Each month, HospitalSoup.com will feature a health care professional in our monthly series: "A Day in the Life." The series aims to provide readers with a realistic view of what working as a health care professional entails, and provides an inside view and opportunity to get to know some extremely talented and dedicated health care professionals.

A Day in the Life.....with Informatics Nurse
Lt. Col. Florence Valley

Interview and editing by Bonnie Garrington for HospitalSoup.com

Background: Lt. Col. Florence Valley joined the U.S. Air Force in 1982, the year she received a B.A. in nursing from the College of Saint Catherine in St. Paul, MN. She began her career as an obstetrics staff nurse, moved into the role of assistant nurse manager, then worked at another facility where they needed a medical-surgical nurse manager. While in Bitburg, Germany, she managed outpatient clinics starting in pediatrics and ending in family practice. After she worked as an inpatient obstetrics head nurse at another facility, she began course work at the University of Arizona and graduated with a M.S. degree. Her nursing studies focused on case, systems and data management. Today she works at a military medical treatment facility that serves a population of 28,000 beneficiaries at Offutt Air Force Base, Nebraska. Valley has worked as an informatics nurse since 1999.

Q. What made you choose nursing informatics as a career?
To a certain extent, by happenstance, but I also wanted to find something that would set me apart from my peers. Many of them were also nurse managers, so we had the same skills. I really don't consider myself in the role of "nursing" informatics. I am a nurse that does informatics. I value the business aspect of health care, and I knew that providing quality health care was often data driven. Also, the military health system had recently become part of a network of contracts representing possibly the biggest HMO in the nation. Information is so very important in every aspect of this enterprise. Because of my course work at Arizona, I kind of fell into data management because I knew that data drove many decisions. Another reason was that my husband is an avid computer "geek," so the environment was familiar. It's a long story, but my experience has prepared me well for this career. It has all come together. With my clinical background, I know the processes that produce the data. With my computer background, I'm able to retrieve data and transform it into information needed to improve medical care.

Q. Describe what you do.
I'm responsible for obtaining data from multiple data repositories within the military hospital. One repository includes information about patient demographics, laboratory work, radiology, and appointment utilization. Others involve prevention programs for our active duty personnel, and immunization tracking. After I export the data, I transform the data into information that is useful to the end user. Hospital executives, for example, might want aggregated data on clinical outcomes of diabetes care. On the other end of the spectrum, our providers need specific information about the diabetic patients enrolled to them specifically. Perhaps the data might show that a diabetic patient hasn't had an eye exam in three years, although it's recommended annually. I relay this information to the provider and their teams so they can proactively encourage patients to get the preventative service aimed at preventing blindness. My job isn't just informatics. I'm responsible for integrating processes, as well. At times, I feel like a plate spinner, moving back and forth between plates to keep them spinning.

Q. What's a typical day like for an informatics nurse?
There are no typical days! That's what I like so much about my job. Some days I'm briefing the executive team, some days I'm mentoring a nurse on how to build a disease management database. On another day I might be data mining our patient database or evaluating a consumer-based web education program. Perhaps I'll help a provider examine new cost-effective technologies--palm pilots, for example--that can be integrated into primary care settings. I might evaluate computer-based schedules that providers use to book appointments to ensure the best use of their time. Do they have the right type of and amount of appointments to meet the demands of the population enrolled to them? By "providers," I mean physicians, physician assistants and nurse practitioners. I do interact with patients. The other side of my job is that I sometimes fill in for absent nursing staff. Every so often I'm on the triage line when patients call in with their problems: Do they really need a same-day appointment? Do they need home care advice? Maybe they're having trouble getting an appointment with a civilian agency for their specialty consultation. My office is right in the middle of the primary care clinic, so I get pulled from my primary job to do all sorts of things, blood sticks included. This is so beneficial because I can evaluate our processes from many angles, including the staff member.

Q. How does your role differ from that of other nurses?
I believe I can improve patient care on a much larger spectrum than what I could do with one-on-one encounters. I can provide information that might improve the care for all our four hundred diabetic patients, whereas if I were a clinic nurse, I'd interact with a select group assigned to my team. I'm more of a facilitator of technology, whereas a clinical nurse may be the end user. I'm also investigating new technologies or coordinating their implementation with our current practices. I'm much more autonomous than a clinical nurse. I run my own shop, pick my own projects and prioritize my work day. You've got to be a self-starter. Some people like structured environments, so this job is not for everyone.

Q. What education is necessary to prepare for this role?
I'm fortunate to have grown up with the systems I'm now managing or evaluating. But my master's course work was pivotal. Between the three management areas I studied, I was well prepared to take on my present role. My studies helped me understand outcome management - making use of stored data - and develop a real appreciation for high quality medical care that can be delivered with a reasonable price tag. Because the University of Arizona sits in the middle of an HMO dominated area -- learning how a health maintenance program operates has proved so helpful to me. Starting in 1996, the Air Force started a network of HMO's operating under the umbrella of the military health system. Knowing how an HMO functions assists me in interacting with our civilian contractors.

Q. What is the most positive aspect of your job?
My position is in its infancy, so to a great extent I'm able to create my job. Working at many different levels within my organization never gets boring.

Q. What is the most challenging aspect of your job?
What is most challenging is keeping abreast of current technologies. I don't want to be recommending a specific technology when waiting three months would give me a better product at a lower cost. I recently attended the American Medical Informatics Symposium in Los Angeles and realized that I need to catch up with the literature. Being a mom, wife, and full-time Air Force member doesn't always leave enough room or hours in the day for keeping up with all the changes in this field.

Q. Are there growing opportunities for informatics nurses?
I think the opportunities for nurses who develop technical and clinical expertise are boundless. Just a few years ago, nurses never thought of themselves as playing the role of liaison between the two fields. Now it's a burgeoning field for them. In some areas of the country, it's moving like gangbusters. The academic centers are leading the way. They're able to combine medical informatics with traditional computer programs because of the resources available to them. The Universities of Arizona, Maryland and Colorado have solid nursing graduate programs in informatics, which has spilled over into their undergraduate programs.

Q. How much room is there for advancement?
In medical settings, data analysts are often paid six-figure salaries, yet generally they're lacking the clinical piece of the puzzle-they might not know what kind of data is needed to improve care for patients. There's also communicating with the provider staff. It's easier for a nurse to translate the technical problem to the providers because we can translate it into something they will understand. I'm not saying that the two roles are interchangeable, but because my position is unique among my peers, my chances of promotion are greatly enhanced. Nurses are always cost-effective. We're good at analytical thinking--in taking a problem, splitting it into pieces and conquering each piece.

Q. What's the average salary for an informatics nurse?
I'm not really sure. Jobs that deal with informatics don't always have the same job title. I make $78 thousand, but I've been with the Air Force for more than 18 years. Longevity has its advantages in any company or organization.

Q. What changes in nursing have taken place since you started?
When I graduated from college, nurses chose either clinic or hospital roles. About 90 percent of those who worked in hospitals were floor nurses. Now our options include outpatient surgery, community health, home health, wellness clinics, extended care facilities and nursing homes to name just a few. Informatics nursing is just one role among many. Nurses now play an increased role in coordinating patient care. These days, the smart providers use an integrated team approach to care for their patients.

Q. What would you tell someone who is interested in becoming an informatics nurse?
If they're not computer phobic and want to positively influence patient outcomes on a large scale, then informatics is a viable option. Working your way into this new role in your current job is optimal, because you already know their systems and how the processes function currently.

Q. Are there any closing thoughts you'd like to share?
This isn't an area you can jump into right out of college. Get some nursing experience first, but don't pidgeon-hole yourself. I've played many nursing roles, and the variety has prepared me to understand processes throughout the facility. Stay committed to your goal, but in the meantime, have fun and keep learning.

This concludes HospitalSoup.com's interview with Lt. Col. Florence Valley.HospitalSoup.com would like to thank Lt. Col. Valley for contributing her time, knowledge and experience for this article!

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