Measuring the value of nursing

Data may not be the first thing you think of when it comes to nursing. But Dr Evelyn Hovenga, a pioneer of health informatics and digital health in Australia, begs to differ.

“Nursing is always about data,” says Dr Hovenga. “You’re always making observations and assessments to work out what you can do for a patient to really assist them.”

Dr Hovenga commenced her nursing career in 1960s Melbourne as a 17-year-old trainee at the Royal Children’s Hospital. From those humble beginnings, she was recognised as one of 25 Brilliant Women in Digital Health by Telstra Health in 2021.

Data allows nurses to make optimal everyday clinical decisions. And the systematic capture, processing and astute application of health care data on a greater scale can lead to improved outcomes for patients, health professionals and the entire health care system.

It also allows the value of nursing to be measured and for nurses to be compensated fairly.

“What I’ve always found to be missing is the ability for nurses to demonstrate their value; in many ways, a nurse’s contribution is invisible,” says Dr Hovenga, who throughout her career has focused on improving nurses’ working conditions, career progression, and financial and social recognition.

“People who receive nursing care certainly understand the benefit of having nurses, but we need to be able to make the contribution of nursing care much more visible. 

“The politicians think that all we do is wash, toilet and feed people; however, nurses are highly qualified, they do a lot of information processing, and they have an awful lot of knowledge. And I don’t believe that is being recognised appropriately.”

An excellent career

A trailblazer in the field of digital health, Dr Hovenga is well qualified to speak to the challenges facing nurses.

Her career in health informatics has been extensive and diverse, and she’s founded and led many organisations that have paved the way for Australian digital health activities.

Dr Hovenga has been a nurse, a researcher, and a teacher and mentor in health informatics and digital health. She created eHealth Education, which is a registered training organisation (RTO), consultancy and online business which specialises in training courses in health informatics and clinical coding. She’s written informatics books, helped to develop national and international health data standards, and been awarded numerous fellowships.

Along the way, she’s studied everything from programming, to a Master of Applied Science, to a PhD in Health Administration – and built a global network of health informatics peers. 

Dr Hovenga moved into academia in 1992, when she was invited to help develop a postgraduate health informatics program at Central Queensland University. She progressed to professor and established and managed the Health Informatics Research Centre until her retirement in 2007.

Now, Dr Hovenga is Professor of Digital Health at Australian Catholic University (ACU), where she’s developed a Master of Digital Health program and three component units. She’s also working with academic staff to integrate digital health components into the undergraduate curriculum. 

Teaching nurses why data and IT skills are essential for safe, quality patient care, how to extract data effectively, and how to apply these tools in a meaningful way is essential for today’s world she says.

“Nurses think of themselves as doers and they should be thinking of themselves as knowledge workers, because it’s the knowledge that drives the doing.

“And you’ve got to focus on the knowledge in a digital world. Then you can start thinking about, well, how does all the technology we have available best support me to maximise my use of the knowledge and information that’s available?”

Questions from a workforce that thinks digitally can kickstart all sorts of improvements, she says, from driving the development of fit-for-purpose digital health technologies to influencing high-level decision-making that’s based on data and informed by clinical experience. 

Curiosity, persistence and connection

Dr Hovenga’s achievements are remarkable, particularly considering she had to leave school at 14 to work full-time and contribute financially as the eldest child in an immigrant family.

“I’ve always been curious, and I always want to know how things work, how things happen. So, I asked a lot of questions from a lot of people and I took every opportunity to learn,” she says. 

“For example, when I was working as a nurse in radiology and learning how to take x-rays, I decided to go to night school and do a physics course so I could understand it better. And as a very junior office worker, I learned how to use the typewriter in my lunch time.” 

Her advice for new nurses echoes her own experience: take every opportunity to learn and to understand what computers are capable of, question what is, and never accept no as an answer to your suggestions for change.

“You’ve got to be persistent,” she says. 

“Most nurses are very accepting of what’s put in front of them – but we have to start making some demands of our own to make sure that we can care for our patients according to how we’ve been taught: in the best possible way. And we’ve got to make sure that the infrastructure enables us to do that. 

“Of course, we’ve got to be reasonable. There’s only so much that people can do, but by working together – networking, influencing people – you can do so much more.

“Analyse the issues and know where the barriers are, where the limitations are, so that you can start looking at strategies and how to best overcome them.”

Dr Evelyn Hovenga is Professor in Digital Health at ACU. She is also a Founding Fellow of the International Academy of Health Sciences Informatics, a Fellow of the Australian Computer Society, a Fellow of the Australasian Institute of Digital Health, a Fellow of the Australian College of Nursing, and a Fellow of the Australasian College of Health Service Management (previously the Australian College of Health Service Executives).

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