was successful at interview, then I would have to resign my permanent position - with no guarantee that the lead nurse for informatics role would be extended.
Our reaction at home was: "Which fool would take that risk?” Ten minutes later I was preparing my application for submission.
Because of my fixed term contract, my current remit is limited to implementing an electronic prescribing and medicines administration pilot, taking forward eRostering as an option for the trust, and moving on the concept of nursing documentation on an electronic system.
However, it has become clear that there is a need to have a permanent clinical voice associated with these systems, as they grow and evolve. So, it’s been five months of proving the worth of having a nurse in such a post, raising my profile, and high level networking. All new experiences; with the threat of unemployment being a great driver to perform!
It’s all about communication at all levels
I’ve found that communication and networking is key to keeping the role “alive” in the minds of my colleagues. Awakening people to how systems can improve patient care and safety also sells the worth of the post. And I've tried to make people think about how they can access me in the future to support improvements within their service area.
There has been plenty of “can you do this?”, “we want it to do this”, and “why doesn’t it do that?” Getting the staff to take ownership of answering these questions and moving their ideas forward is vital in making it real for them.
Otherwise, it’s something that they’ve suggested and no one cares about. The reality is that informatics projects have to be owned and commissioned by someone – but finances and workload mean that informatics cannot be responsible for everyone’s “wish-list”.
Despite being in a fixed term post, I can’t help but try and be visionary and look at where IT can take patient care in the future; how we can release nurses to be more patient focused, and aggregate data from several sources to drive better outcomes.
As we continue to climb the steep curve of technological development, more and more clinically relevant systems become available: in the past these systems have been made available without a controlled implementation.
The value of having nursing/clinical representation involved in all stages of system selection, implementation and evaluation/ maintenance is significant in realising the benefits for organisations and patients.
It also minimises unnecessary expenditure on, and deployment of, unsatisfactory systems. Clinical involvement helps to maintain the focus that health informatics is about serving patient care and delivering positive outcomes.
Postscript from Airedale NHS Foundation Trust (31 March 2015): Since Richard wrote this piece, we have extended his contract for a further 12 months as his input has proved invaluable to the project and the team.