by Michelle Troseth, MSN, RN, DPNAP

Why did you become a nurse? My immediate response when anyone asks me this question is “divine intervention.”  I was in high school when I was called out of class one afternoon by a high school guidance counselor.  He informed me that I fit the profile perfectly for a new nurse co-op aide program with a local hospital, and before he could say any more I exclaimed, “I don’t want to be a nurse!”  He encouraged me to consider this unique opportunity and after discussing it over with my parents I decided to enroll in the program.

Michelle Troseth, RN, MSN, DPNAP

My initial reaction about nursing was primarily due to having no nursing role models in my life, and the stereotypical television characters of nurses back in the ’70’s did little to entice me into the career.  But here is the good news…..when I started working in the hospital and side-by-side with nurses….I was AMAZED by who nurses were and what they did. 

I saw quickly how they played a key role in patient care.  I also was in awe of how much nurses knew (and how much they needed to know) to deliver the best care possible.  I am forever grateful for the knock on the door from my high school counselor, Mr. Rice.

Last December, I had the honor of being recognized as Alumni of the Year at Grand Valley State University (BSN ’83 and MSN ’97) and one of the highlights of the evening was being able to have Mr. Rice there, who I had not seen in over 30 years, to thank him for being the angel in my life that introduced me to nursing!

How did you transition into informatics?  After working three years in critical care, at the same hospital where the nurse co-op aide program was, I decided to go to another hospital where a new professional practice model of care was starting.  Bonnie Wesorick, MSN, RN, DPNAP, FAAN, was an assistant professor my senior year in college, and a mentor of mine. 

She left academia to start the Clinical Practice Model (CPM) and to create the type of environment and tools nurses needed to support their professional practice.  It was through the evolution of CPM, and my transition to a leadership role at the hospital, working in partnership with allied health and the hospital information system department, that I co-led a very committed group of clinicians in creating the first evidence-based, interdisciplinary clinical documentation system based on the CPM Framework. 

In 2001, I left the hospital and joined the CPM Resource Center to help lead the integration of professional practice and technology, and to help guide a growing CPM Consortium through the transition from paper to computerized documentation.  My first title was VP of Point-of-Care Automation, which I loved, because it represented the need to automate at the point of care – where care happens!  In the ’80’s and ’90’s so much of the focus in healthcare automation was in billing and non-direct care areas – it has been a long road looking back.

Part of my informatics journey involved becoming part of a software company (Eclipsys) from 2004-2007, which has led to my current home at Elsevier Clinical Decision Support, (2007-current) where Elsevier CPM has continued to grow and thrive.  Today, we have close to 400 hospitals using multiple health information technology systems that are using the same CPM tagged data-base for intentionally designed automated evidence-based interdisciplinary care planning and documentation. 

This year, we have accomplished another milestone by working directly with hospitals, even if a business-to-business partnership does not exist with their health IT vendor –and it has been strong nurse leaders advocating for the clinical team to ensure they have the practice support they need as they automate their care processes.

Another major part of my informatics journey has involved my engagement with key groups to advance the evidence and informatics agenda to prepare educators and practitioners for the 21^st century of practice.

I am proud to say:

• I have been part of TIGER (Technology Informatics Guiding Education Reform) since its first meeting at Johns Hopkins School of Nursing in January of 2005. 
• I have since served as the TIGER Summit Program Chair (2006) and co-chaired the TIGER Collaborative “Usability and Clinical Application Design” (2007-2008).
• I am now the Co-Chair of the newly formed TIGER Initiative Foundation, now a 501(c) (3) organization operating for charitable, educational, and scientific purposes.
• I also have been engaged with HIMSS Nursing Informatics and Usability Task Forces and have presented at national and local HIMSS conferences.

What advice would you give nurses looking to get into the informatics field?

• Make the connection between professional practice and technology.
• Volunteer to get engaged with efforts at your school/primary practice/hospital/health system to automate their clinical systems.
• Partner with all disciplines. Just as nurses are the coordinators of care at the point of care, informatics brings coordination for nursing informatics at the system level.  Patient care includes all disciplines and it must be well-integrated.
• Partner with nurse leaders (CNOs, Directors of Nursing, etc) to hear their vision of what informatics can do to improve patient care.
• Join HIMSS at the local and national levels – and get engaged with various work groups.
• Become engaged with the TIGER Initiative Foundation and use the TIGER Reports in your efforts to understand and implement information systems.
• Become a Polarity Thinker – healthcare is complex, and it requires the ability to manage polarities vs. solving problems. The CPM Resource Center has presented Polarity Management™ for healthcare at HIMSS, ANIA, AONE and other national conferences as an important competency for leaders in informatics.

What do you see your role as within nursing informatics today? I see my role to expand the current thinking and understanding of what nursing informatics can be today.  Nursing informatics can be at the helm of healthcare transformation as long as we ask the right questions and engage the right people.  Healthcare transformation requires a deep understanding of not only the role of informatics, but the roles of culture and professional practice to create true sustainable and interoperable health information systems. 

Ultimately, I see my role as being an advocate for nurses, physicians, allied health practitioners and patients to influence health policy so we achieve the type of interoperability we desire that represents our professionalism and the best patient-centered care across the continuum of care.

Michelle Troseth, RN, MSN, DPNAP, is Executive Vice President and Chief Professional Practice Officer for the CPM Resource Center.