Beyond Recognition: An Unequivocal Demand for Greater Investment in Nursing Practice, Nurses’ Technological Skills and Inclusion in Healthcare Decision-Making

While the recognition and support to nurses and midwives as they addressed of the pandemic is appreciated, the following, developed by the steering members of the HIMSS Europe Nursing Informatics Community, contains the real needs for nurses identified by nurses as well as strategic actions towards leveraging the pivotal role of nurses and nursing practice.

Statement

The pandemic has demonstrated the critical role nurses play in keeping our communities healthy, their tireless work in ensuring the resilience of our health systems, and the price they pay along the way. And although the amount of recognition, gratitude and praise has been undeniably received in abundance, this has not eased the challenges nurses face on a daily basis nor has it paved a better and more supported career path in the future. Acknowledging the fact that there is a global shortfall of 5,9 million nurses reported in the State of World’s Nursing Report 2020, and the impending reality that this shortfall will widen further in the future, we call for a firm action in supporting the professional and technological development of nurses, and alongside their inclusion in the healthcare management process by attaining leadership positions and compensation packages relative to those of their peers.

Context

Demystifying Recognition:

• Most countries in Europe don’t have a recognized senior role for informatics nurses, and if they do—for instance chief nursing informatics officer—they are not necessarily included in the decision-making.
• We have recognized nurses (and midwives) especially in 2020 with WHO designating it as the Year of the Nurse and the Midwife and in particular with the hit of the pandemic, but this has been perceived as a mare tap on the shoulders.
• Why have nurses not been included in developing protocols for vaccinations if their role on the front line has been recognized as critical? Recognition needs to imply a seat on the decision-making table.

Lack of Education:

• Let’s consider the digital revolution and the need of learning on digital tools and remote care as a way forward for the nursing field.
• Nurses are concerned about the lack of preparedness, but they are also concerned about the lack of support that they have received, feeling under-invested.

Nursing Informatics

HIMSS defines nursing informatics as the specialty that integrates nursing science, computer science and information science to manage and communicate data, information, knowledge and wisdom in nursing practice. It supports consumers, patients, nurses and other providers in their decision-making in all roles and settings. This support is accomplished through the use of information structures, information processes, and information and technology.

Nursing informatics, at its core, takes the clinical and the technical languages of health and translates them into one. It also promotes meaningful, user-friendly and patient-centric innovation while driving improved outcomes for patients and enhanced clinical workflows for healthcare staff.

Resolution

Nurses will have a major role to play in what comes after COVID-19. Their experience means they have a very powerful and legitimate voice that we must use to influence health systems of the future.

Aligning with WHO/Europe’s advocated efforts, we go beyond with tangible actions:

WHO/Europe Points	Proposed Actions
Improve their working conditions including through fair salaries	Ensure minimum wage for nurses and clear salary growth schemes/bonus packages that are comparable with those of peers at the same career levels/departmental roles. (1)
Invest in their education	Incorporate nursing informatics courses in nursing degrees and ministries to incorporate bespoke Informatics programmes for nurses. (2)
Expand their roles	Influence ministries and all healthcare providers to incorporate the role of chief nursing informatics officer/chief midwifery informatics officer (or digital leads) and make a seat in the management board. (3)
Protect their health and well-being	Ensure a focus on well-being in the workplace; protect patient-nurse/midwife ratios and cap caseloads at a safe level. (4)

 

Proposed Actions

1. Ensure minimum wage for nurses and clear salary growth schemes/bonus packages that are comparable with those of peers at the same career levels/departmental roles

Immediate Actions:

• Enable a traineeship scheme for nursing students that corresponds to the needs of the education curriculum and is of a limited duration. Ensure a remuneration comparable with those of peers in related industries, life sciences for example.
• Minimum wage for practicing nurse should be at least four times that of working students and should come in effect immediately once receiving the full-time employee status.
• In times of global health emergencies, ensure tax-free bonus packages that would be awarded universally and timely, without complex criteria and requirements that could affect the prospects of reward for the invested resources and sacrifice.

Long-Term Action:

• Enhance mobility of nursing professionals to, from and within regions and ensure fair and equitable compensation across all European countries.

2. Incorporate nursing informatics courses in nursing degrees and ministries to incorporate bespoke Informatics programmes for nurses

Immediate Action:

• Include informatics as required specialty and allow time for completion of nursing informatics courses in the first year of deployment of advanced practice nursing, clinical nursing informatics specialist and nursing practice roles.

Long-Term Action:

• Update nursing curricula with mandatory nursing informatics educational courses and training in the higher education level.

3. Influence ministries and all healthcare providers to incorporate the role of chief nursing informatics officer (CNIO) and make a seat in the management board

Immediate Actions:

• Introduce national advanced nursing informatics training schemes to onboard CNIOs for newly opened positions at health and care organizations.
• Introduce national roles for CNIO and deputy CNIOs of health systems and where appropriate, regional and local counterparts working directly with governments and regional/local health authorities.
• Impose digital nursing strategy to ministries of health and where appropriate, local and regional health authorities to be developed in collaboration with respective nursing associations.

Long-Term Actions:

• Launch higher education programmes for undergraduate and postgraduate specialization in nursing informatics or incorporate the science of nursing informatics in existing health administration informatics, public health administration and related academic programmes.
• Establish nursing informatics excellence centres with strong higher education collaboration for competence with in-practice involvement for competence building and traineeship of the next nursing workforce.
• Enable nursing-led hackathons and support nursing innovation by securing patents and training in application to patents as well as public or private investment in piloting nursing-led solutions. Provide financial incentives to hospitals that offer test-beds and support nursing workforce in driving innovation.

4. Ensure a focus on well-being in the workplace; protect patient-nurse/midwife ratios and cap caseloads at a safe level

Immediate Action:

• In times of global health emergencies, ensure dedicated times for wellness, mindfulness and relaxation exercises that could be taken in shifts to ensure continued patient care and uninterrupted delivery of the health service.

Long-Term Actions:

• Introduce minimum patient-nurse/midwife ratios across all European countries.
• Include dedicated times for wellness, mindfulness and relaxation exercises as part of the daily nursing practice.

Signing Parties

HIMSS Europe Nursing Informatics Community Steering Committee formed by:

• Outi Ahonen, Laurea Universities of Applied Sciences, Finland
• Shawna Butler, Nurse Economist. Radboud UMC, The Netherlands
• Susan Clarke. Clinical Lead, NHS Digital, United Kingdom
• Walter De Caro, President, CNAI -the Italian Nurses Association, Italy
• Loretto Grogen, National Clinical Information for Nursing and Midwifery Health Services, Ireland
• Mikko Harkonen, Development Manager, National Institute for Health and Welfare, Finland
• Daniel Johnston, Clinical Workflow Specialist, Imprivata
• Pirkko Kouri, PhD, PHN, RN, Principal Lecturer, Savonia University of Applied Sciences, Finland
• Jacqueline de Leeuw, Chief Nursing Informatics Officer, Radboud UMC, The Netherlands
• Angela Reed, Senior Professional Officer at NIPEC, Chair of the 5 Country Chief Nursing Officer, Nursing & Midwifery Digital Leadership Group, United Kingdom
• Kaija Saranto, PhD, Department of Health and Social Management, University of Eastern Finland
• Mette Maria Skjoeth, Head of Department, PhD, RN, Odense University Hospital, Denmark
• Caron Swinscoe, Chief Nurse (AI) & Clinical Informatics Professional Lead, NHS Digital, United Kingdom
• Anna Sort, Nurse; Founder, PlayBenefit, Spain
• Jeroen Windhorst, Chair, V&VN, The Netherlands