Canadian Journal of Nursing Informatics

Nursing Student Awareness and Utilization of Educational and Professional Resources Towards Informatics Competency Development

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by Danielle Lysak, RN, BScN, MN Student,

Kathryn Palamarek, RN, BScN,

Joanna Trieu, RN, BScN,

& Dr. Manal Kleib, MSN MA PHD RN


Lysak, D., Palamarek, K., Trieu, J. & Kleib, M. (2022). Nursing Student Awareness and Utilization of Educational and Professional Resources Towards Informatics Competency Development. Canadian Journal of Nursing Informatics, 17(1).

Informatics Competency Development


Background: Informatics is a core nursing competency. Little is known about the professional and educational resources students use and their perspectives regarding how these resources help them acquire informatics competency during their undergraduate nursing education.

Objective:The study purpose was to explore nursing students’ awareness and utilization of resources available to support nursing informatics competency development. A secondary aim was to compile a list of accessible resources to augment informatics learning at the undergraduate level.

Method: An exploratory descriptive cross-sectional survey was used. Undergraduate nursing students in a western Canadian university were invited to participate. Data collection was completed between June-August 2020. Descriptive statistics were applied to summarize quantitative data, and content analysis for responses to open ended questions.

Results: Most participants were familiar with nursing informatics competencies; however, their understanding of the concept of nursing informatics was limited. Three themes were identified: 1) the meaning of nursing informatics, 2) resources students commonly use toward nursing informatics competency development, and 3) students’ views on their learning and suggestions for fostering nursing informatics competency development.

Conclusion: Further integration of informatics into undergraduate nursing curricula and increasing access to learning resources are critical strategies for improving graduates’ readiness for competent practice with digital health. Recommendations for nursing education and research are discussed.


Informatics is a core nursing competency (Canadian Association of Schools of Nursing [CASN], 2012). Educating nursing students about informatics increases their success upon graduating and joining the workplace, as nurses are increasingly required to utilize digital health technologies to support care delivery (Booth, 2006; Canada Health Infoway, 2020; Fetter, 2009a; Nagle et al., 2020a). Nursing informatics (NI) is defined as the “science and practice [which] integrates nursing, its information and knowledge and their management with information and communication technologies to promote the health of people, families and communities worldwide” (International Medical Informatics Association [IMIA], 2009, para. 2).

Nurses should have clear expectations to guide their practice in informatics; therefore, there have been substantive efforts worldwide to define informatics competency requirements for nurses and nursing students (Kleib et al., 2021a). These competency lists serve to guide the integration of informatics into nursing curricula as well as continuing education for informatics competency development. In Canada, the Entry-to-Practice NI competencies for registered nurses represent the core requirements (i.e., knowledge, skills, and attitudes) that nursing students must have upon completing their undergraduate educational program (CASN, 2012). These core competencies include information and knowledge management, professional and regulatory accountability, and use of information and communication technologies in the delivery of patient care. The CASN’s NI competency framework also provides guidance to nursing programs regarding aspects to incorporate within their undergraduate curricula for teaching students about informatics.

Educating students about these NI competencies ensures graduates are well prepared for the provision of safe nursing care when this care is supported by digital health tools such as the use of electronic health records and other technologies (CASN, 2012). However, research involving Canadian schools of nursing showed limited integration of informatics content in nursing curricula as well as limited utilization of the Entry-to-Practice competencies and several other educational resources developed by CASN to assist nurse educators in teaching their students about NI (Nagle et al., 2020a). These gaps negatively impact graduates’ abilities to understand the relevance of informatics to their nursing practice. Further, while this research highlighted the status of NI integration from the perspective of educators and academic nurse administrators, students’ perspectives were not captured in this study (Nagle et al., 2020a, b). Understanding students’ views is vitally important for informing policy and practice with regards to informatics readiness among future Canadian nurses.

The purpose of this study was to explore undergraduate nursing students’ awareness and utilization of educational and professional resources available to support nursing informatics competency (NIC) development. A secondary aim was to compile a list of accessible resources that could be used to augment learning about informatics at the undergraduate nursing education level. We addressed two research questions: 1) What do undergraduate nursing students utilize to support their NIC development? and 2) What do undergraduate nursing students recommend regarding strategies, resources, and supports needed to assist them in acquiring required NIC?

Methods & Procedures

Design and Sample

An exploratory, descriptive, cross-sectional online survey was used. Exploratory survey research is appropriate when there is limited literature available, as it provides a snapshot about phenomena of interest at a particular point in time (Creswell & Creswell, 2018). The population of interest was nursing students enrolled in different years of study in the undergraduate nursing programs within one Western Canadian University and three of its collaborative programs. Convenience sampling was applied because hypothesis testing was not planned in this study and accessing the study population was granted at no cost (Heavey, 2015, p. 72).


A validated measure that aligned with the purposes and research questions of this study could not be located for use in this study; therefore, the authors developed survey items based on a review of relevant literature on different approaches for developing NIC in nursing education, and then obtained feedback on the draft survey from an expert in the field of NI, which enhanced the survey’s content validity (Heavey, 2015).

The survey had a total of nine questions, some pertained to demographic information to describe the characteristics of the study sample, and some were focused on aspects related to learning about informatics including awareness and application of the informatics competencies, and students’ preferred resources for informatics learning. In addition, a few short answer questions were used to enable sharing of rich data related to research questions. The survey was hosted on REDCap, an online survey platform which made the survey accessible to any student with an electronic device. In addition, this platform was a secure tool because data is housed within Canada.

Recruitment and Data Collection

To recruit participants, a poster was sent to the Deans/Directors of nursing programs of schools identified for them to circulate it to potential participants via email and to also share it on their Facebook page to increase awareness about this study. Students were able to voluntarily participate in the survey by clicking a public link embedded in the invitation poster and completing the survey. The survey took approximately 10-15 minutes to complete to reduce participant fatigue. After initial recruitment, one email reminder was circulated again.

Data Analysis and Management

Research data was transferred from the REDCap database and saved securely on a password-protected computer with access restricted to members of the research team. Quantitative data analysis was completed using the Statistical Packages for the Social Sciences (SPSS) version 25.0. Fully and partially completed surveys were included in the analysis and incomplete surveys were excluded. After data cleaning, descriptive statistics were applied to summarize and describe quantitative survey responses. A correlation analysis using Pearson correlation coefficient was conducted to investigate associations between the program and year of study, and the three domains of NIC. For open ended questions, an inductive approach to content analysis was applied to identify meaningful units such as phrases, ideas, and attitudes related to research questions (Caulfield, 2019). Codes were then compared and grouped into larger categories to identify common themes within the data (Caulfield, 2019). Authors reconvened after each independent analysis of the data to compare, share, and discuss notes and impressions. This process was repeated to achieve consensus on identified themes. A list of resources commonly used by students to learn about informatics, as identified by the study participants, was compiled.

Ethical Considerations

This study was conducted following the principles of the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (Canadian Institutes of Health Research et al., 2018). This study was submitted to and approved by a Research Ethics Board (REB 2: Human Research) identified under #Pro00100272. A secondary ethics approval was also required by one of the participating colleges, which was also obtained through their REB. Participants were provided with an information document outlining the study procedures and associated risks and benefits. Participation was voluntary and participants were able to exit the survey at any time prior to submission. By completion and submission of the survey, consent from the participants was implied. Participant identifying information was not collected to maintain anonymity. Due to the anonymous nature of the survey, participants were unable to withdraw their responses once they had been submitted. There was minimal risk to participating in this study. Questions were not personal in nature; thus, we did not anticipate participants would experience any discomfort responding to them.


A total of 66 participants responded to the survey. Of these, 21 surveys were fully completed, 16 surveys were partially completed (the respondent had answered at least one non demographic question) and 29 surveys were incomplete (no questions were answered, or only demographic questions were answered). Analysis of results was based on fully completed and partially completed surveys (i.e., 37 participants). Over half of participants (n=19: 54.3%) were enrolled in the Collaborative program, with a few participants from the Honors, After degree, and Bilingual nursing programs.

In response to the question regarding familiarity with CASN’s NIC, participants indicated being familiar with the three core NIC, with 72.2% being least familiar with the competency “Use of Digital Health Technologies in the Delivery of Patient Care” (Table 1).

Table 1: Students’ Familiarity with CASN NI Entry-to-Practice Competencies (n= 36)

  Competency(n/%) Yes(n/%) No(n/%) Unsure
Information & Knowledge Management(n=32: 88.9%)(n=1: 2.8%)(n=3: 8.3%)
Professional and Regulatory Accountability(n=29: 80.6%)(n=3: 8.3%)(n=4: 11.1%)
Use of Digital Health Technologies in the Delivery of Patient Care(n=26: 72.2%)(n=4: 11.1%)(n=6: 16.7%)

As shown in Table 2, a strong positive correlation was identified between information and knowledge management and professional and regulatory accountability, r = 0.509, n = 36, p < 0.01 and between information and knowledge management and the use of digital health technologies, r = 0.506, n = 36, p < 0.01. A moderate negative correlation was identified between the year of study and the professional and regulatory accountability competency, r = – 0.341, n = 35, p < 0.05; indicating that the higher the year of study, the less likely participants were familiar with this competency.

Table 2: Correlations between Program, Year of Study, and NIC

1. Program1    
2. Year of study0.2231   
3. Information and knowledge management-0.081-0.2641  
4. Professional and regulatory accountability-0.193-0.341*0.509**1 
5. Use of digital health technologies-0.022-0.0970.506**0.1171
*p < 0.05 (2-tailed); **p < 0.01 (2-tailed).

Theme 1: The Meaning of NI

Participants shared their perspectives on the question “what does NI mean to you?” A majority of participants associated NI with the use of technology as a tool for searching information and gaining knowledge to enhance nursing practice. For example, some stated that NI includes:

“using technologies to utilize nursing information and knowledge” and “using computer/digital tech to enhance nursing practice.”

Other participants shared:

“Nursing informatics is a wide body of knowledge which nurses use to base their clinical judgement and guide their practice.”

Another commonality was referring to NI as a means of communication between healthcare professionals and patients. One participant stated that the integration of NI into practice allowed

“increase[d] communication with patients and other healthcare professionals.”

This was echoed in other responses which described NI as the ability to “communicate information” and “share data.”

Many participants alluded to NI as a tool to facilitate information management and sharing in which they combined concepts of technology and communication together, for example:

“NI is using technology to store and communicate information” and “ [NI] means health information and technologies that nurses use to … increase communication with patients and other healthcare professionals” and “to me, nursing informatics means a method of providing information important to nurses through the use of technology in order to improve nursing practice and communication between healthcare professionals.”

A few participants described NI as:

“a way to organize and display/categorize health information” and informatics as “visual information [as a means] to make nursing…information easier to understand.”

A few participants viewed NI as a tool to promote the health of persons and communities. These included “promotion of public health” and NI was used to make “healthcare more easily accessible and understood.”

Theme 2: Resources Students Commonly Used Toward NI Competency Development

Participants were asked to share some of the resources they commonly used that they thought facilitated their development of NIC. Common tools named by participants included online clinical support applications such as the Nursing Reference Center, mobile drug guides (i.e., Davis Drug Guide and Lexicomp), and Alberta Health Services (AHS) clinical resources. Table 3summarizes these responses organized according to each category of CASN’s NIC. 

Table 3: Resources Students Perceived as Facilitating NIC Development (n=22)

NI CompetencyResources
Information & Knowledge ManagementAHS Insite; AHS Parenteral Manual; Connect Care; Davis Drug Guide; Google Drive; Khan Academy; Lexicomp; Mendeley; MetaVision; Netcare; Nursing Reference Center Plus; One Note; Online Drug Guide; Osmosis; Purdue Owl; Pyxis; University of Alberta Library Databases; University of Calgary Pathophysiology Database; VAX; Wikipedia; YouTube
Professional and Regulatory AccountabilityAHS Confidentiality Training and Guidelines; AHS Modules; AHS Policies; College and Association of Registered Nurses of Alberta [CARNA]; Canadian Nurses Association [CNA]; Connect Care; Google Drive; In person Lectures; myAlberta Digital ID; Netcare; Patient Chart; Pyxis; University of Alberta Policies; VAX Proficiency; Undefined
Use of Digital Health Technologies in the Delivery of Patient CareClinical Learning; Drug Guides; Lectures; MetaVision Electronic Charting; Monitoring Devices; Netcare Training; Personal Devices to measure blood pressure, heart rate, and sleep; Staff Computers; VAX; Wonder Guards;

Participants also reported why they found these resources helpful or contributing to developing their NIC. Key responses included a desire for independence in evidence-based practice, as one participant stated that:

“students need to learn how to seek, locate and find resources by themselves.”

One participant justified their use of Lexicomp, a clinical medication database application, by stating that:

“having reliable and easy resources to navigate knowledge sources is incredibly valuable.”

Many participants indicated a need for an extensive range of resources available to support their practice and knowledge base.

Theme 3: Students’ Views on NI Learning and Suggestions for Fostering NIC Development

Several participants alluded to a poor quality of NI education and resources provided within their undergraduate nursing program. Participants shared that current methods of NI teaching lacked depth and were not very effective in facilitating the development of NI skills. According to one participant:

“more time is needed to develop electronic charting competency when entering the clinical setting so that time that should/could be spent providing care is not hindered by an inability to use the technology used for charting.”

Another participant mentioned:

“there is very little actual instruction of how to use… any of the resources… So much of the program has been about relying on other students to get the knowledge we need.”

Regarding the delivery of the curriculum, one participant expressed a desire to receive more opportunities to:

“practice using … clinical informatics resources instead of just [being shown] to them.”

Participants also provided suggestions regarding what they believed was needed to further assist them in acquiring NIC. Participants identified two main approaches to improving NI learning: further integration of NI into the curriculum and increasing access to NI learning resources. Regarding the first approach, many students alluded to a need for greater exposure to and detailed instruction on NI skills within the clinical and lab settings. According to one participant:

“Nursing informatics was … a very small topic in (nursing courses), when I know for a fact that [it] is a major part of our nursing career. We should be taught more on familiarizing ourselves with Nursing Informatics because we live in a very techy world now.”

Similarly, many other participants suggested that greater hands-on practice and time for learning in a safe practice environment would increase their confidence with NI skills and competencies.

With respect to the second approach, several participants indicated that having greater access to Canadian NI learning resources to facilitate learning about NI through guided instruction and independent study would be ideal. Also, participants expressed a desire for resources that were more straightforward and comprehensive. According to one participant:

“They [students] could have been provided with more free online studying resources … rather than having to discover them for [himself/herself].”

This perspective was echoed by several other participants who suggested that increased access to resources, such as “peer reviewed, reliable video resources”, in-class presentations, and learning assignments would assist them in developing NIC. Another participant shared:

“it would also be helpful to have more scenario-based examples where students can practice using the technology or to troubleshoot it.”


Even though this was a relatively small-scale study, results revealed important insights about nursing students’ awareness and utilization of educational and professional resources for informatics competency development. Overall, participants indicated being familiar with the Entry to Practice CASN’s NI competencies. Of these three required NIC, participants were least familiar with the “use of digital health technology in delivery of patient care” competency. This finding was not surprising as most participants were in their second and third year of education in their program; thus, they may have not had sufficient exposure to technologies used in care delivery, which is congruent with the general literature (Kleib et al., 2021b; Nagle et al., 2020a, b).

Regarding the negative correlation identified between the year of study and the professional and regulatory accountability competency, whereby the higher the year of study, the less likely participants were familiar with this competency, it is plausible that participants in this study did not receive adequate education about this competency or have had limited opportunities to draw connections about ethical and legal dimensions relevant to NI practice. Positive correlations identified though indicate that these NIC are interrelated, suggesting that an integrated approach addressing all three core NIC would be more beneficial for students to be able to develop a comprehensive understanding of NI and the required NIC. It must be noted that when responding to this question, the focus was on familiarity and not the participants’ perception of NIC. It is important that future research examines how nursing students perceive their NIC as well as whether they have a well-developed understanding of these NIC requirements, as opposed to just knowing about them. These speculations were further supported by the analysis of participants’ narrative responses with respect to their understanding of NI.

Participants in this study understood NI as a tool for improving communication between care providers and patients, facilitating knowledge development and evidence-based practice, and overall information management in healthcare. These descriptions, although relevant, also reflect a narrow view of what NI entails. Similarly, this limited understanding was not surprising given that NI is a relatively new concept and often not talked about in depth within the nursing curricula (Nagle et al., 2020a, b). Further, these findings are not alarming as opportunities for students to address these gaps and learn more about NI prior to graduation are still possible.

With respect to the different resources that participants used to learn about NI, most participants provided examples of informatics tools that could support learning relevant to the information and knowledge management, and element of NIC. In a professional program such as nursing, using evidence-based, reliable sources to support clinical practice is crucial to competent care (Found, 2012; Jetté et al., 2010). This finding was encouraging and implies that students can confidently access appropriate databases and literature in a way that meets aspects of informatics competency, specifically information and knowledge management. However, many of the tools that participants discussed such as YouTube, Khan Academy, and Osmosis fall within the generic information technology tools commonly used for educational and learning purposes. These are quite different from clinical applications nurses use to manage healthcare and patient-related information (Nagle et al., 2020 a, b). This observation is further supported by the finding relevant to participants indicating being less familiar with digital health technologies. It is vitally important that students have opportunities to understand these differences as well as to assess whether students’ technology skills within a learning context are transferable to the clinical environment.

Examples discussed in the category of professional and regulatory accountability NIC suggest participants in this study had accessed resources that could help increase awareness about this competency. Policies and guiding documents issued by professional associations such as CARNA and CNA can be important resources that nursing students could benefit from because these documents are also typically integrated across nursing courses. For example, the CARNA entry-to-practice competencies document has been recently updated to reflect the integration of CASN NI competencies (CARNA, 2019). This provides an important transition in nursing; however, it remains within the educators’ roles to enforce the linkages between ethical and professional nursing practice and the application of these concepts relevant to informatics.

Many students provided examples of technologies used in the delivery of patient care including medical devices, electronic records and charting, and personal fitness devices. These findings suggest that students have somewhat limited exposure to the broad spectrum of clinical informatics tools. This is congruent with findings from prior research on nursing students’ preparedness in NI, which indicates students typically have a limited exposure to technologies used in clinical settings (Fetter, 2009a, b; Jetté et al., 2010; Kleib et al., 2021b; Nagle et al., 2020a, b). Nagle, Kleib, and Furlong (2020 a, b), explained that in nursing education there are often assumptions that most students are savvy in technology. The authors challenged that computer proficiency should not be equated with informatics competency and that students still require comprehensive and focused education about NI and its relevance to nursing practice. Increasing nursing students’ exposure to the clinical applications of informatics can enhance their confidence and overall preparedness to use digital health technologies in the context of patient care upon joining the workplace (Kleib et al., 2021b; Nagle et al., 2020a, b).

With respect to education and resources on NI within the nursing program, our findings were congruent with the general literature on NI education in Canada. In the study by Nagle et al. (2020a), it was found that only 31% of nursing educators (n= 360) teach about the use of CASN Entry-to-Practice NIC to support student learning in their programs. Moreover, a majority of nursing educators indicated “not at all” to “minimal” use of other CASN resources to teach students about NI (Nagle et al., 2020a). Furthermore, Nagle et al. (2020a) found that less than 20% of educators reported the use of a simulated electronic health record during lab teaching, confirming that students have limited opportunities to learn about computerized charting. These findings may indicate a lack of resources provided to students to support their NI competency development.

Several studies emphasized a need for greater inclusion of NI education in the nursing program curriculum. Participants in a study by Fetter (2009b) recommended greater integration of information technology training into all clinical and theory nursing courses. In a study by Jetté et al. (2010), few participants (n=14) were found to have received training or had knowledge about information systems used in healthcare settings. Most of their experience was limited to exposure they received as nurse trainees.  In another study by Kleib et al. (2021b) authors also pointed to several challenges in students’ learning about computerized charting and the need for expanding the use of simulated electronic records in nursing education programs (Kleib et al., 2021b).

Results from our study reinforce the need for greater exposure to and use of digital health technologies among nursing students to increase their familiarity and confidence in using these technologies when providing patient care, i.e., demonstrating informatics competency. Ongoing education about NI is a shared responsibility between nurse educators and students. As adult learners, nursing students should continue to pursue learning about NI through self-directed study. Nursing educators are also encouraged to continue utilizing CASN’s free of charge educational resources to augment teaching and learning about informatics at the undergraduate level.

Table 4 includes a compilation of resources that were identified by the research team, which may serve as a guide to facilitate learning and education about NIC that we hope would be helpful for both undergraduate students and educators.

Table 4: Nursing Informatics Resources for Student and Educator Use

ResourceLink or How to Access
CNIA website
CNA website on informatics
Informatics position statement published by CNA & CNIA
CARNA learning modules
CASN toolkit for nursing informatics
CASN YouTube channel.
  CASN Whiteboard on: The Use of Social Media
CASN whiteboard animation on: The value of clinical standards
CASN Digital Health Resource
Clinical Key: Elsevier’s medical and surgical content in books, articles, guidelines, and procedure videos.!/
Lippincott AdvisorAccessed via AHS Services Insite at Clinical Sites.
RNAO Resource on Digital Health
Use of apps to access evidence-based resourcesPubMed Mobile Application
Use of drug reference guides through mobile devicesLexicomp Davis Drug Guides
Use of social networking applicationsTwitter Facebook Instagram Indeed
Use of multimedia applications to support learning.YouTube Podcasts
CARNA Case Studies Relevant to informatics
Use of electronic documentation in clinical settingConnect Care Training (Accessed via AHS) AHS Insite Web Pages Connect Care Dashboard
Use of drug calculation appsInfinite Dose (available on the app store)
Use of library databases to access evidence-based resources

Study Limitations

Results of this survey study represent the views of respondents to this survey. Response bias, which refers to those who have chosen to respond because they were interested in the topic of the study versus those who did not choose to respond, may have influenced results. Further, the sample size of this exploratory study was small with participants mainly from one western Canadian university, therefore, findings should not be generalized beyond this context.

Implications & Recommendations

This study provided important insights about nursing students’ views and their recommendations to support students’ NIC development. An important next step for educators is to prioritize the integration of NI in undergraduate nursing curriculum and to make connections between informatics concepts addressed in clinical and theory courses and other general nursing courses, while also recognizing the difference between having mere computer proficiency skills and NIC. The competency of ICT use in delivery of patient care is a top priority to address, because in this unprecedented time of online education and virtual care, which has further expanded with the advent of the COVID 19 pandemic, student nurses need to have the ability to transfer their digital literacy skills to the clinical context to promote health and advance nursing knowledge through informatics, as opposed to only being focused on technical skills needed for operating the technology (CNA & Canadian Nursing Informatics Association, 2017; CASN, 2012)

Research involving larger sample sizes and participants from other Canadian settings is needed. As we evolve into a world that is increasingly becoming reliant on the use of information technologies, nursing education must adapt to reflect the current and future needs of healthcare. Providing comprehensive education about NI and digital health as well as reliable and accessible information resources about NI helps support nursing students’ self-study about NI as well as nursing educators’ utilization of these resources to teach about NI. This study stands as an important step in understanding how to best augment learning about NI to ensure future generations of nurses are ready to provide competent and safe care once they join the workplace.


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Author Biographies

Danielle Lysak, RN, BScN with Honours

Danielle is currently a Master’s in Nursing student at the University of Alberta and graduated from her BScN Honours degree in April 2021. She currently works as an RN in Paediatric Cardiology and Gastrointestinal acute care.  Her research interest continues to be improving undergraduate nursing education and also in Child Health.

Kathryn Palamarek, RN, BScN with Honours

Kathryn currently works as Registered Nurse in a Paediatric Operating Room after completing her BScN Honours Degree in April 2021. She maintains an interest in informatics and the emergence of new digital health technologies in the nursing field. 

Joanna Trieu, RN, BScN with Honours

Joanna graduated from her BScN Honors Degree in April 2021 from the University of Alberta. She currently works as an RN in the areas of Obstetrics and Public Health.

Dr. Manal Kleib, MSN MA PHD RN

Dr. Kleib is an Assistant Professor at the Faculty of Nursing, University of Alberta. Her research program focuses on the nursing workforce preparedness in digital health. 


We would also like to acknowledge and express gratitude towards Dr. Anna Santos Salas of the University of Alberta’s Faculty of Nursing.  She was the course instructor for the honours class in which this study was built in and remained an instrumental part of our team to create this manuscript. 

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