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As U.S. healthcare providers install and build out electronic health records (EHR) systems, nurses are demanding leadership roles in IT projects. And hospitals across the country appear to be responding by creating the position of chief nursing information officer (CNIO).

According to a survey from executive search firm Witt-Kieffer, 70% of multi-hospital systems and 82% of hospitals that are part of multi-hospital systems surveyed said they had a CNIO or equivalent. A majority of freestanding hospitals, integrated delivery networks, and academic medical centers also have hired a lead nursing informaticist. Seventeen percent said they planned to bring in a CNIO in the next year or two.

"It's definitely an evolving and a growing position, but it's already a big focus for people who wouldn't have thought about it five years ago," said Linda Hodges, senior VP and leader of Oak Brook, Ill.-based Witt-Kieffer's IT search practice.

"It's growing in terms of the need to have a nursing leader involved in IT," Hodges added during a session at the College of Healthcare Information Management Executives (CHIME) Fall CIO Forum in San Antonio last week. "Nursing has lost its voice with the rise of the CMIO," or chief medical informatics officer, she said.

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But that is changing, as the Witt-Kieffer statistics suggest, even if hospitals don't exactly know what they are looking for. "It's an emerging role, a new role, and we're still trying to define it," Hodges said. "Sometimes senior leadership does not understand the need for this position."

Often, there are already too many "C" roles within healthcare entities, according to Hodges, leading some to choose the title of VP of nursing informatics rather than CNIO. In either case, the emphasis is on informatics rather than clinical practice. "A person moving into this role has to be broader than just pure nursing," Hodges said.

How broad can vary widely. The CNIO job is new enough that there are a lot of questions about what it entails--though not completely new. Chris Wierz, a Witt-Kieffer senior consultant who's also a registered nurse, said she was hired in the late 1980s as "the computer nurse." (Early on, when she used the term "Ethernet," colleagues thought she was talking about an anesthetic, Wierz noted, half-jokingly.)

The Witt-Kieffer survey indicated that 57% of hospital executives consider the primary CNIO responsibility to be nursing strategy as it relates to IT, while just 24% said their primary responsibility is day-to-day project management. More than 40% of those taking the survey were chief nursing officers (CNOs), while another 28% were CIOs.

The job does not include ongoing nursing practice or a research component, at least not yet. There may be some research activities in the future as EHRs are implemented and requirements for later stages of Meaningful Use demand quality improvement, Hodges said.

Base salary for a typical CNIO now is about $200,000-$250,000, up from about $175,000 as recently as a year ago, this informal survey found. There are exceptions, notably at government-owned health systems, which tend to pay less. Barriers to additional growth include budgetary constraints, the fact that some organizations have someone informally filling the CNIO role, lack of clear definition of the job, and senior leadership not seeing the value of such a job, for a variety of reasons.

Hodges told InformationWeek Healthcare that she has seen a marked increase in requests to hire a CNIO or VP of nursing informatics in the last 12 months. The available talent pool is small, though. "There's a tremendous amount of education involved," Wierz said; some institutions may even expect a Ph.D. in addition to a nursing degree.

In terms of skills required, 85% said a background in nursing informatics was important, 71% named health IT implementation experience, and 68% cited project management experience, despite the relatively small need for this in their own jobs. The ability to collaborate with colleagues and resolve conflicts also were important, according to survey participants. Just 20% said finance skills were necessary.

"Nursing clinical informaticists are used to represent nursing needs in project planning and implementations. There is a need for a nurse with a more strategic vision and better IT knowledge and skills than a CNO to take on this role," an unnamed CMIO said, according to Witt-Kieffer.

While the CNIO generally needs to be the public face of nursing informatics for the organization, nursing staff won't see the CNIO as one of their own unless the person reports to the chief nursing executive, according to Wierz. Plus, the CNIO should be a peer of the CMIO, not a subordinate. Some organizations may get the idea of creating a combined role of chief clinical officer, but this may not be a great idea because CMIOs have been successful, Wierz said. "Don't start playing around" with the CMIO position, she advised. "This has to be a very collaborative, joined-at-the-hip relationship," Hodges said.