A Delphi Study to Determine

Informatics Competencies for Nurses

at Four Levels of Practice
Nancy Staggers ▼ Carole A. Gassert ▼ Christine Curran

Background: Despite its obvious need, a current, research-

based list of informatics competencies for nurses is not
available.
T he message is clear from healthcare leaders and
organizations. Healthcare professionals need to
have informatics knowledge and skills (AACN 1997,

Objective: To produce a research-based master list of infor- 1998; Gassert, 1998; IMIA, 1999; Pew, 1998). These can
matics competencies for nurses and differentiate these com- range from how to use a clinical application or knowledge
petencies by level of nursing practice. about basic technology terms to more advanced concepts


surrounding nursing structured languages or evaluating the
Methods: After a comprehensive literature review and item
impact of a clinical system on practice. Because of the need
consolidation, an expert panel defined initial competencies. to manage data volume and complexity, nurses need infor-
Subsequently, a three round Delphi study was conducted to matics skills and knowledge for survival in any arena.
validate the items. Participants were expert informatics As early as 1988, the National League for Nursing
nurse specialists in the United States of America. published categories of informatics competencies for

Results: Of the initial 305 competencies proposed, 281 com- nurses. These were developed by a workgroup from the
petencies achieved an 80% or greater agreement for both International Medical Informatics Association or IMIA
importance as a competency and appropriateness for the (Peterson & Gerdin-Jelger, 1988; Grobe, 1989). More
correct practice level. Five competencies were rejected. Six recently, the Pew Commission affirmed that communica-
competencies were considered valid competencies but the tion and information technologies were 1 of 21 compe-
appropriate level of practice could not be agreed upon. Thir- tencies required by all health professionals (Pew, 1998).
The American Medical Informatics Association (AMIA)
teen competencies did not reach any consensus after the
focused the entire 1999 AMIA Spring Congress on the
three Delphi rounds. informatics education of health professionals (Staggers,

Discussion: The Delphi study had a high rate of participation, Gassert & Skiba, 2000). Within nursing, the American
demonstrating the great level of interest and need for a list of Association of Colleges of Nursing (American Associa-
informatics competencies for nurses. Out of the initial 305 tion of Colleges of Nursing, 1998) and the National
competencies, only 24 items were not validated. Respon- Advisory Council on Nursing Education and Practice
dents commented during each round about whether com- (Gassert, 1998) released general guidelines about nurses’
puter skills should be considered informatics competencies. education in healthcare and information technologies.
The authors propose that computer skills, while not high More recently, IMIA approved broad guidelines and core
level, are one set of tools within the larger category of infor- informatics concepts for information technology (IT)
matics competencies. This sample of experts did not deem users and specialists in health informatics (International
programming skills as necessary for informatics nurses. This
research study is an initial effort to fill the void of valid and Nancy Staggers, PhD, RN, FAAN, is Associate Chief Information
Officer, Information Technology Services, and Associate Profes-
reliable informatics competencies. It is the first study to span sor, Clinical Informatics, University of Utah, Salt Lake City.
four levels of nurses, create competencies for both entry- Carole A. Gassert, PhD, RN, FAAN, FACMI, is Informatics
level and experienced informatics nurse specialists, and Nurse Consultant, Division of Nursing, Bureau of Health Profes-
examine the categories of computer skills, informatics sions, Health Resources and Services Administration, Rockville,
Maryland.
knowledge and informatics skills.
Christine Curran, PhD, RN, CAN, is Director, Nursing Infor-

Key Words: informatics competencies • nursing informatics matics and Research, The Ohio State University Medical Center,
competencies and Clinical Associate Professor, College of Nursing, The Ohio
State University, Columbus.

Nursing Research November/December 2002 Vol 51, No 6 383

384 A Study to Determine Competencies Nursing Research November/December 2002 Vol 51, No 6

Medical Informatics Association, 1999). Hebert (2000) Perceptions About Competencies

stated, however, that to date informatics has belonged to Verhey (1999) evaluated students’ perceptions pre and post
the specialists. Instead, all nurses would benefit from computer literacy training finding that perceptions about
technical, conceptual and applied skills in nursing infor- knowledge and skills improved after training. Austin (1999)
matics (NI). on the other hand, surveyed nurse educators about their per-
In addition to guidelines, authors published specific ceptions of instructor competence in 60 computer literacy
material about informatics knowledge and skills needed by skills as well as the integration of these skills into baccalau-
nurses. Unfortunately, authors did not agree about the com- reate education. Austin discovered that 21 of the 60 skills
petencies required for nurses, they did not publish compe- were performed at least “well” by 50% of the respondents;
tencies for advanced informatics nurse however, only 3 of the 60 skills were
specialists, and the lists are not current. integrated into teaching by at least 50%
Thus, a recent, research-based, and vali- of the educators surveyed.
dated list of informatics competencies is Carter and Axford (1993) studied
not available to guide curricular devel- the computer learning needs of 96 clini-
opment in formal education programs. cal nurses with either beginning or
Likewise, employers have no validated Computer skills, while not expert computer knowledge in Aus-
informatics competencies to apply to high level, are considered a tralia. They only agreed that one area of
nurses’ performance in the work setting. competency was essential, the one
The purpose of this study was to component of informatics addressing practical knowledge and
produce a research-based master list of competencies skills for computer operations.
informatics competencies for nurses
and to differentiate these competencies Lists of Competencies
by level of nursing practice. A master Using a two-round Delphi technique,
list is a comprehensive set of skills and Armstrong (1986) surveyed a panel of
knowledge that nurses exhibit across nurse educators about present and
sub-specialties within the field. It does future needs for computer competence
not necessarily mean that every nurse at a given level in nursing practice and teaching. The resulting list included
would be competent in all items at that level. For exam- psychomotor, cognitive and affective competencies in the
ple, an informatics nurse specialist would not be expected areas of: (a) knowledge about computer technology, (b) the
to be competent in all 174 identified and validated com- nurse’s role and issues with computers, and (c) computer-
petencies. ized documentation development.
With the creation and validation of these competencies, Later, Bryson (1991) developed a comprehensive list of
this study is the first one to span four levels of nurses, cre- competencies from nursing educators’ perceptions about
ate informatics competencies for both entry-level and expe- the amount and kinds of computer training needed in bac-
rienced informatics nurse specialists, and examine the cate- calaureate programs. This list was organized by seven
gories of computer skills, informatics knowledge and computer literacy domains, including knowledge, atti-
informatics skills. tudes, and computer skills. The list included: (a) basic com-
puter hardware and software, (b) computer operations,
and (c) understanding the concepts of programming (not
Review of the Literature programming courses). Staggers (1994) measured com-
The following terms in combination with the words puter experience across levels of nurses with a 43-item tool
“skills, competency, literacy or knowledge” were used to assessing: (a) computer knowledge and computer uses, (b)
search databases for relevant literature: (a) computer, (b) hospital information knowledge and uses (c) nursing infor-
information technology, (c) information systems, and (d) matics specialist role activities, and (d) the number of
informatics. In additional to numerous terms, the authors informatics/computer courses completed. For informatics
used several databases to locate literature, including MED- students’ self-assessment, Gassert and MacDowell (1995)
LINE, CINAHL, PubMed, and HealthSTAR. The resulting developed a list of computer literacy, systems analysis, and
literature is organized into major themes: (a) categories of informatics role skills.
competencies, (b) perceptions about competencies, and (c)
past lists of competencies. Observations About Studies
A majority of these cited works were based in academic
Categories of Competencies programs and examined either nursing faculty or students’
Authors do not agree about categories of NI competencies. perceptions about informatics needs or competencies
Some emphasize computer literacy skills (Walker & within educational programs (Staggers, Gassert & Curran,
Walker, 1994; 1995; Lewis & Watson, 1997); while others 2001). Carter and Axford’s (1993) study is unique in that
speak to information literacy (Verhey, 1999), a combina- the sample is bedside clinical nurses; otherwise, samples
tion of informatics knowledge and computer skills (Arm- were students and faculty.
strong, 1986; Bryson, 1991); patient-centered information The studies dealt more often with entry-level compe-
(Travis & Flatley Brennan, 1998); or methods for integrat- tencies (computer skills) than those needed by either expe-
ing competencies into nursing curricula (Riley, 1996; Van- rienced nurses or nursing informatics specialists. The
derbeek & Beery, 1998). knowledge and skills informatics nurse specialists require,
Nursing Research November/December 2002 Vol 51, No 6 A Study to Determine Competencies 385

FIGURE 1. Information Management Framework.

e.g., systems analysis, or system selection techniques, are ciency in the use of computer hardware and software. Com-
outlined in only two publications (Staggers, 1994; Gassert puter skills, while not high level, are considered a compo-
& McDowell, 1995). However, the knowledge and skills nent of informatics competencies.
required by highly experienced and/or educated informat- Other elements in the framework include informatics
ics nurses (e.g., great depth of expertise), were absent. knowledge and skills, a set of competencies beyond just
Except for Staggers, authors did not address specific com- learning how to manipulate computer technology. As the
petencies across several levels of nurses. initial list of items were examined, they inductively sepa-
The available publications built less upon each other rated into the categories of informatics skills and knowl-
than was anticipated (Staggers, et al., 2001). For example, edge. Informatics knowledge is the theoretical and con-
the validated competencies from Armstrong (1986) and ceptual basis for the specialty, while informatics skills are
Bryson (1991) have been available for many years, but the use of methods, tools and techniques particular to
their adoption into curricula is not yet evident. More informatics. For example, informatics skills include tech-
important, these informatics competencies are seemingly niques and tools in systems analysis and project manage-
absent from competency determinations within work set- ment. Informatics knowledge includes familiarity with
tings. In summary, then, there is a critical need for a cur- nursing taxonomies and reasons for systems slowness. The
rent, research-based and specific list of informatics compe- larger construct of information management includes
tencies for nurses at various levels of practice. skills in cognitive information processing capabilities.
However, this study focuses upon informatics competen-
cies and the antecedent categories represented in the con-
Framework for the Study ceptual framework.
The authors developed a conceptual framework to guide the
study (Figure 1). The terms and concepts in the framework
were derived from a synthesis of nursing and informatics
Methods
sources. The skills and knowledge concepts were basic con- To validate the competency statements and level of perfor-
cepts mentioned in literature about competencies in nursing; mance, the study included five steps: (a) competencies were
these two concepts are foundational for competency devel- extracted from the literature, (b) unique competencies were
opment. The informatics terms evolved from categorizing listed, (c) competencies were leveled and expanded by an
the 1,159 database items extracted from the literature. To be expert panel, (d) pilot test was administered, and (e) three
consistent with the competency literature, the authors chose Delphi rounds were conducted. The initial competency
the term computer skills to represent basic functioning with development in steps (a) through (c) is described elsewhere
technology. This term corresponds to others used in the lit- (Staggers, et al., 2001). The levels of nurses are defined in
erature i.e., computer literacy or information technology Table 1. After step (c), the list of competencies included
skills. Computer skills is defined in this study as the profi- 304 statements in 39 categories (Table 2).
386 A Study to Determine Competencies Nursing Research November/December 2002 Vol 51, No 6

TABLE 1. Definitions for Levels of Nurses

Beginning nurses (Level 1) have fundamental information management and computer technology
skills and use existing information systems and available information to manage their practice.
Experienced nurses (Level 2) have proficiency in their domain of interest (e.g., public health,
education, administration). These nurses are highly skilled in using information management and
computer technology skills to support their major area of practice. They see relationships among data
elements, and make judgments based on trends and patterns within these data. Experienced nurses
use current information systems but collaborate with the informatics nurse specialist to suggest
system improvements.
Informatics specialists (Level 3) are registered nurses prepared at least at the baccalaureate level
who possess additional knowledge and skills specific to information management and computer
technology. They focus on information needs for the practice of nursing, which includes education,
administration, research and clinical practice. Informatics specialists’ practices are built on the
integration and application of information science, computer science and nursing science. In their
practice, informatics specialists use the tools of critical thinking, process skills, data management
skills (includes identifying, acquiring, preserving, retrieving, aggregating, analyzing, and transmitting
data), systems development life cycle, and computer skills.
Informatics innovators (Level 4) are educationally prepared to conduct informatics research and to
generate informatics theory. These nurses lead the advancement of informatics practice and research
because they have a vision of what is possible, and a keen sense of timing to make things happen.
Innovators function with an ongoing healthy skepticism of existing data management practices and
are creative in developing solutions. Innovators possess a sophisticated level of understanding and
skills in information management and computer technology. They understand the interdependence of
systems, disciplines, and outcomes, and can finesse situations to maximize outcomes.

Pilot Test “develops implementation plans” and “develops marketing

A pilot test was conducted to identify any issues with the materials.” Participants mentioned that some items were role
questionnaire or the individual items. The goals were to specific for administrators or educators. However, the goal
assess: (a) the average amount of time required to complete was to develop a master list of competencies, so no qualifi-
the questionnaire, (b) clarity of items, (c) clarity of instruc- cations were placed on the competencies that were role spe-
tions, and (d) adequacy of the format. Content issues cific by the expert panel and the items were retained.
included the importance of the item as an informatics com-
petency for nurses and whether the item was correctly Delphi Study
placed within levels were also examined. Three experts, well
known as pioneers in the NI field, participated in the pilot. A Delphi study approach was used to achieve consensus
Respondents reported that between 45 to 60 minutes about a master list of informatics competencies required for
were needed to complete the questionnaire. There were no nurses with differing levels of expertise in the United States.
suggestions for improving the presentation format and no Three rounds were needed to reach consensus. To be consis-
items were added or deleted from the list. Seven items needed tent with the expert panel work used to establish the initial
clarification, and these items were reworded for the Delphi competencies, a threshold of 80% consensus was used. A
rounds. Participants recommended that one item be split into purposive sampling technique was used to identify partici-
two statements. Consequently, the item “develops imple- pants who had the following criteria: (a) registered nurses
mentation plans and marketing materials” was split into with a master’s degree or higher in nursing, (b) five years

TABLE 2. Number of Subcategories in Each Level of Practice

Beginning Experienced Specialist Innovator

Category Level 1 Level 2 Level 3 Level 4
Computer skills 9 8 6 2
Informatics knowledge 4 5 7 2
Informatics skills 0 2 15 6
Nursing Research November/December 2002 Vol 51, No 6 A Study to Determine Competencies 387

TABLE 3. Number of Participants Contacted and Items Sent by Round

Round 1 Round 2 Round 3

Dec 1999 July 2000 Feb 2001
Number of participants 79 72 70
Item importance 305 88 33
Appropriate level 305 11 9

experience in NI practice, and (c) visibility within the spe- appropriate level data were given for all items within each
cialty through presentations, publications, or an officer in category. Seventy subjects (97%) responded to Round 2.
informatics organizations. Expert panel members suggested The third and final round of surveys was sent in Febru-
potential study subjects and supplied their e-mail addresses. ary 2001. The data presentation format was the same as
The final “Informatics Competencies for Nurses” ques- Round 2. Because the Round 3 questionnaire contained only
tionnaire for Round 1 of the Delphi study was 19 pages 33 items and was 6 pages long, the 70 subjects were given an
long and included 305 items in 39 subcategories within the option of receiving either an electronic or hardcopy version
3 broad categories of computer skills, informatics knowl- of the questionnaire. Most (65) subjects preferred an elec-
edge, and informatics skills. Because of the length of the tronic copy. Sixty-five (93%) respondents returned Round 3
questionnaire, 110 potential subjects were contacted by e- surveys; all but one returned the survey electronically. An
mail to determine their willingness to participate. In overall retention rate of 87% from the beginning to the end
December 1999, the questionnaire was mailed to the 82 of the Delphi study reflects the interest and enthusiasm of the
nursing informatics specialists who agreed to participate in Delphi study participants in identifying and differentiating
the study. After survey receipt, three subjects did not meet informatics competencies for nursing (Table 3).
the requirements for participation. Of 79 eligible subjects,
72 (91%) returned usable responses. Results of the Delphi Study
In July 2000, 72 respondents received Round 2 sur- By the end of Round 3, 281 items (92%) of the original
veys. Only the 88 items that failed to meet 80% consensus 305 competencies were accepted as valid competencies for
were included in the 9-page questionnaire. The question- both the importance of the item and the appropriateness of
naire contained three sections of data for each item: (a) the the level (Table 3). Table 4 lists the percent agreement by
total participant response (in percentages) by response cat- level of practitioner while Table 5 depicts the number of
egory for every item on Round 1, (b) that participant’s competencies validated by level of practice. The master list
individual responses for each item, and (c) space for the of validated competencies is available at http://www.
individual’s Round 2 responses. Both item importance and nurs.utah.edu/informatics/competencies.htm.

TABLE 4. Percent Agreement on Items by Level of Practitioner and

Delphi Round

Round 1 Round 2a Round 3a Cumulative % After Round 3

Usable surveys 72 70 65
Item importance
Beginner (%) 56 63 14 86
Experienced (%) 46 63 100 100
Specialist (%) 75 59 63 96
Innovator (%) 90 100 n/a 100
Appropriate level
Beginner (%) 95 50 0 98
Experienced (%) 97 0 100 100
Specialist (%) 97 0 40 98
Innovator (%) 92 34 0 95
Overall total
Importance (%) 71 63 39 93
Level (%) 96 18 34 97

a
Percentages represent the % agreement within the round and are not cumulative across rounds.
388 A Study to Determine Competencies Nursing Research November/December 2002 Vol 51, No 6

TABLE 5. Number of Competencies Approved TABLE 6. Rejected Competencies

by Level of Nurse
Experienced Nurse
Level of Nurse Initial Final
• Uses applications for diagnostic coding
Beginner 43 37 • Uses desktop publishing
Experienced 35 32
Nurse Informatics Specialist
Specialist 187 174
• Applies computer-assisted software engineering (CASE) tools
Innovator 40 38
• Manages central facilities to enable data sharing
Total 305 281
• Writes an original computer program and modifies it

Of the 24 competencies not validated, only 5 were Other items with comments had only 1 or 2 comments
rejected (Table 6), 2 competencies from the experienced each. In general, comments varied from “don’t think this is
nurse level and 3 from the informatics specialist level of a NI competency” or “only if in an administrative role,” to
practice. The competency “writes an original computer recommending wording changes, especially verb changes,
program and modifies it” was rejected early at Round 1. (e.g., circled “manage” and changed to “analyze”).
The other 4 competencies did not reach an 80% agreement Twenty-one (30%) participants made comments on
to discard them until Round 3. round 2. Only 2 items had 3 or more comments. About 20
Six competencies were determined to be valid compe- comments on this round occurred at the bottom of pages
tencies but no agreement was reached about their practice and were not related to specific competencies. Examples
level. Only 1 of these 6 competencies achieved the 80% include “remain concerned that there is no advanced nurs-
threshold of agreement that it was at the wrong level, but ing content here,” “many of the elements identified here
subsequently, respondents could not reach agreement on a are appropriate for selected jobs but are not core compe-
correct level (Table 7). No competencies changed levels of tencies for all nurses at level 3,” and “believe all of these
practice as a result of the Delphi study. are computer literacy and not informatics.”
Thirteen items did not reach agreement as valid com- There were 25 comments from 16 respondents (25%)
petencies. Interestingly, these fell into 2 distinct practice on round 3. General comments included:
levels: the beginning nurse and the informatics specialist.
All of these beginning nurse competencies came from the 1. Matching the appropriate level of research activity
computer skills category. For the informatics specialist and the informatics level. Specifically, that level 3
level, which clearly had the largest number of competen- nurses should apply and use research but that level
cies by level of practice, items that did not achieve consen- 4 nurses should generate research (3 comments).
sus came from all three major categories. 2. The perspective each individual used to respond to
Only the experienced nurse level achieved a 100% con- the survey (i.e., several individuals felt that responses
sensus on listed competencies by the end of Round 3 for changed as their jobs changed) (3 comments).
importance and level. The nurse innovator level reached 3. The informatics specialist nurses “modifying” soft-
100% agreement for item importance but 2 items ware, which should be left to programmers (2 com-
(“teaches informatics competencies required for specific ments).
role functions for the practicing nurse, the nurse adminis- 4. Basic computer skills such as spreadsheets and pre-
trator” and “evaluates applications supporting clinical sentation software being a pre-nursing (and pre-col-
care (including decision support), education, administra- lege) requirement (2 comments).
tion, and/or research”) did not achieve agreement about 5. The competency “evaluates network capacity” being
appropriate practice level. too technical, but that the knowledge component
On all three rounds, participants were given the oppor- should be included as a competency (2 comments).
tunity to write in comments or additional competencies. 6. A number of respondents commented favorably
The research team a priori set a criterion that 10% of the about receiving the survey via e-mail.
participants had to introduce the new competency or com-
ment on the same competency for those items to be
included in the next round. Fifty-four percent of the par-
Discussion
ticipants (39 individuals) made comments on Round 1. The high response rates of 91% in Round 1, 97% in
Comments involved 85 items (28% of the total items). Round 2 and 93% in Round 3 demonstrated the great level
Only 7 items had 3 or more comments and none met of interest and need for a comprehensive list of informatics
the minimum criteria of 7 comments. One item received 5 competencies. Despite the 19-pages in the initial question-
comments. However, this item had a printing error when naire, a majority of participants completed the form, and
sent out. Of the 7 items, 1 item, “Has the ability to inte- the study had a high response rate overall.
grate different applications or programs” was in the com- The vast majority (92%) of competencies and their
puter skills category and the other 6 were in the informat- associated levels were validated. Out of 305 competencies
ics skills category. and their associated levels, only 24 items were not vali-
Nursing Research November/December 2002 Vol 51, No 6 A Study to Determine Competencies 389

TABLE 7. Valid Competencies With an Undetermined Level of Practice

Valid Competency With Consensus That Item Is at The Wrong Level

• Uses authoring tools to develop CAI for students, nurses and/or patients (originally at the
experienced nurse level; 77% placed this competency at the informatics specialist level)
Valid Competencies With No Consensus About Level
• Recognizes computerized diagnosis equipment (e.g., CAT scan, MRI, digital imaging)
• Conducts research to examine effects of computer technology in nursing (originally at the
informatics specialist level)
• Conducts research in informatics (originally at the informatics specialist level)
• Teaches informatics competencies required for specific role functions for the practicing nurse, the
nurse administrator (originally at the nurse innovator level)
• Evaluates applications supporting clinical care (including decision support), education,
administration and/or research (originally at the nurse innovator level).

dated for both importance and level. Five additional items The IMIA provided broad guidelines such as knowledge
were deemed important competencies but consensus could about general characteristics of health information systems.
not be reached about an appropriate level. This study outlines the specifics of those characteristics.
Respondents commented during each round about There are limitations to this work. While the expert
whether computer skills should be considered informatics panel added competencies to the nurse innovator level, the
competencies. One respondent even crossed out all the Delphi participants added no new competencies. Thus, the
items related to computer skills during Round 1 and said current list may not be exhaustive. The research team set a
that none of these skills should be considered part of infor- threshold of 10% for the addition of a new competency.
matics competencies. In the literature, the terms computer Future research should state the required threshold on the
skills and computer literacy are ill defined and often used survey as well as provide a summarized overview of com-
interchangeably. As per the information management ments made regardless of the frequency of the comment.
framework used in this study, computer skills are one set Since the creation and validation of competencies is a
of tools within the larger category of informatics compe- time-consuming process, additional competencies should
tencies that are ultimately needed to manage information. be added to the master list. New competencies should also
Participants clearly did not view computer program- be added to the master list as the specialty evolves and as
ming as a required competency for informatics nurse spe- more nurses develop expertise in a specific subspecialty
cialists. The competency directly speaking to programming within informatics (e.g., database design).
(i.e., “writes an original computer program and modifies Competencies were validated only by informatics nurses
it”) was rejected in Round 1. Similar competencies such as and not by beginning and experienced nurses. The research
“identifies the more common programming languages in team specifically chose only informatics specialist or inno-
use today,” did not reach consensus after 3 rounds. Com- vator level nurses because non-informatics nurses may not
ments were made that these competencies applied to “pro- know the competencies required at their level of practice.
grammers” and not informatics nurse specialists. However, one participant in Round 2 commented that
The results of this Delphi study created a master list of he/she “remained concerned that there is no advanced nurs-
informatics competencies for nurses at four levels of prac- ing content.” Interestingly, the competency “uses applica-
tice. In the past, Armstrong (1986), Bryson (1991), and tions for diagnostic coding” was eliminated from the expe-
Staggers (1994) used research techniques to create lists of rienced nurse level on Round 3. Perhaps if advanced practice
competencies for nurses. Armstrong studied the “computer nurses (i.e., master’s prepared nurse practitioners, had par-
competence” needed for nursing practice and teaching in the ticipated) they would have retained the competency above
early-1980s, while Bryson created a list of skills needed for item and generated additional items for review.
computer training in baccalaureate programs. Staggers This study provides a current, research-based list of
(1994) created a list of skills and knowledge for nurses in the informatics competencies. Few competencies were elimi-
early 1990s. Despite numerous discussions about the need nated or failed to meet consensus and the resulting list spans
for informatics competencies, no research-based competen- many topics, showing the content diversity of informatics.
cies were created since the early 1990s. Therefore, this study The last research-based work in this area was in the
answers the need for valid informatics competencies, and it early 1990s, did not include advanced informatics content,
is the first study to span four levels of nurses, create compe- and it did not include four levels of nurses. Follow up to
tencies for both entry-level and experienced informatics this specific research should define the core competencies
nurse specialists, and examine the categories of computer for nurses by level of practice and job type and to create
skills, informatics knowledge and informatics skills. valid and reliable tools to evaluate informatics competency
The study results complement the work performed by levels. Other research could concentrate on explicating the
the International Medical Informatics Association (1999). full set of competencies needed within the framework cre-
390 A Study to Determine Competencies Nursing Research November/December 2002 Vol 51, No 6

ated for this study (i.e., adding the competencies for Grobe, S. J. (1989). Nursing informatics competencies. Methods of
human information processing to informatics competen- Information in Medicine, 28(4), 267-269.
cies). Then, the full suite of competencies would be expli- Hebert, M. (2000). A national educational strategy to develop
cated for nurses’ management of information. ▼ nursing informatics competencies. Canadian Journal of Nursing
Leadership, 13(2), 11-14.
International Medical Informatics Association. (1999). Recommen-
Accepted for publication August 18, 2002. dations of the International Medical Informatics Association
The authors thank the expert panel members and the experts par- (IMIA) on education in health and medical informatics: Interna-
ticipating as pilot subjects: Barbara Carty, EdD, RN; Sue Grobe, tional Medical Informatics Association. ttp://www.imia.org.
PhD, RN, FAAN; Mary McAlindon, PhD, RN; Ramona Nelson, Lewis, D., & Watson, J. E. (1997). Nursing faculty concerns
PhD, RN; Rita Snyder-Halpern, PhD, RN, C; and Cheryl B. regarding the adoption of computer technology. Computers in
Thompson, PhD, RN, and especially Melody Rydgren, MS, RN, Nursing, 15(2), 71-76.
whose participation in this work and obvious dedication to nurs-
ing informatics was remarkable. Peterson, H., & Gerdin-Jelger, V. (1988). Preparing nurses for using
information systems: Recommended informatics competencies.
The views expressed in this article are solely those of the authors New York: NLN Publications.
and not necessarily those of the Health Resources and Services
Administration, Department of Health and Human Services. Pew. (1998). Recreating health professional practice for a new cen-
tury: The fourth report of the Pew Health Professions Commis-
Corresponding author: Nancy Staggers, PhD, RN, FAAN, Infor- sion. San Francisco, CA: Pew Health Professions Commission.
mation Technology Services, University of Utah, 421 Wakara
Way, Suite 204, Salt Lake City, UT 84108 (e-mail: nancy.stag- Riley, J. B. (1996). Educational applications. In K. A. McCormick
[email protected]). (Ed.), Essentials of computers for nurses (2nd ed.). New York:
McGraw Hill.
Staggers, N., Gassert, C. A., & Curran, C. (2001). Informatics
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