E-volution
Graduate studies in nursing informatics pay off early for USDA-based RN

By Scott Mace
November 7, 2003

Kimberly Elenberg, RN, originally wanted to go back to school to become a pediatric nurse practitioner, but a graduate program that let her continue to work full time allowed her to advance her career even before she completed her studies.

The graduate program she chose was one of the country's only programs in nursing informatics, at the University of Maryland's Baltimore campus. "I've always had an interest in computers," Elenberg said. While at Walter Reed Army Medical Center, Elenberg built an education center, a cluster of computers linking hospitalized children with cancer to their families and friends around the world. Seeing the success of this project sparked a passion for computer technology that led her to UM.

After being promoted from staff nurse at Walter Reed to head nurse of the pediatrics, hematology and oncology clinic there, Elenberg entered the UM graduate school. Meanwhile, she switched her day job to research nurse in pediatrics and oncology at the National Institutes of Health, then came to the U.S. Department of Agriculture, after her deployment for the response to the anthrax scare after the Sept. 11 attacks.

By this time, Elenberg, a full-time, active-duty nurse, had moved from the Army branch of the U.S. uniformed services to the United States Health Service Commissioned Corps (USPHS), under the auspices of the U.S. surgeon general. She now holds the title of consumer compliant monitoring system (CCMS) program manager in the Human Health Sciences Division of the USDA's Food Safety and Inspection Service (FSIS).

As an outgrowth of her role as CCMS program manager and with the skills gained from this program, Elenberg is participating in the development of a universal information technology system that will augment public health responses to naturally occurring and intentional outbreaks, as a member of a National Science Foundation working committee. "I want to help people, and the program at Maryland has increased my skills so that they are applicable on a more national and international level vs. just at the bedside," Elenberg said.

Elenberg, who holds the rank of lieutenant commander in the USPHS, says the master of science degree she will be awarded next year at UM "definitely has implications for promotion, but the bottom line is I'm really honored to be in public service."

Graduates of the UM nursing informatics program are trained to analyze nursing information requirements, design system alternatives, manage information technology, identify and implement user training strategies and evaluate the effectiveness of clinical or management information systems in patient care.

"Informatics is just a tool," said Kathleen Charters, Ph.D., RN, an assistant professor at UM who coordinates the nursing informatics program. "Most students want to apply it to a particular field of study." It's not unusual for a grad student in the program to have a dual concentration in informatics and in administration or managed care or health policy, she said.

At present, 150 students are enrolled in the school of nursing's master's program, 15 in the doctoral program and 15 to 20 students in a post-master's certificate program. Students can complete a master's program in two years, but many take classes part time and have up to five years to complete the master's. Doctoral students theoretically can complete their work in four years, "but that would be getting their dissertation done in an extraordinarily short time," Charters said. Doctoral candidates are strongly encouraged to have a master's degree in nursing already, she added. Preference is given to Maryland residents, but a fair number of out-of-state students are enrolled, she said.

After its initial blossoming some years ago, the number of graduate schools offering nursing informatics programs has shrunk, Charters said. "A lot of programs migrated into what I call health informatics, where they were looking at training multidisciplinary teams," she said. "There [are] a lot of those programs out there today. There are pros and cons to each approach, but we've remained focused on nursing informatics, teaching our people to be part of a team, but speaking up for what nurses need."

"Hospitals have realized the necessity for the informatics nurse, and there simply have not been enough out in the field with the broad IT education and experience needed," said George Harbeson, MSN, RN, president of the American Nursing Informatics Association, based in Rancho Cucamonga, Calif. "Enter forward-thinking nursing schools that have introduced IT at both the undergraduate and graduate levels in their curriculums and have gone on to offer informatics as a graduate program."

At the end of the UM master's program, students complete a practicum, a "capstone" course taken after all skill development is completed, spending 96 hours at an institution or agency, typically working under a nurse informatician, to apply their knowledge to create a tangible product for that agency. "Within the government, we've placed people within the office of the assistant secretary of defense for health affairs," Charters said. Others have done stints with government contractors, supporting teams that make recommendations about which information systems to implement, requirements analysis and other consulting roles.

"Then we have nurses we place within what we consider traditional hospital settings," Charters said. "In this area-D.C. and Baltimore-most hospitals have some kind of clinical information system that's a legacy system, that is being turned over for a new system. Our students get involved in that evolution, with implementing that new technology."

These hospital-based graduates also work with staff education and training departments, developing computer-assisted or Web-based learning modules to train nurses in how to use new information systems, Charters said.

The majority of grad students do not come directly from receiving a bachelor's degree, Charters said. "Most have been in the real world and decided they have something specific they want to do," she said.

Classes typically occur in the late afternoon and evening, but with a high-tech twist: most of them are offered online, with the exception of three master's core courses. By next fall, it will be possible to take every master's degree course online, Charters said. "When we say online, [we mean] they don't have to set foot on this campus in order to complete this degree," she said.

New students are encouraged to come to the campus for an orientation. From that point on, the graduate school of nursing employs Web-based technology from Blackboard Inc., giving students e-access to online health science library resources and electronic health journals. Students submit classwork, instructors mark it up and students receive this via e-mail. Faculty post grades electronically, and students can pull up their transcripts online. Students in the program also support each other through group projects. Each course requires students to work closely together as a team on a project reflective of real-world conditions, Elenberg said.

The program lets Elenberg take additional online courses through the University of Maryland's University College (UMUC), even though she's never set foot on its Adelphi, Md., campus. This college's business administration courses reflect different core values than the school of nursing's programs, but "it is valuable to broaden your insight into the corporate world," Elenberg said.

Don't think that online graduate courses are easier than attending class in person.

"Online, you have to have references for all of your input, and you're required to participate in order for learning to occur," Elenberg said. "It is much more difficult than listening to a face-to-face presentation." Online courses facilitate participation from students all around the world, again reflecting real-world globalization.

Elenberg said her studies have been "very well-rounded. Some at UMUC are very technical, where I needed to know specific languages like Oracle when I learned how to build a database. From the nursing informatics program at UM, I learned from a nursing perspective how to do a systems analysis, understand the relationships within a database and how to most effectively harness that information so it is useful to the end user."

The payoff: Elenberg's used this training on an ongoing basis as she's been re-architecting a database for the USDA's Food Safety and Inspection Service. "This is my primary job," she said. "They just happen to marry up nicely." The database identifies potential food hazards in meat, poultry and egg products through standard data and nontraditional data. By mining this data through spatial geotemporal algorithms, Elenberg and others will be able to better identify food hazards and initiate investigations. Elenberg is leading the overhaul of the existing database and will be the project manager.

"Dr. Charters has been very helpful in keeping me connected or getting me contacts within the field of nursing informatics and bio-surveillance," Elenberg said. "The classes have been fantastic, the professors invaluable. They have exposed me to every aspect of nursing informatics. They are a safety net for me, as I learn my job."