Introducing the CNIO role
The chief nursing information officer role is usually broad but, at its heart, it is about bridging the gap between technology and clinical practice. CNIOs should have a seat at the table when the clinical technology strategy is being set, and then through the procurement, planning and implementation stage of any new system. As CNIOs, we ensure the focus is on using technology to improve outcomes for patients and citizens.
What’s it like starting out in a CNIO role?
If you’re starting out in a CNIO role, you may be replacing an existing postholder or it may be an entirely new post for the organisation. You may also be a lone digital nurse, or you may be part of a team. It may be your first senior nursing role, which you’ve gained through previous digital experience, or you may already be a senior nurse and new to digital. These experiences are all slightly different.
When you’re the first
Being the first CNIO for an organisation can feel like a daunting prospect. It’s important to remember the positive aspects: that you have a fabulous opportunity to develop the role and to bring others along with you.
You will be able to set the agenda and direction, but it’s likely others will try and point you towards meeting existing agendas. Instead, give yourself some time to decide what you want the priorities to be – and agree with your senior colleagues that this is the approach you’ll be taking. You will have a more positive impact in the longer term, as well as getting personal satisfaction and a feeling that you are personally developing too.
If you’re going solo
If you’re the only digital clinical leader in your organisation, then the job can feel like a lonely one and really quite different to what most of us are used to as nurses.
The key thing to do in this situation is to form networks. In your own organisation, it’s helpful to connect to other senior nurses. A good way to do this is by joining existing nursing collaboration groups (these will have different formats in different organisations). Although these colleagues will have different specialisms and interests, they too will have a focus on nursing strategy and workforce development.
If you are not directly reporting to your chief nurse/director of nursing, make sure that you meet with him or her in the early weeks in post and continue updating on progress. The digital nursing agenda should now be a key part of every chief nurse/director of nursing’s portfolio, and he or she will be relying on you to help drive it forward.
Outside your organisation, there are plenty of opportunities to connect with fellow digital nurses. This includes via the Digital Health CNIO Network and via regional and sector-specific groups. There are also the likes of the Faculty of Clinical Informatics’ nursing professional interest group, the BCS (Chartered Institute for IT) nursing specialist group, and the Royal College of Nursing eHealth forum.
If you’re joining a pre-existing team
If you are lucky enough to be joining an existing team, this is likely to be multi-professional. That means it’s important to link with clinical and non-clinical colleagues to determine who will lead on which aspects of the digital strategy. You don’t want to step on each other’s toes, but it’s really important to make sure that all the clinical professions feel that their views are being heard. That means you may also be the identified lead for allied health professionals or other professional groups.
Who leads on what is likely to be based on individual interests and experience, but together the team will need to have input on areas such as research, clinical governance, digital clinical safety and patient/citizen involvement.
An important first step is to understand what has already been done – ask your colleagues to run you through progress over the past couple of years. Focus on what has gone well, but don’t forget to ask about the lessons learned so that you can make improvements in future. Quality improvement is a key aspect of the CNIO role, and it needs to start early and continue always. You will then be able to gain a clear idea of what needs to be done in future, and will increase your understanding around stakeholder relationships (including with system suppliers), transformation and change activity within digital and across the wider organisation, and how involved your nursing colleagues already are in the digital agenda.
Be careful with how much you take on
It’s hard to say no to things when you are new in post, but it’s important not to take on too much – the danger is you won’t be able to deliver, and that’s really demoralising.
Be especially cautious of taking on work which could or should be done by others. Although it’s tempting to ‘fix’ problems (especially for most nurses), you will get overloaded. The digital nursing agenda will be your key one, but it’s important to recognise that you will also want to get involved in things which improve your knowledge and/or pique your interest. It is important to leave time to be able to do those things too, and if you’ve taken on too much work you won’t have time to do so.
Remember there’s no one best way to be a CNIO
As you start out as a CNIO, remember there is not one best way to do the role. It will depend on your own background and how much leadership or digital experience you already have.
Remember too that while some of the digital aspects of what you are doing might be new for you, you have lots of existing and transferable skills from your previous experience – and that’s true whatever previous experience you have.
If you are coming into the role as an existing senior nurse with limited digital knowledge, make friends with colleagues in the IT/digital team. They will be keen to share their knowledge and experience with you, and it’s a really good way to learn the ‘language’ of digital healthcare.
If this is your first post at this level but you have previous digital experience, then the relationships you will likely need to work on are those with other senior nurses and clinicians. This can feel difficult if you haven’t done it before, but also because you are likely to be the one who has most digital knowledge. You’ll need to be prepared to teach, and to encourage others’ understanding and interest in digital, while developing these key peer relationships.
What skills do I need to flourish as a CNIO?
There are a number of key skills that I think you will need to succeed as a CNIO. Some you’ll have already, but all you’ll need to work on and develop.
- Teamwork. You need to work as part of the team, to collaborate with and motivate others.
- An authentic, credible style and a passion for improving clinical outcomes by using technology. This will often get you moving forwards even when times are most tough. It’s important to have resilience and tenacity, as well as a pragmatic but can-do attitude.
- A knowledge of your own limits. You need to know the boundaries of your own abilities, and to be able to ask for help.
- An ability to make decisions. You’ll need to be able to understand the issues facing colleagues and patients and be able to determine the best actions (sometimes without all the facts you would like).
- Leadership. You need to be a good leader of others. Supporting and developing your colleagues is such an important part of the job of the CNIO. Some of my proudest moments as a CNIO have been seeing others develop into CNIOs (and other clinical leaders) themselves.
Don’t forget development
The CNIO community is a vibrant and very giving one; in my experience, people will be generous with their time to support you and teach you. The benefit for them is that they will also learn from you.
There are digital nurses in all kinds of roles and across sectors, so make your networks big; include non-nurses and don’t be afraid to link up with digital clinicians working in different sectors, including in industry and outside the NHS.
Know you’re part of a team that is continuing to grow
I was one of the first CNIOs in the UK and am very proud of that fact. What I’m more proud of though is that we have grown in number over the last 10 years and that we will continue to grow as a community of CNIOs and digital nurses. I’m proud too that we are now being recognised as an integral part of any healthcare team which is aiming to transform care through the use of technology. Good luck and keep in touch!
About the author: Jo Dickson is chief nurse at NHS Digital. She had a varied clinical background before moving into technology roles, and was previously chief nursing information officer at Leeds Teaching Hospitals NHS Trust and clinical informatics director at Nuffield Health. Jo is a past chair of the CNIO Network and a founding fellow of the Faculty of Clinical Informatics.