Karolyn Wyble's job — director of clinical informatics — didn't exist even a decade ago.

“It's a very fast growing field in health care,” said Wyble, whose duties include managing, modifying and training staff on the electronic health record system for Quality Life Services.

Wyble is a registered nurse who spent years providing direct care.

“Having that background helps in the decision-making process,” Wyble said. “Having someone who is only a computer tech in this job would be a disadvantage, because they wouldn't understand day-to-day circumstances like a fellow nurse.”

There's no doubt a number of societal factors are driving rapid change in health care: transitioning needs of Baby Boomers, the state of Medicare and declining insurance reimbursements, to name a few.

Nurses, who man patient care's front lines, “are at the forefront of these changes” according to Karen Allen, RN, chief nursing officer and vice president of patient services at Butler Health System.

Like most in the field, it was a desire to care for others that first drew Karen McCreary to nursing.

Now chief operating officer at Concordia Visiting Nurses, McCreary said that the basic fundamental quality of nurses has not changed.

But new demands, such as learning the electronic record-keeping system, present additional challenges.

“When I was a new nurse, we learned care and process,” McCreary said. “Now they must learn to document it correctly as well. Insurance companies put so much emphasis on documentation that if you don't do it exactly right, they might not pay for the care.”

Already, the role nurses play in the home and hospital has changed extensively. Not only is there a push toward outpatient procedures, but events that might once have required a week-long hospital stay, like childbirth, are now short visits. Additionally, many procedures once performed in a hospital or doctor's office now might be done by home health care professionals.

“Home health care nurses are taking care of sicker and sicker patients. The skill sets required and the procedures done (at home) have greatly advanced in the past 20 years,” McCreary said. “Nurses must be experts in many different things.”

In addition to direct care, home health care professionals also monitor circumstances and coordinate care between specialists and primary care physicians.

“Nurses must know the whole patient,” McCreary said. “They work diligently to get patients the right level of care. Healthcare is changing. Nurses must be willing to change with it because it's going to change more and more in the next 10 years.”

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