354 ■ ROLE FUNCTIONS OF DOCTORAL ADVANCED NURSING PRACTICE
foundational to the nursing informatics. Each level along the continuum represents
an increasing level of complexity and cognitive capability. Knowledge management
reflects the interpretation, integration, and understanding of patterns of data. Doctoral
preparation of the APN embraces the competency of data extraction from informa-
tion systems and databases, data analysis for understanding trends, and the intuitive
thinking of expert nurses to support health care practitioners in decision making.
In 2011, the IOM released the Health IT and Patient Safety: Building Safer Systems for
Better Care. In this work, the IOM makes the argument that merely installing health IT
in health organizations will not result in improved care. Health IT cannot exist in isola-
tion for its context of use. Health IT is a part of a larger system, a sociotechnical system,
and safety emerges from the interaction of various factors. Since the APN competency
includes the analysis in the selection, use, and evaluation of patient care technology and
health care information systems, awareness of this framework and recommendations
by the IOM should be included in this chapter. Leadership in the cross- disciplinary
research toward the use of health IT as a part of the learning health care system is a
challenge by the IOM and key for expert leadership in nursing.
One concept mentioned by these authors that should have been elaborated is the
concept of practice knowledge— identified as a key competency involving the ability to
combine information from a variety of data sources to create new information and possi-
bly new knowledge. This is fundamental to the APN who is called to design and imple-
ment processes to evaluate outcomes of practice, practice patterns, and systems of care
(AACN, 2006). Use cases indicative of leveraging technology to contribute to practice
knowledge would have been excellent exemplars here. For example, the attributes of
data collated to create a nurse- driven protocol to enhance outcomes in a nurse- sensitive
indicator (falls, catheter-associated urinary tract infection [CAUTI] , etc.). Practice
knowledge is possible because of data obtained, aggregated, and supported through
the use of informatics.
Without question, I agree that the doctoral APN is expected to exhibit leadership
that not only contributes to the body of scientific knowledge but also serves as a cata-
lyst for change. Technology advancement with the adoption and meaningful use of the
electronic health record, although forced by regulatory mandates, is one of the great-
est disruptive innovations of our career lifetimes. This electronic health record is the
base for knowledge management systems, as stated by these authors. Nurses must lead
through this transformation and use the data to continue to build the evidence- driven
organizations.
The cultural transformation influenced by the development of technology is only
in its infancy in health care. Challenged by the reimbursement shifting landscape from
volume- based, fee for service, to value- based payments, the health care industry will
seek new and innovative models of care. Technology will be at the core. For example, as
virtual care becomes commonplace in the topography of technology, roles will change
and the innovative nurse leader may capitalize on carving out new roles for nurses as
we study the evidence and expand our influence in health outcomes. Home monitoring
in the mobile health (mhealth) and virtual visits (e- visits) will demand new competen-
cies of nursing as new technologies produce new data sources. The field of informatics
and the competencies required to facilitate the use of technological tools and informa-
tion management will be the cornerstone for an effective nursing practice. The doctorate
of nursing practice must continue to develop expert practitioners to lead our profession
in this domain.