Developing Informatics Competencies of ICU Novice Nurses Based on Miller’s Pyramid Model Case Study

Sir Run Run Shaw Hospital (SRRSH), affiliated with the Zhejiang University School of Medicine, was established in 1994 and is located within the Zhejiang province in China. Over the last 23 years of comprehensive scientific development, SRRSH has developed into a tertiary, research-oriented general hospital with two campuses (Qingchun Campus and Xiasha Campus) totaling 190,333 square meters with 2,400 beds, 32 clinical specialties, 77 nursing units and nine ancillary departments.

SRRSH is the first public hospital in China accredited by the Joint Commission International for four times in succession. From 2014-2016, SRRSH was named in the “100 Best Medical Organizations to work for in China.”

The nursing service campaign promoted by the National Health and Family Planning Commission of the People’s Republic of China have raised higher requirements for nurse core competencies. In addition, the growth of the nursing profession since the 21st century has developed substantial evidence which links IT with improved patient safety, care quality, access and efficiency.

However, nurses took over general documentation duties beyond primarily nursing issues, as they are highly involved in patient process and information management. It can therefore be concluded that there is a great demand for competencies in managing patient data and processes electronically, operating the technical systems, knowing about their context in terms of data quality and availability, confidentiality and integrity.

There is a concern that many nurses may not possess these capabilities and nurse educators may not get prepared to teach them. Furthermore, traditional methods applied in educating nurses do not concentrate on the clinical information competency.

Deficits in IT competencies are a significant concern, because our hospital has mandated a complete implementation of an EHR system early this year. EHRs require all nurses to use IT to deliver, document and obtain reimbursement for patient care. IT will no longer be an add-on; it will be ubiquitous, fully and seamlessly integrated into every aspect of care, documentation and reimbursement. Informatics competencies are essential for basic functioning at SRRSH and simply a foundation for higher-level practice. Therefore, informatics competencies must become a critical element of basic nursing orientation.

Intensive care units (ICU) are specialized medical environments with sophisticated monitoring facilities for critically ill patients. It requires nurses to have highly developed professional skills. ICUs at SRRSH abandoned manual documentation early this year. Informatics competencies were not a concern in the previous ICU orientation program.

Nurse managers, educators and five experienced instructors in the SRRSH ICU worked jointly to design activities that will help new nurses gain informatics competencies. We also invited 10 inexperienced nurses to engage in the design to fully understand how to support their learning needs. We chose Miller’s pyramid model as the framework of this effort, as the team successfully completed a comprehensive orientation program for ICU novice nurses in 2010.