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This CNIO is a Nurse First

Analysis  |  By Jennifer Thew RN  
   May 10, 2016

Once on track to be a CNO, Amy Rosa took an unexpected detour to becoming a nurse leader and now uses her clinical experience, collaboration skills, and knowledge of informatics to affect patient outcomes as a CNIO.

"So you used to be a nurse?" I can't tell you how many times I've been asked this after explaining my non-traditional career path to someone.

When I started my career at the bedside in a large, urban teaching hospital, no one ever questioned whether I was a "real" nurse or not. I wore scrubs, passed out medications, and worked weekends. It was clear in the minds of many that I was a nurse, because that's what people believe nurses do.

But now that I'm working in the media industry again—I've moved between publishing and clinical care throughout my 17-year career—I'm back to having the "used to be a nurse" discussion.

Even though I spend the bulk of my day thinking about, talking to, or writing about nurses and healthcare, there always seems to be some question about whether I'm a nurse or not.  

I've seen this happen to other nurses as well. I once heard a radio piece where the reporter referred to Marilyn Tavenner, who was CMS administrator at the time, as a former nurse even though she still held an active RN license.  

I've also heard nurses who are COOs, chief patient experience officers, vice presidents of various services lines referred to in this "used to be a nurse," manner despite the fact that skills in collaboration, planning, implementing evidence-based policies and procedures, are the cornerstones of nursing practice.

Related: Big Data Means Big Potential, Challenges for Nurse Execs

A few months back, I talked about this phenomenon with Amy M. Rosa, RN, DNP, MSMI, chief nursing information officer, Baptist Health, Jacksonville, FL.

I brought it up because the more I talk with people about health information technology, the more I feel that nurses who work in the IT realm, are also getting that "used to be a nurse" label.

Below, she shares her thoughts on how RNs who have chosen IT as a specialty use their nursing skills on a daily basis and how she functions as a nurse leader rather than strictly a technology expert. The transcript has been lightly edited.

On the path to nursing leadership:

I was on a CNO track. I was being directly mentored by a CNO at a hospital I worked at for 14 years to eventually be in that position.

I was very much looking forward to it, but then life happened. The vice president of IT for that same organization had acquired a job [elsewhere] as CIO for a large health system in the same county.

It was at the same time that EMR implementations were firing up, and she had the foresight to realize she needed a clinical person on that leadership team to lead that change.

She offered me the job of manager of clinical applications. I had never done anything in IT before—ever. So I jumped into this and I was overseeing clinical applications for a health system of 8,000 people and learning it very fast.

The first thing I did was build relationships with the nursing executives at the facilities. I so much enjoyed [it] that I got my masters of science in medical informatics.

On becoming a CNIO:

I really wanted to pursue informatics leadership in a much greater, more strategic way. I wanted to be at the table, rather than just leading teams in a management role.

The CIO here at Baptist Health, Roland Garcia, has a great vision for that and they had listed a position for director of clinical informatics. When I interviewed, I realized that position would allow me the path to be involved [in that] manner.

They developed the CNIO position for me in the last eight months.  It's really thrilling and very flattering. The senior leaders went to bat and developed this position, so I'm the first CNIO here at Baptist.

This is a combination of my passion of nursing and the quality of information and seeing redundancies in healthcare—so all this stuff is really rocking my boat. I just love it.

On the value of clinicians in IT:

When I got here, the team was—and this is a phenomenon across the country—very implementation-oriented.

Even though they were clinicians, they had never been coached that once we get past implementation phase, your real value as a clinician is to understand how you can help design systems to affect patient outcomes.

There was a lot of coaching and encouraging them, that when they're sitting with their colleagues and designing systems, to keep in mind the whole tapestry, the whole long-term result, and [to think about] where that information flows across the system and [whether] we can design it a little bit differently so we can start making a difference with outcomes.

We're another department that is functioning as nurses affecting care, just in a different way.

You have analysts, you've got people that are familiar with designing systems, but not many people can take that information and design it to affect patient outcomes. You have to know clinical practice and be able to bring that to the table.

On how to collaborate with CNOs:

Being able to have collaborative strategic planning with the nursing executive team, I've worked very hard to educate them on IT. I feel that my role as their colleague is to sit at the table and tell them about what happens in IT so they're comfortable.

Any CNO needs to be aware of how IT runs and what the expectations are, so I've been trying to impart that information to them. [I also try] and bring more of the industry information, the health IT information to our executive meetings so they understand what is going on there as well.

Related: IT Rounding Pays Off for Nurses, Patients…and IT Staff

I have a dotted line to [the system CNO] Diane Raines, RN and I meet with her monthly, and 60% of my time is spent in clinical operations meetings.

I meet with my nurse execs individually, once a month, and I sit on the nurse executive team. Then I'm coming back and translating that with IT.

I do all that footwork and analysis and then recommend the approach that I think we should take for whatever has become, in my observation, priority for the clinical end user. We round, we do tracers, and every Wednesday I'm out there in scrubs.

Our support specialists wear scrubs. Our clinical informatics specialists wear lab coats so that we are seen as being part of the clinical team.

Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.

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