Background: Artificial intelligence (AI) is redefining healthcare delivery, yet its adoption within rural nursing practice remains underexplored. Rural nurses in South Dakota, Alabama, and Texas encounter unique barriers, limited broadband access, scarce informatics resources, and insufficient training, that influence their readiness to integrate AI-enabled tools. Understanding these factors is essential to inform future workforce development and digital equity initiatives in nursing informatics.
Purpose: This proposed future study will examine the perceptions, attitudes, and readiness of rural nurses toward AI integration in clinical practice across three states representing diverse geographic and socioeconomic contexts. The aim is to identify shared barriers, facilitators, and educational needs that influence AI adoption and inform targeted interventions. Suggested competencies will also be identified.
Methods (proposed): A two-phase mixed-methods design is planned. Phase 1: An integrative literature review (2019–2025) will synthesize evidence related to AI readiness, digital literacy, and rural nursing informatics. Phase 2: A descriptive cross-sectional survey will be distributed electronically to nurses in rural and critical-access hospitals via state ANIA chapters, hospital associations, and rural health networks. The survey will assess awareness, confidence, perceived barriers, and willingness to engage in AI education. Quantitative data will undergo descriptive and correlational analysis; qualitative responses will be examined using thematic content analysis.
Anticipated results and implications: It is expected that nurses with prior exposure to telehealth or informatics will report higher confidence in AI use, while broadband limitations and lack of training will emerge as primary barriers. Findings will guide the development of AI literacy curricula, mentorship programs, and leadership pathways through organizations such as ANIA, ANI, and HIMSS. Outcomes will support future funding applications and strategic policy recommendations for rural digital health equity.

Clinical decision support (CDS) tools are crucial for enhancing patient safety, minimizing harm, and promoting evidence-based care. However, when alerts are poorly designed, misaligned with workflow, or irrelevant to front-line roles like nursing, they can contribute to alert fatigue and reduced clinical trust. This presentation describes a quality improvement initiative focused on evaluating and optimizing CDS alerts within a large healthcare system to align with the “five rights” of CDS: the right information, to the right person, in the right format, through the right channel, at the right time in workflow.
Purpose: The initiative aimed to improve the clinical value and relevance of CDS tools while reducing alert burden and minimizing unnecessary disruptions in care delivery.
Description: A multidisciplinary team, including nursing informaticists, conducted a structured review of high-volume and high-override CDS alerts. Using system usage data and clinician feedback, each alert was evaluated against the five rights framework. Alerts that were outdated or not actionable were deactivated or redesigned. Interventions included narrowing triggering criteria, tailoring alerts to specific patient risk groups, updating logic to reflect current guidelines, and transitioning from interruptive to passive formats when appropriate. Throughout the process, care was taken to ensure that clinical integrity was preserved and that changes supported bedside nurses in real-time decision-making.
Evaluation/outcome: Post-intervention evaluation included measuring alert firing frequency, override rates, and success metrics. Results showed a reduction in non-actionable alerts and an improvement in success of CDS interventions. Importantly, these changes did not result in an increase in observed clinical errors or adverse outcomes, demonstrating that reducing alert volume did not compromise patient safety.
Conclusion: Ongoing evaluation and thoughtful redesign of CDS tools are essential to their effectiveness. Applying the five rights framework provides a practical and evidence-informed approach to reducing cognitive burden while enhancing decision support for nurses and the broader care team. This session will share actionable strategies and real-world examples of how nursing informatics can lead efforts to optimize CDS, mitigate alert fatigue, and uphold the quality and safety of care.
Learning outcome: Participants will be able to identify strategies for evaluating and improving CDS alerts to better support clinical decision-making while minimizing the risk of alert fatigue and enhancing clinical workflow.

Learning outcome: Participants will be able to describe leadership strategies for developing and sustaining ambulatory care downtime readiness processes across various sites; identify the role of nursing informatics in bridging communication between information management (IM), information technology (IT) and front-line staff; and apply lessons to enhance operational readiness related to downtime preparedness.
Downtimes in hospital systems can disrupt clinical workflows, delay patient care, and compromise service quality. When staff members are familiar with established downtime processes, they can act faster, maintain confidence, and minimize downtime disruptions. Downtime preparedness ensures operations continue safely and effectively.
Following an extended downtime, significant gaps were identified in ambulatory care downtime readiness, particularly in satellite locations, where standardized procedures and ownership of processes was lacking. In contrast, inpatient areas had well-defined workflows and accountability structures.
To address these disparities, nursing informaticists (NI) led a collaboration with ambulatory care, IM, and IT leadership to develop sustainable, end user-driven downtime readiness assessment processes. The goal was to create a consistent framework that empowered front-line teams to own their readiness activities, ensuring operational reliability across all sites.
Key interventions included the creation of standardized downtime binders, integration of Microsoft Forms to guide and track computer assessments, establishment of regular binder refresh schedules, and development of simplified ambulatory care instruction materials aligned with hospital policy. These instructions were designed for reference during high-stress situations, reducing reliance on dense or legalist language.
The initiative involved 17 ambulatory care sites, spanning both specialty and primary care. NI partnered with clinic managers, super-users, and IM to pilot and refine processes, templates, and educate staff. Regular feedback sessions and local site champions supported adoption. Meeting with ambulatory care, IM, and IT leadership began monthly to address recurring hardware and software issues and areas of low compliance and transitioned to quarterly as processes matured.
To sustain engagement, NI distributes monthly completion reports, coordinates binder refreshes, and assists in escalating outstanding tickets. As a new site opened, the standardized process was extended to ensure consistent downtime readiness across the expanding ambulatory care areas.
This initiative demonstrates how nursing informatics leadership can drive clinical transformation by linking operational readiness with change management principles. Through structured collaboration and empowerment of end users, nursing informatics bridged the traditional divide between IM/IT and front-line care teams.
Post-implementation audits revealed marked improvements in downtime preparedness: several sites reached 100% completion of required assessments within the first quarter. From January to October 2025, 350 assessments were performed across 43 computers at 17 sites, generating 35 help desk tickets. Preliminary findings indicated fewer downtime-related incident reports and reduced reliance on immediate IT support during planned outages. Qualitative feedback demonstrated increased confidence in managing downtime events, clearer role delineation, and stronger ownership of readiness tasks.
Overall, this project highlights the value of nursing informatics as a driver of system readiness, safety, and communication alignment across complex ambulatory care environments. It reinforces that sustainable readiness depends not only on technology but also on empowering end users to actively engage in the maintenance and ownership of their local processes.

A health systemwide project focused on replacing paper-based code blue documentation with a tablet based digital application across their multiple facilities. The corporate designed application facilitates interoperability between code blue documentation and the electronic health record (EHR) system. Paper-based documentation posed several challenges including inefficiency of information capture, lack of EHR interoperability, and lack of real-time clinical decision support. The new digital workflow allows real-time documentation of cardiac arrest events with lead nursing staff to record resuscitation interventions. These include medications, rhythm analysis, pulse checks, and energy delivery for defibrillation from a crash cart secured tablet. Streamlined data capture with integration of completed code blue records into the EHR supports continuity of care and ease of documentation review. Key activities included end user training, integration testing, timeline efficiency, draft notification distribution list setup, and tablet deployment. The project successfully deployed and implemented labeled and secured tablets with user guides across adult inpatient units. Early outcomes demonstrate improved transcription efficiency of code blue events, interoperability with the EHR, and increased data accuracy. While initial feedback was resistance to changing the longstanding paper-based process, front-line clinicians expressed satisfaction with usability of the code blue digital application and presence of the code record in the EHR. The clinical informatics team concentrated on facility readiness, the monitoring of education compliance, and alignment of technical and clinical workflows necessary for a successful go-live. Ongoing surveillance and follow-up on end user feedback, system performance, and user adoption continues to maintain adequate workflows and interoperability.

This submission presents an evidence-based initiative to improve nursing assessment documentation, a critical component of safe, high-quality patient care. Before the implementation of a new flowsheet, documentation practices were inconsistent, inefficient, and difficult to interpret, especially during patient clinical changes. These issues stemmed from outdated documentation culture and a lack of standardization across inpatient units.
In 2023, a multidisciplinary team of nurses and clinical informaticists launched a quality improvement project aimed at reducing documentation burden, enhancing clarity, and aligning documentation with the nursing process, organizational policy, and legal standards. The team introduced a standardized assessment flowsheet that consolidated multiple unit-specific templates, eliminated redundant rows, and prohibited entry of normal findings. Charting by exception and enhanced “within defined limits” (WDL) criteria were central to the redesign. Additionally, three previously missing body systems, peripheral vascular, musculoskeletal, and psychosocial, were added to ensure comprehensive assessments.
The new flowsheet went live on September 8, 2025, replacing legacy templates. Implementation included robust education and interactive scenario-based training to support adoption. Evaluation methods combined subjective and objective data. Nurse surveys assessed perceptions of clarity, ease of use, and alignment with clinical workflows, while system metrics tracked documentation time and volume.
Outcome data showed a significant improvement in documentation efficiency. Values entered per patient day decreased from 138 to 106. Time spent per shift hour initially increased (7.8 minutes post-implementation vs. 6.4 minutes pre-implementation) but is stabilizing as staff acclimate to the new flowsheet. Data was collected over four-week periods pre- and post-implementation. In the EHR playground environment, nurses reported greater confidence in documenting clinical changes. Ongoing analysis includes follow-up nurse surveys at 3, 6, and 12 months.
Participants will gain actionable strategies to streamline workflows, challenge outdated practices, secure buy-in, and improve documentation clarity and legal defensibility. The approach aligns with American Nursing Association documentation standards and supports real-time, patient-specific care.

Background: Intrathecal pain pumps (IPP) are used for severe chronic pain but pose significant safety risks, including life-threatening medication interactions. A nine-hospital Southwestern network experienced patient safety incidents due to lack of IPP visibility in the EMR.
Purpose: To design an EMR workflow that improves IPP documentation and alerts, reducing adverse events and enhancing multidisciplinary communication.
Methods: Two informatics nurse specialists led a workgroup of physicians, nurses, and IT analysts. The team developed implant documentation for IPP and associated medications; passive alerts for nurses, physicians, and pharmacists; pharmacy notifications tied to implant documentation and problem lists; pop-up advisories for opioid orders when IPP is present; and physician order visibility on MAR for nursing handoff.
Results: Implemented workflows improved IPP identification and communication across inpatient, procedural, and emergency settings. Passive and active alerts increased staff awareness, reducing risk of medication errors and patient harm.
Conclusion: Integrating IPP documentation and alerting into EMR workflows enhances patient safety and multidisciplinary coordination.

Background: In addition to the utilization of smart pumps, recommendations exist to use bi-directional interoperability to enhance safe medication delivery. Successful implementation of bi-directional smart pump technology with an EHR requires a multidisciplinary team approach.
Purpose: The primary purpose of this project was to evaluate all IV infusion pumps for device integration with the EHR and identify all areas in the hospital system that perform IV infusion to determine project scope. The secondary purpose of this project was to plan for a comprehensive nursing education plan related to integrated IV infusion pump utilization.
Method: A multidisciplinary team evaluated all smart pumps, infusion medications, drug libraries, and care locations in which IV infusions are delivered.
Result: Specialized teams lead different portions of the project including pump software upgrade, device integration build, drug library consolidation, and development of comprehensive nursing education.
Outcome: All inpatient nursing units were deemed in scope for integration, as well as certain ambulatory care locations that routinely perform IV infusion. Emergency departments and operating room locations were deemed out of scope for integration. Certain medications, including override medications and blood products, were deemed out of scope for integration via the project.

PICOT question: In nursing education programs (P), does transformational leadership compared to traditional management approaches (I vs. C) improve faculty adoption of informatics technologies, faculty confidence, and student NCLEX performance on informatics competencies (O)?
Clinical/operational focus: Despite AACN Essentials mandating informatics competencies, faculty resistance remains a critical barrier to technology adoption. Programs struggle to integrate learning management systems, simulation platforms, and technology-enhanced teaching methods necessary for preparing digitally competent nurses. This systematic review investigates whether transformational leadership strategies drive faculty adoption, increase confidence, and improve student informatics outcomes.
Informatics components: This review examines three domains: 1) learning management systems for course delivery, analytics, and competency tracking; 2) simulation technologies including virtual reality, augmented reality, and electronic health record training; and 3) technology competence aligned with QSEN and TIGER standards. These technologies develop students' clinical decision support, documentation proficiency, telehealth capabilities, and digital health literacy.
Method and status: A systematic literature review is underway using CINAHL, PubMed, ERIC, and Scopus databases (2015-2025). Search terms include "transformational leadership," "nursing education," "informatics adoption," "faculty development," "technology integration," and "simulation." Inclusion criteria require peer-reviewed empirical studies examining leadership approaches with measurable outcomes: faculty adoption rates, confidence scores, student competencies, or NCLEX performance. Database searches identified 847 articles. Title and abstract screening is in progress using Covidence systematic review software. Full-text review and data extraction are scheduled for February 2026. Data extraction focuses on study design, sample characteristics, informatics technologies, leadership frameworks, outcome measures, effect sizes, and barriers/facilitators. Quality appraisal will use validated tools.
Preliminary insights: Early screening reveals transformational leadership's effectiveness. Studies demonstrate that when leaders employ Bass and Avolio's four dimensions—idealized influence, inspirational motivation, intellectual stimulation, and individualized consideration—faculty show higher adoption and confidence vs. mandate-based approaches. Emerging themes include importance of faculty champions and peer mentoring, need for individualized professional development, role of protected time and resources, and connections between faculty confidence and student performance. Several studies show positive correlations between transformational leadership and improved NCLEX pass rates on informatics items, though effect sizes vary by context.
Expected findings: By June 2026, this review will provide comprehensive synthesis quantifying faculty adoption, confidence improvements, and student outcomes associated with leadership approaches. Analysis will identify specific transformational strategies that are the most effective for overcoming resistance and building capacity, with comparative examination across institutional types, program levels, and technology categories.
Impact and nursing relevance: This review addresses a critical gap by synthesizing evidence on leadership strategies for informatics integration. Findings provide academic leaders with evidence-based frameworks for culture change beyond compliance mandates. Results support ANIA's mission to advance nursing informatics through leadership excellence, offering actionable strategies for workforce readiness, patient safety, and healthcare quality. This research ensures nursing graduates possess informatics competencies essential for practice in digital healthcare environments.

As healthcare organizations continue to adopt increasingly complex digital ecosystems, ensuring clinical readiness is essential for maximizing use and for promoting safe, efficient, and effective care delivery. Our organization has developed and implemented a clinical readiness program, a standardized, multidisciplinary initiative designed to optimize provider onboarding, technology access, and digital proficiency. With the main objective of ensuring that providers are fully prepared to function clinically on their first day, this program integrates key stakeholders and leverages informatics best practices. This approach bridges the gap between HR onboarding, credentialing, training, and provisioning, ultimately improving both provider and nurse satisfaction.
The clinical readiness program begins at the earliest stages of the onboarding process, starting with HR and credentialing validation. Our team tracks the individual’s status through the onboarding and/or credentialing pipeline, then initiates a comprehensive checklist to coordinate (or provide) training, provisioning, scheduling intake for surgeons, and complete with a final pre-start personalization appointment.
Unlike traditional onboarding models, this program introduces a workflow-driven approach to orchestrate collaboration between informatics, clinical leadership, IT, human resources, and support teams. A central informaticist manages the queue, ensuring that access to all applications (e.g., EHR, imaging, communications platforms) are secured, tested, and tailored to the clinician’s specific specialty and work environment prior to their first day of patient care.
The strategies implemented in this clinical readiness program optimized healthcare technology workflows, including the design and implementation of personalized EHR configurations, role-specific templates, and automation of provisioning processes. Following a clinical readiness workflow significantly reduces the time needed for clinicians to start working, enhances clinicians’ confidence, and sets the stage for clinicians to begin work with all the tools for success.
Training and education are core to the program’s success. By aligning with national informatics competency frameworks, we deliver tiered training pathways tailored to varying levels of digital literacy and clinical roles. Our approach emphasizes just-in-time learning, peer mentoring, and ongoing competency assessment, empowering clinicians to adapt to evolving technologies with confidence. Leadership engagement is cultivated through targeted briefings and key performance indicator dashboards that demonstrate readiness metrics, system usage, and user satisfaction, reinforcing accountability and driving continuous improvement.

Rounding plays a crucial role in informatics work, bridging clinical practice, healthcare operations, and technology. Purposeful rounding is an essential process for establishing and maintaining close relationships with end-users, supporting the adoption of health informatics tools, and helping to improve clinical and operational workflows with the technologies we deploy.
As we began the process of consolidating our enterprise informatics team from multiple regional health ministries into one larger team, we made the decision to focus on normalizing informatics practices across the enterprise. Standardizing our rounding practice was the first objective chosen for review at a corporate level.
To accomplish a substantial change and manage a program such as this, we formed a committed team of health informaticists representing a cross section of specialists from across the organization.
Planning began in October 2024 and focused on standardization of rounding processes, communication to leadership about the change, and ways to deliver effective education to the greater enterprise informatics team. The team met on a weekly basis to define the standards – how should informaticists prepare to round, interpreting the importance of relationships in coverage areas, how often should leadership be engaged in rounding discoveries and initiatives, how should we communicate with our coverage areas, what should informaticists study during the rounding experience, and how to document our rounding outcomes consistently.
Research for best practice was conducted and reviewed, drawing from both evidence and practice based. Education was created by the group and provided to all team members across the enterprise beginning January 2025; six education sessions were held. The education was tracked in our learning management system (LMS) and was comprised of a data and analytics review module as pre-work, then a live class, and a post-test following the live class.
A survey was sent to the entire organization which gleaned a perspective from the staff and operations not previously done. This information provided valuable information to informatics management enabling adjustments and expectation setting with the informatics staff as the education was rolling out.
Our goal was to work with operational managers and staff to observe, assess, and study clinical workflows, increase staff engagement, incorporate data into rounding assessments, improve performance by decreasing time in the electronic health record (EHR), and encourage consistency of rounding practices across the organization.
Our work continues as we evaluate the work we began over a year ago. Following plan, do, study, act (PDSA) logic are identifying areas for additional learning for colleagues, reviewing and analyzing survey results, and starting the development of guidelines for purposeful rounding in our acute and ambulatory spaces.