E D U C A T I O N A L IS S U E S I N N U R S I N G P R A C T I C E

Nursing informatics competencies: assessment of undergraduate and

graduate nursing students
Jeungok Choi and Jean E De Martinis

Aims and objectives. To report the informatics competencies of students in selected undergraduate and graduate nursing
programmes, to examine whether informatics competencies differed between the different programmes and to suggest com-
petency-based applications that will strengthen informatics courses and informatics-related content throughout the curricula.
Background. Nursing students in undergraduate and graduate nursing programmes have different educational backgrounds
and different practice experience. Thus, their informatics preparation is apt to be varied, and nursing curricula must reflect
this variation while advancing students towards informatics proficiency. However, studies on informatics competency assess-
ment in these nursing students are scarce.
Design. A descriptive survey design.
Methods. Data were collected from 289 nursing students using a 30-item Self-Assessment of Nursing Informatics Competen-
cies Scale via an email sent to students using a LISTSERV mailing list. The email embedded link to the Internet survey pack-
age, SurveyMonkey, which included the Self-Assessment of Nursing Informatics Competencies Scale and demographic
questions along with an online consent form.
Results. Students in both programmes were competent in three subscale areas: basic computer knowledge and skills, clinical
informatics attitude, and wireless device skills. Graduate students reported slightly higher mean competency scores than did
undergraduate students in three subscales: clinical informatics role, clinical informatics attitude and wireless device skills.
Conclusions. Findings indicate specific topics for nurse educators to consider when designing informatics curricula. The com-
parison of undergraduate and graduate students indicates similarities in informatics competencies in terms of areas where
students were competent and small mean score differences. Further studies are suggested to examine whether there are
differences in informatics competencies between undergraduate and graduate students.
Relevance to clinical practice. These results assist nurse educators in determining specific areas of informatics content that
need greater focus and inclusion in the design of better nursing educational programmes. Examples of integrating competen-
cies into existing curriculum or informatics courses are suggested.

Key words: accelerated baccalaureate, doctor of nursing practice, graduate nursing students, nursing informatics competencies,
RN to baccalaureate, self-assessment of nursing informatics competencies scale, SANICS, traditional baccalaureate, undergradu-
ate nursing students

Accepted for publication: 10 November 2012

technologies to promote safe and evidence-based nursing

Introduction
Establishing a baseline of informatics competencies in nurs-
ing students is vital to planning an informatics curriculum
and adequately preparing students to use information
care (Hebda & Calderone 2010). Despite the importance of
assessing informatics competencies, there is a dearth of
studies to date that have reported informatics competencies
of nursing students in undergraduate and graduate pro-

Authors: Jeungok Choi, RN, MPH, PhD, Assistant Professor, Correspondence: Jeungok Choi, Assistant Professor, School of Nursing,
School of Nursing, University of Massachusetts, Amherst, MA; University of Massachusetts, 120 Skinner Hall, 651 North Pleasant
Jean E De Martinis, PhD, FNP-BC, Associate Professor, School of Street, Amherst, MA 01003-9299, USA. Telephone: +1 413 545 5689.
Nursing, University of Massachusetts, Amherst, MA, USA E-mail: jeungokc@nursing.umass.edu

© 2013 John Wiley & Sons Ltd

1970 Journal of Clinical Nursing, 22, 1970–1976, doi: 10.1111/jocn.12188
Educational issues in nursing practice
grammes. Furthermore, there are no studies that compared
competencies of students in undergraduate and graduate
programmes. Nursing students in different programmes
have different educational backgrounds and nursing prac-
tice experience; thus, they likely have different prepro-
gramme preparation levels in informatics. For example,
undergraduate students are generally younger and have less
or no experience in clinical nursing practice compared with
graduate students (Maag 2006). Yet, although they have
less preknowledge of nursing and therefore less exposure to
healthcare informatics systems such as electronic health
records, they typically are more proficient in basic use of
the computer and in computer applications through their
primary and secondary school education. Because nursing
students within and across academic programmes have such
unique educational and nursing practice backgrounds, their
preparation in informatics is apt to be varied, and nursing
curricula need to reflect this variation while advancing the
students towards proficiencies in informatics competencies.
Identifying informatics competency needs across pro-
grammes and comparing them side by side give valuable
baseline information for nurse educators in designing infor-
matics curricula. Because of the progressive nature of the
competencies, that is, more experienced nurses would pos-
sess the competencies expected of novice nurses (Gassert
2008), graduate students’ competencies must be built upon
the ones required for undergraduate students. Therefore, it
is important to ensure that competencies for graduate
students are built upon the ones needed for undergraduate
students and to monitor the progress of students in devel-
oping the competencies required in each programme. In
addition, a comparison of competencies between under-
graduate and graduate students gives data for nurse educa-
tors to distribute educational resources needed for teaching
informatics competencies in a streamlined way.
The purpose of this study was to (1) report the informat-
ics competencies of students in selected undergraduate and
graduate nursing programmes of the school of nursing of
one state university, (2) examine whether informatics com-
petencies differed between the different programmes within
the school, and (3) suggest competency-based applications
that will strengthen the informatics courses and informat-
ics-related content throughout the curricula.
Background
Informatics competencies in undergraduate nursing stu-
dents and recommended interventions to improve these
competencies have been studied by several researchers.
Overall, undergraduate nursing students’ competencies by
© 2013 John Wiley & Sons Ltd
Journal of Clinical Nursing, 22, 1970–1976
Informatics competencies in nursing students
self-report remained at a basic level, for example confidence
in Internet searches, word processing, using email and sys-
tems operations (Desjardins et al. 2005, McDowell & Ma
2007, Fetter 2009). Students perceived themselves lowest
on nursing care documentation and planning, valuing infor-
matics knowledge, skills development and data entry com-
petencies (Fetter 2009). After formal training and hardware
provision were given, improvements were found in basic
computer knowledge and skills, but fewer gains were found
in advanced skills and information literacy for the bacca-
laureate nursing students (McDowell & Ma 2007) and the
postbaccalaureate nursing students (Cole & Kelsey 2004).
However, baccalaureate nursing students perceived them-
selves higher on their computer skills than their actual per-
formance of those skills, indicating that actual competency
levels are lower than self-reported levels (Elder & Koehn
2009).
For graduate students, a few studies have addressed
informatics competencies. Studies have defined the infor-
matics competency (Curran 2003, Cronenwett et al. 2009)
or updated the early definitions of informatics competencies
(Chang et al. 2011), or the extent to which graduate pro-
grammes have integrated information technology skills and
knowledge in nursing curricula in master’s programmes
(McNeil et al. 2003), or suggested strategies to incorporate
informatics competencies into a Doctor of Nursing Practice
(DNP) or a master’s curriculum (Grant & Brettle
2006, Jenkins et al. 2007, Manning & Frisby 2011). In the
study by McNeil et al. (2003), the deans and directors of
266 baccalaureate and higher nursing programmes in the
USA reported that standard languages or terminologies, or
data standards for information systems were the lowest
informatics technology areas taught in the graduate pro-
gramme (McNeil et al. 2003). Jenkins et al. (2007) pro-
posed strategies for integrating informatics throughout the
DNP curriculum, for example use of informatics tools to
investigate population-based health and evaluate knowledge
for evidence-based practice in epidemiology, research and
statistics courses. A study by Manning and Frisby (2011)
used multimethod teaching strategies to integrate selected
competencies into an existing online quality and safety
course for post-master’s DNP students. There, the students
formed teams to produce educational videos on hand
hygiene, providing a vehicle for experiential learning, inter-
pretative thinking, reflective practice and peer review. Use
of integrative strategies to embed the most current informa-
tion technology methods within an existing course served
as an excellent enhanced teaching-learning platform for
these DNP student teams. Within the course, the students
were better able to achieve advanced competency attain-
1971
J Choi and JE De Martinis
ment across several American Association of Colleges of
Nursing (AACN) DNP Essentials (AACN 2006) key indica-
tors such as team collaboration, communication, use of
evidence-based practice information for improved health-
care quality and safety, and, in particular, informatics
knowledge and skills acquisition (Manning & Frisby 2011).
Similarly, Grant and Brettle (2006) also reported that there
was a significant improvement in the Ovid MEDLINE
search skills of master’s students after taking a Web-based
interactive tutorial developed and pilot-tested as part of a
12-week evidence-based practice module on health and
social care (Grant & Brettle 2006).
This review reveals that baccalaureate nursing students
have competent (Desjardins et al. 2005) or moderate infor-
matics and technology knowledge, attitudes and skills
(McDowell & Ma 2007, Fetter 2009). However, the review
also reveals a lack of studies on informatics competency
assessment of graduate students. Current literature has
focused on defining or updating the areas of competency
(Curran 2003, Cronenwett et al. 2009, Chang et al. 2011)
or the strategies to integrate informatics competencies into
a DNP or master’s curriculum (Grant & Brettle 2006,
Jenkins et al. 2007, Manning & Frisby 2011). As a result,
assessment of informatics competencies in graduate students
is imperative for successfully designing informatics curricula
for them. In addition, no studies have examined or com-
pared informatics competencies of students in undergradu-
ate and graduate programmes. Assessing and comparing
informatics competency needs across the programme pro-
vide valuable baseline data for nurse educators when dis-
tributing or sharing educational resources in a streamlined
way. Thus, this study was undertaken to assess and com-
pare the informatics competencies of students in undergrad-
uate and graduate programmes.
Design and methods
A descriptive study design was used. Nursing students who
were enrolled in three undergraduate tracks, including the
traditional prelicensure baccalaureate (BS) in nursing, RN to
baccalaureate in nursing (RN to BS) and second baccalaure-
ate in nursing (second BS), and in one graduate programme,
the Doctor of Nursing Practice (DNP) programme at one
state university in Massachusetts, USA, were surveyed during
the fall term 2011. The RN to BS track provides a baccalau-
reate nursing degree to those individuals who are licensed
registered nurses with an associate degree (AD) in nursing
(AACN 2011b), and the second BS track offers the BS in
nursing to students already holding a bachelor’s degree in a
non-nursing discipline (AACN 2011a). The DNP degree is
1972
the new practice doctorate in nursing, the terminal degree for
advanced practice nurses (AACN 2006).
The 30-item Self-Assessment of Nursing Informatics Com-
petencies Scale (SANICS) was used to assess informatics com-
petency (Yoon et al. 2009). The SANICS was developed
based on a set of informatics competency statements for
beginning and experienced nurses (Staggers et al. 2001, 2002)
along with additional items associated with standardised
terminologies, evidence-based practice and wireless communi-
cations. Exploratory principal component analysis with obli-
que promax rotation extracted five factors comprising 30
items that explained 63
7% of the variance: clinical informat-
ics role (Cronbach’s a = 0
91), basic computer knowledge
and skills (a = 0
94), applied computer skills (a = 0
89), clini-
cal informatics attitudes (a = 0
94) and wireless device skills
(a = 0
90) (Yoon et al. 2009). Each item is rated on a 5-point
Likert scale (1 = not competent to 5 = expert). The psycho-
metric properties of the SANICS were well supported through
a factorial validity, and high internal consistency reliabilities
and scale responsiveness (Yoon et al. 2009).
After the university institutional review board approved
the study, the LISTSERV mailing list for two programmes
was obtained from a director of each programme. At the
beginning of the fall semester, students were introduced via
email to the study and the SANICS. This email included an
introduction to the SANICS, an explanation of the study pur-
pose and an embedded link to the Internet survey package,
SurveyMonkey, which included the SANICS and demo-
graphic questions along with an online consent form. The
email also included a statement regarding participants’ free-
dom to withdraw from the study. At the end of the consent
form, students checked a box to indicate consent to partici-
pate. A reminder email was sent again in mid-November,
encouraging students to participate in the study. Students’
data including the consent form were stored in the Survey-
Monkey secure site, which was password-protected. The
LISTSERV (e.g. SON-RN-BS@nursing.XXX.edu) did not
reveal any specific identifiers, for example student names or
individual email addresses, and the only identifier that the
SurveyMonkey collected was the individual IP address,
which does not give any identifiable information to trace
back to the student. Students were also informed that the
information was being collected for informatics course evalu-
ation and improvement purposes and that responses to the
survey would have no effect on their current or future success
in the course or the programme.
Students’ informatics competencies were summarised
using descriptive statistics (means and SDs). Differences in
informatics competencies between undergraduate and grad-
uate students were analysed by independent t-tests.
© 2013 John Wiley & Sons Ltd
Journal of Clinical Nursing, 22, 1970–1976
Educational issues in nursing practice Informatics competencies in nursing students

Results When looking at the subscales, both the undergraduate

and graduate students were competent in three subscale
The sample population is comprised of 289 nursing stu-
areas: basic computer knowledge and skills (mean = 3
35,
dents: 158 (54
7%) graduate students and 131 (45
3%)
SD = 0.75; and mean = 3
39, SD = 0.75, respectively),
undergraduate students. The response rate was 56
9%.
clinical informatics attitude (mean = 3
66, SD = 0.92; and
Table 1 reflects the sample demographics and computer use
mean = 4
10, SD = 0.79, respectively) and wireless device
in each programme.
skills (mean = 3
00, SD = 1
34; and mean = 3
36,
SD = 1
12, respectively).
Informatics competencies

Competency scores are summarised by programmes in Comparisons of competency scores (undergraduate vs.
Table 2. With competence indicated by a minimum score graduate students)
of 3, overall, students were competent in informatics:
Overall, graduate students (mean = 3
23, SD = 0.70)
mean = 3
01, SD = 0.72 for undergraduate students;
reported a higher mean informatics competency score than
mean = 3
23, SD = 0.70 for graduate students.
did undergraduate students (mean = 3
01, SD = 0.72)
(t = 2
35, p = 0.02). When the subscales were considered,
Table 1 Respondents’ characteristics graduate students reported slightly higher mean scores than
undergraduate students in all five subscales. However,
Graduate Undergraduate
the differences were statistically significant in only three
students students
Variable n (%) n (%) subscales: clinical informatics role (t = 5
16, p < 0
001),
clinical informatics attitude (t = 3
98, p < 0
001) and
Gender
wireless device skills (t = 2
26, p = 0
02).
Female 142 (92
2) 125 (96
2)
Male 12 (7
8) 5 (3
8)
154 (100) 130 (100)
Discussion
Race/Ethnicity
Asian/Pacific Islander 4 (2
5) 11 (8
4)
Black, non-Hispanic 28 (17
7) 3 (2
3) Competence areas
Hispanic/Latino 17 (10
8) 4 (3
1)
The study findings indicate students in both programmes
White, non-Hispanic 101 (63
9) 106 (80
9)
Other 8 (5
1) 7 (5
4) were most confident in their basic computer skills such as use
158 (100) 131 (100) of the Internet, word processing, systems operations skills
Age range (years) and graphical and multimedia presentation as similarly
20–29 33 (23
6) 107 (81
7) shown in the study findings of Fetter (2009) and Desjardins
30–39 27 (19
3) 7 (5
3)
et al. (2005). Students in both programmes also fully recog-
40–49 56 (40
0) 15 (11
5)
>50 24 (17
1) 2 (1
5) nise the value and positive impact of informatics on nurses
140 (100) 131 (100) and nursing practice (Maag 2006).
Nursing experience (years) Contrary to the above, students in both programmes did
<2 8 (7
2) 93 (71
0) not perceive themselves as competent in two subscales of
2–5 19 (17
1) 13 (9
9)
informatics competency: applied computer skills and clinical
5–10 12 (10
8) 17 (13
0)
informatics role. They did not perceive themselves as compe-
>10 72 (64
9) 8 (6
1)
111 131 tent in accessing or extracting information from clinical data
Frequency of computer use sets (e.g. minimum data set), participating in design, imple-
Several times/day 110 (99
1) 125 (95
4) mentation and evaluation of systems, and seeking available
Once/day 1 (0.9) 2 (1
5) resources to help ethical decisions in computing or using
Several times/week 0 (0) 3 (2
3)
applications to develop educational materials (e.g. e-learn-
Several times/month 0 (0) 0 (0.8)
158 (100) 131 (100) ing). These areas of perceived deficiency should be emphas-
Computer experience ised by nurse educators when designing informatics courses
<6 months 3 (2
7) 10 (7
6) in nursing curricula.
 2 years 0 (0) 2 (1
5) An interesting finding is that students in both pro-
>2 years 108 (97
3) 119 (90
8)
grammes exhibited almost the same competency scores in
111 (100) 131 (100)
basic computer knowledge and skills (mean = 3
35 for

© 2013 John Wiley & Sons Ltd

Journal of Clinical Nursing, 22, 1970–1976 1973
J Choi and JE De Martinis

Table 2 Summary of competency scores by programmes

Undergraduate Graduate Independent

students students t-test*

Competency scale Mean SD Mean SD t p

Total (30 items, Cronbach’s a = 0
96) 3
01 0
72 3
23 0
70 2
35 0
02
Basic computer knowledge and skills (15 items, Cronbach’s a = 0
94) 3
35 0
75 3
39 0
75 0
37 0
09
Applied computer skills (four items, Cronbach’s a = 0
90) 2
03 0
96 2
22 0
96 1
53 0
13
Clinical informatics role (five items, Cronbach’s a = 0
89) 2
24 0
91 2
84 0
85 5
16 <0
001
Clinical informatics attitude (four items, Cronbach’s a = 0
90) 3
66 0
92 4
10 0
79 3
98 <0
001
Wireless device skills (two items, Cronbach’s a = 0
87) 3
00 1
34 3
36 1
12 2
26 0
02

*Comparison of undergraduate students vs. graduate students.

undergraduate students and 3
39 for graduate students).
Contrary to the common belief that the younger student is
more proficient in computer use, undergraduate students
reported competency scores similar to those of graduate
students. This similarity may reflect the online learning for-
mat of our DNP programme, which is an exemplar adopted
by nursing schools nationwide. DNP students are familiar
with basic computer knowledge and skills through their use
of online learning systems.
Differences in competency scores between undergraduate
and graduate programmes
Graduate students reported slightly higher mean scores than
undergraduate students in all five subscales. These findings
may reflect graduate students’ longer years of working in
nursing practice (64
9% having more than 10 years) com-
pared with less or no nursing experience of undergraduate
students (97
1 % having no experience or <2 years). Much
experience in clinical nursing practice may result in much
exposure to informatics systems knowledge and skills. How-
ever, the mean score differences were very small, ranging
from 0
3 (wireless device skills) to 0
6 (clinical informatics
role); thus, the importance or usefulness of the findings in
curriculum development needs to be further studied. In addi-
tion, the differences were verified statistically in only three
subscales: clinical informatics role, clinical informatics atti-
tude and wireless device skills. Further studies to examine
whether there are differences in informatics competencies
between undergraduate and graduate students are needed.
Limitations
The study participants were restricted to one state univer-
sity on the east coast of the USA, which may limit the
generalisability of the findings. An inherent limitation is the
potential for non-response bias because the participants
were volunteers and there was a relatively low response
rate (56
9%). Informatics competencies were measured
using students’ self-report, not their actual informatics
knowledge and skills. Therefore, the students’ actual infor-
matics competencies might be lower due to over-reporting
because of the tendency for students to describe only their
desirable attributes.
Conclusion
Establishing a baseline of informatics competencies in under-
graduate and graduate nursing students is vital to planning
informatics curricula and adequately preparing students to
promote safe, evidence-based nursing care (Hebda & Calder-
one 2010). The findings of this study indicate that students in
both programmes did not perceive themselves as competent
in two subscales of informatics competency (applied com-
puter skills and clinical informatics role) and that graduate
students reported slightly higher mean scores than under-
graduate students in three subscales.
These findings on specific areas of informatics compe-
tency indicate topics for nurse educators to consider when
designing an informatics curriculum. For example, instruc-
tors might, as a result of this study, want to focus on
applied computer skills (e.g. information access and retrie-
val from large clinical data sets) and clinical informatics
role (e.g. participating in the selection, design, implementa-
tion and evaluation of systems). The comparison of under-
graduate and graduate students indicates similarities in
informatics competencies in terms of areas where students
were competent. Further studies to examine whether there
are differences in informatics competencies between under-
graduate and graduate students are suggested.
Relevance to clinical practice
The results of this study yield valuable insight for informat-
ics curriculum development across and within undergradu-
ate and graduate nursing programmes. The results will

© 2013 John Wiley & Sons Ltd

1974 Journal of Clinical Nursing, 22, 1970–1976
Educational issues in nursing practice Informatics competencies in nursing students

assist nurse educators to determine the specific areas of
informatics content that need greater focus and inclusion in
the design of better nursing educational programmes, so
that they ensure all graduates are competent with the
fundamentals of informatics in clinical nursing practice.
To address the deficiencies in informatics curricula, nurse
educators must first prioritise students’ most urgent improve-
ment needs and then strategise how to include content in the
informatics curriculum that will lead to informatics compe-
tencies. Two content areas where students were not compe-
tent can be strengthened by course assignments through
individual or group projects. For a group project, for example,
students could break into groups of 3–5 to simulate an infor-
mation system selection committee and work as a team to
develop a proposal to design and implement a healthcare
information system and to develop evaluation methods to
measure effect of the system on patients and/or institutional
outcomes. At the end, students could do oral and narrative
class presentations using PowerPoint slides accompanied with
Wimba voice recording tool (Wimba 2012). For an under-
graduate project, students, individually or as a group, do a
review of literature about a role of informatics in nursing
practice. Students search research databases, Current Index to
Nursing and Allied Health Literature (CINAHL) and Pub-
Med, retrieve full-text articles from electronic journals, write
a paper and format it according to the American Psychologi-
cal Association (APA) Manual (APA 2010) using RefWorks,
an online citation and reference management software.
To efficiently and effectively incorporate informatics com-
petencies into the nursing curriculum, collaboration with
other nursing instructors is necessary (Jenkins et al. 2007,
Flood et al. 2010). For example, exercises using clinical data
set would be included in DNP courses in nursing research,
intermediate biostatistics, leadership or health quality.
Familiarising students with extracting information from
large clinical data sets for quality improvement projects
would be incorporated into leadership or health quality
courses. Applied computer skills would be incorporated into
clinical practicum courses in the DNP curriculum by apply-
ing point-of-care technologies for decision support and doc-
umentation. Administrative, clinical and educational
databases would be used in the planning and conducting the
capstone project. For the undergraduate programme,
students’ clinical informatics for the nursing practice role
would be improved through collaboration with instructors
in the professional role course to expand the professional
nurse’s role into the clinical informatics role.
Acknowledgements
None.
Contributions
Study design: JC, JD; data collection and analysis: JC, JD
and manuscript preparation: JC, JD.

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Reasons to submit your paper to JCN:

High-impact forum: one of the world’s most cited nursing journals, with an impact factor of 1
118 – ranked 30/95
(Nursing (Social Science)) and 34/97 Nursing (Science) in the 2011 Journal Citation Reports® (Thomson Reuters, 2011).
One of the most read nursing journals in the world: over 1
9 million full text accesses in 2011 and accessible in over
8000 libraries worldwide (including over 3500 in developing countries with free or low cost access).
Early View: fully citable online publication ahead of inclusion in an issue.
Fast and easy online submission: online submission at http://mc.manuscriptcentral.com/jcnur.
Positive publishing experience: rapid double-blind peer review with constructive feedback.
Online Open: the option to make your article freely and openly accessible to non-subscribers upon publication in Wiley
Online Library, as well as the option to deposit the article in your preferred archive.

© 2013 John Wiley & Sons Ltd

1976 Journal of Clinical Nursing, 22, 1970–1976