How can clinical informatics be applied to nursing council competencies? Can nurses demonstrate they meet the competencies for registered nurses that describe the nurses’ scope of practice?  In this series of articles, Deb Boyd discusses each nursing council domain, and how it relates to nursing informatics. This is the last article in this series - Domain 4: Professional responsibility.

Domain Four: Interprofessional Healthcare & Quality Improvement

This domain contains competencies to demonstrate that, as a member of the health care team, the nurse evaluates the effectiveness of care and promotes a nursing perspective within the interprofessional activities of the team. (Nursing Council of New Zealand, 2016)

Competency 4.1 
Collaborates and participates with colleagues and members of the health care team to facilitate and coordinate care. (Nursing Council of New Zealand, 2016)

This competency requires a nurse to demonstrate their ability to engage with their patients and other health professionals, documenting their patients care continuum (which includes the individualised plan of care), maintaining the clinical notes, developing a discharge plan and being able to make relevant referrals to ensure continuity of care. There are many ways that this is now completed within the digital health environment. One example of this is the electronic medical record. These can be developed to include care plans, which recognise an expected plan of care, with opportunities to note variations to the plan and make changes accordingly. Nurses skilled in Clinical Informatics help with the development of electronic medial records.  Another example of technology being developed to improve patient safety is the Early Warning Scoring tools that are widely used now. These systems have different alerts and rules built into them. If the patient develops changed vital signs that are outside of the normal range, alerts are triggered advising the nurse of the next actions to take. Electronic referrals (E-Referrals) to other services across primary, secondary and tertiary care are common across New Zealand now and enable efficient transfer of health information requesting services for patients.

Competency 4.2 

Recognises and values the roles and skills of all members of the health care team in the delivery of care. (Nursing Council of New Zealand, 2016)

This competency requires nurses to be able to demonstrate their ability to work across the multidisciplinary continuum collaborating, consulting and sharing health information appropriately with health consumers and health professionals. There is also a requirement to demonstrate knowledge and advocacy for the community services and resources available to their clients.
Clinical informatics translates well to this space. Technology and digital solutions offer health consumers access to information that we have never seen before. One example of this is the information from wearable devices which can provide feedback to health professionals and enable them to consult with primary providers regarding treatment options then providing those solutions to patients. This can be done so efficiently using technology, without the patient having to attend a clinic. This information is transferred from the wearable device and accessed by the nurse via an application, the information is considered, and a treatment option agreed. The treatment option is communicated via text, phone call, video call or email. Prescriptions can be sent electronically to a pharmacy and then delivered to the patient without them ever having left home.

Competency 4.3 

Participates in quality improvement activities to monitor and improve standards of nursing.  (Nursing Council of New Zealand, 2016)

This competency requires nurses to demonstrate their engagement with ongoing improvement in standards of nursing care delivery. Within clinical informatics, nurses have a wonderful opportunity to work with the developers of technology to identify system improvements that can be made. This information comes from understanding and reflecting on, their own user experience with the technology and their patients’ user experiences. It’s extremely important that nurses are included in all system development that is related to clinical care delivery.

Nursing Council of New Zealand. (2007). Competencies for registered nurses. Wellington, New Zealand: Author. (Amended September, 2016).

Deb Boyd is the CEO of Auckland Eye. She is a Registered Nurse, Certified Health Informatician Australasia, has a PG Dip in Health Services Mgmt and serves on the Board of HiNZ and Blind and Low Vision New Zealand.