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Nursing Informatics

Nursing Informatics is the "science and practice (that) integrates nursing, its information and knowledge, with management of information and communication technologies to promote the health of people, families, and communities worldwide."

Nursing Informatics Innovators: Harriet Werley, PhD, RN, FAAN, FACMI

Compiled by Virginia Saba, EdD, RN, FAAN, FACMI; Constance Berg, RN, MBA, FHIMSS; Susan K. Newbold, PhD, RN-BC, FAAN, FHIMSS; Jack E. Brixey, BS, MS, MT(ASCP), Juliana J Brixey, PhD, RN

harriet-werley

Harriet H. Werley practiced as a nurse informatician before informatics was named and acknowledged as a field in nursing (Ozbolt, 2003).  Dr. Werley is recognized as a pioneer of nursing informatics and it is in this spirit that we review and honor the highlights of her career.

Werley was born in 1914 in Bern County, Pennsylvania, where her childhood was influenced by the Great Depression of the 1930s.  Werley’s father died at an early age, leaving the family to struggle financially.  These challenges, however, did not prevent Werley from successfully graduating from high school and saving enough money to attend the Jefferson Hospital School of Nursing in Philadelphia.  In 1941, she received a diploma in nursing and joined the United States Army. 

Werley was commissioned as an officer in the nursing corps and served in the Mediterranean Theater.  In 1946 during a break in service, she completed a Bachelor in Nursing degree at the University of California at Berkeley.  In 1948, she returned to military service.  Under the Army’s sponsorship, she completed her Master’s degree in Nursing Administration in 1951 at Teacher’s College, Columbia University, New York.

A career guidance program for Army Nurse Corps officers was established in the Office of the Surgeon General in June 1952.  Captain Harriet H. Werley was assigned as the first career guidance counselor (Feller & Cox, 2016).

Werley began her tenure as an administrator in the career guidance and planning section of the Army Nurse Corps.  In this role she moved the Army Nurse Corps to all bachelor prepared nurses.

At the Office of the Surgeon General, she was the first officially designated nurse researcher at the Walter Reed Army Institute of Research (WRAIR) in Silver Spring, MD.  Dismayed by the lack of positions in the field of research, she began to advocate for more research by nurses. 

In 1955, Werley began work in the Department of Atomic Casualties Study at Walter Reed Army Institute of Research.  Her work at WRAIR led to the creation of the nursing research department where she served as their first director.  As the Chief, Department of Nursing WRAIR, Werley was instrumental in increasing the inclusion of nurses in both medical and nursing research. 

In the late 1950s, she participated in conferences with IBM to identify data processing needs in health care. This interest continued throughout her career.  One significant conference was: the Nursing Minimum Data Set (NMDS) Conference project, sponsored by the University of Wisconsin-Milwaukee School of Nursing (UWM SON).  This was supported by a grant from the Hospital Corporation of America, Nashville, Tennessee (Harriet H. Werley, Principal Investigator), and by the provision of computer resources during the NMDS Conference from IBM Corporation Academic Information Systems. Portions of the conference were published in the 1986 July-August issue of Nursing Management, pages 217-224. The NMDS includes 16 items organized into categories of nursing care and has been used as a framework by other nursing terminologies.

In 1962 Dr. Harriet Werley completed her military career with a tour of duty as the chief nurse of the U. S. Eighth Army.  Although, Werley retired in 1964 as a Lieutenant Colonel she continued with an active professional career. 

Werley earned her doctorate in 1969 from the University of Utah, Salt Lake City.  She held various faculty and administrative positions at Wayne State University, Detroit, MI., The University of Illinois at Chicago, the University of Missouri-Columbia, and the University of Wisconsin-Milwaukee.  In her academic positions, Werley continued advocating for nursing information systems with a research focus.

As a disseminator of knowledge, Dr. Harriet Werley was the first editor of the publication, Research in Nursing and Health.  The second editor was Werley’s colleague, Dr. Margaret Grier.

Dr. Harriet Werley was at the forefront of Nursing Informatics, which she originally labeled “Computers in Nursing Information.”  Werley was an influential leader in its development and integration into the nursing profession.  In 1977, she initiated one of the first computer-research conferences on ‘State-of-the-Art on Nursing Information Systems’ at the University of Illinois with Dr. Margaret Grier.  They convened the key nurses who were conducting research in the field of “Computers in Nursing Information.” As a result of the conference the papers were published in one of the first books on this topic (Werley & Grier, 1981).

In 1984, she initiated the first Council on Computer Applications in Nursing (CCAIN) at the American Nurses Association (ANA) and chaired its first board consisting of Virginia K. Saba, Kathleen A. McCormick, Rita Zielstorff, and Ivo Abraham.  As Chair she, with CCAIN Board members, submitted numerous resolutions to the ANA House of Delegates on the importance of computers in nursing which were approved.  This active board promoted numerous CCAIN activities including several early and first publications in the field of computers in nursing, namely: “Computers in Nursing Education,” “Computers in Nursing Research,” “Computer Design Criteria: For Systems that Support the Nursing Process” (Nursing Practice), and “Computers in Nursing Management.”  The Council also sponsored and conducted demonstration sessions at the American Nurses Association’s (ANA) Annual Nursing Conferences. 

Dr. Werley initiated a major component of nursing informatics in collaboration with Dr. Norma Lang.  At the first invitational conference in Milwaukee, WI, 65 nurse clinicians, administrators, educators, and researchers designed, developed and established the nursing minimum data set (NMDS).  This was followed by a Post-Conference Task Force that finalized the original 16 elements of the NMDS-four of which were focused on nursing content.  In 1990 the ANA House of Delegates endorsed the NMDS described above to define costs and quality of care for the nursing profession. 

Dr. Werley gave presentations at numerous conferences on Nursing Information Systems as well as Nursing Informatics where she emphasized the need for research focus in the field.  One example was an invitational conference in 1990 entitled “State-of-the-art of Information Systems” sponsored by the National Commission on Nursing Implementation Project (NCNIP) held in Orlando, FL.  Besides these key milestones in the history of nursing informatics (NI), she was on the leadership committee of the Nursing Special Interest Group (SIG) at the Symposium on Computer Applications in Medical Care (SCAMC).  The SIG formed in 1981 by Dr. Virginia K. Saba, was the forerunner of the Nursing Informatics Working Group of the American Medical Informatics Association (AMIA) established in 1990.

Dr. Werley mentored several doctoral nursing students in the field of NI Research, NMDS, and early implementation of NI.  She was very visible during the growth of NI and could be seen and heard attending or presenting at many national and international nursing conferences.

In declining health, Harriet Werley attended the 1996 Fall Symposium of the Nursing Informatics Working Group at AMIA located in Washington, D.C.  This was the last symposium Dr. Werley attended.  At this symposium, the Werley Award for the paper that made the greatest contribution to nursing informatics was awarded for the first time to Rita Zielstorff (a pioneer in nursing informatics).  Since then an annual Harriet Werley award is given at AMIA for the best student paper. 

Werley’s contributions to nursing was not limited to informatics. It is of interest that Dr. Werley was one of the founding members of the American Academy of Nursing and designated in 1994 as one of the Academy’s early Living Legends.

Harriet Werley died October 14, 2002 at the age of 88 years.  She had a nursing career of over 50 years and made enormous contributions to the profession of nursing.  Irrevocably, Dr. Werley is recognized as a pioneer of Nursing Informatics. 

Bibliography

  • A Salute to One of Our Own, U.S. Army Medical Department, Office of Medical History.  Retrieved 10/02/2017
  • Feller, C. M., & Cox, D. R. (Eds). (2016). Highlights in the history of the Army Nurse Corps. Washington, DC: U.S. Army Center of Military History.
  • Ozbolt, J. G. (2003). Harriet Helen Werley, PhD, RN, FAAN, FACMI. J. Am. Med. Inform. Assoc., 10(2), 224-225.  Retrieved 10/02/2017 from: https://www.researchgate.net/publication/10893372_Harriet_Helen_Werley_PhD_RN_FAAN_FACMI
  • Saba, V. K., & Westra, B. L. (2015). Historical perspectives of Nursing Informatics. In V. K. Saba, & K. A. McCormick, (Eds.). Essentials of Nursing Informatics (6th Ed.) (pp. 3-22).  New York:  McGraw –Hill Education.
  • Werley, H. H., & Grier, M. R. (Eds.).  (1981). Nursing Information Systems. New York:  Springer Publishing Company.