Clinical Informatics: Interview with Vivian Mae A. Diaz, RN, BSN

My Specialty

Clinical Informatics: Interview with Vivian Mae A. Diaz, RN, BSN

Helping nurses to master electronic documentation

By Keith Carlson, RN, BSN, CPC, NC-BC
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Can you share with us the arc of your nursing career?

I began my career as an ADN and worked in a progressive care unit for about three years; it was very similar to a cardiac step-down.

After those first few years, I found myself wanting something new, so I took a position as a staffing coordinator. While serving as staffing coordinator, I was chosen to pilot a new nursing role in our facility as monitored bed coordinator. I was honored to take on that role. It’s been a very successful project. Serving in those roles opened my eyes to the other roles that nurses can fulfill.

As a young nurse, I initially thought that bedside nursing was the only thing that was open to me. Since expanding my view of what nurses can do, many new career avenues in nursing have become more tangible to me.

How did you move into informatics?

Since I was considered an EHR superuser and was very comfortable with charting in the system, I had the opportunity to help our facility during its transition from paper charting to the EHR. I saw a flyer about the clinical informatics coordinator position and decided to apply. The interview questions focused on our electronic infrastructure and my proficiency with the system. I did well and was offered the position.

What is it like being a nurse informaticist?

I’ve been in this role for a year now. For the most part, our job is to collect data that helps us to assess how our nurses are using the EHR. We then analyze the data in order to identify gaps in knowledge, workflow issues and identify any issues we may need to address. When we analyze data, we look at how it applies to the cognitive processes and workflow of the nurse. We ask ourselves how we can concisely and efficiently translate direct nursing care into the EHR so that what our nurses do is accurately captured in the electronic documentation.

We also analyze whether there are knowledge gaps in how our nurses use the EHR and whether the documentation workflows are interfering in any aspect of the nurses’ work with patients. If so, we provide education to address those issues. Furthermore, when new system enhancements are implemented, we provide education and training to the nurses for a smooth transition. Public speaking and nurse education are important aspects of what we do.

How do you feel about having a non-clinical role at this point in your career?

This question comes up a lot. I have honestly asked myself if I’m still a real nurse if I’m not providing direct patient care. I realized that in this role, I’m still taking care of patients, just in a different way. It took me a while to truly understand that my work within the clinical informatics department allows me to directly assist our nurses: easing their workflow, providing education and helping to maximize patient care and outcomes.

While I don’t provide one-to-one patient care at this point in my career, if I can make nurses more comfortable and conversant with electronic documentation, in the end, I actually help them to provide better, safer care.

Do you teach nurses how to prevent electronic documentation from impeding the nurse-patient connection?

One of the things we teach is how to make use of the system throughout the patient care workflow less awkward at the bedside. We teach our nurses how to perform real-time charting while also staying connected with the patient. Optimal use leads to increased efficiency and the ability to remain present and communicative with patients.

What’s an exciting change you see coming in electronic documentation?

New technologies are being developed in order to improve ease of use for our nurses. One potential change is the introduction of a coded ID card that will automatically logs the nurse onto the computer when she or he is standing in front of it. When the nurse walks away, they’re automatically logged off. This could be seen as a very small thing, but not having to log on and off multiple times per day would save a great deal of time and help the nurse be more efficient. In addition, new software is being considered in which patient acuity, calculated from nursing documentation, would directly determine the appropriate nursing staff required to cover each unit. This would enhance the current patient flow process.

If a nurse is interested in informatics as a career path, what should they do?

If you’re comfortable with computers, that’s a great start. Being able and willing to play around, learn what certain controls mean and become conversant with multiple systems is very helpful. Many EHRs are actually quite similar to the Windows operating system, so understanding Windows is a plus. Becoming a superuser can lead to an informatics career path.

There are master degree programs in informatics, of course, but you can begin with learning on the job. Also, it’s important to understand that informatics is more than just IT. Informatics also means having an understanding of nurses’ workflow, how and why they do what they do and how electronic documentation can enhance or hinder patient care and nurse efficiency and function.

What are some challenges you see in nurses’ comfort with the EHR?

We did an assessment and found a small group of nurses who are less conversant with the system. We’re trying to bridge that gap. Some older nurses are not as comfortable with electronic documentation because they were taught paper documentation before the age of computerization. At the same time, we’ve found that some of the older nurses are doing very well with it. We use a “train the trainer” approach.

We’ve learned to use the people who are more comfortable with the system as teachers for those who are struggling to catch up. It’s sometimes easier for a nurse who needs help to ask a trusted coworker a question rather than bring it up in class. So, we provide our nurse superusers with the materials to teach proficiency skills to their colleagues.

Among our nurse superusers, we identify individuals who might want a role within the clinical informatics department. We need nurses who would like to serve as clinical liaisons between informatics and the clinical staff. Nurse liaisons can more readily see what issues are coming up at the bedside and then relay those issues to us for analysis and problem-solving.

How do you see current developments in EHR technology impacting nursing care?

I think that EHR technology has improved nursing care enormously. While some people feel that it has decreased the nurse-patient connection, it has made our work as nurses more efficient and more accurate. And when we’re more efficient, we can learn to use that time to improve patient care, safety and the nurse-patient relationship.

What are your current career goals?

I’m currently pursuing my master’s of healthcare administration with a concentration in informatics at the University of Phoenix. An online master’s program is very convenient for a working parent. I love my work and how it helps both patients and nurses. I eventually want to assume more responsibility as a supervisor, nurse administrator or nurse executive here at Harbor-UCLA Medical Center. I’m looking towards the future.

 Keith Carlson, RN, BSN, CPC, NC-BC, has worked as a nurse since 1996 and has maintained the popular nursing blog Digital Doorway since 2005. He offers expert professional coaching for nurses and nursing students at

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