Community Hospital Nurses’Views of Effect of EHR Use on Work and Patient Outcomes

Community based hospitals are using electronic health records (EHRs) with increasing frequency. These systems represent major resource investments and have the potential to improve – or create obstacles to-- work performance, communication, and documentation. The extent to which EHRs enhance or detract from nurses’ role performance can be expected to affect patient outcomes, yet few studies have addressed this issue. This study’s purpose is to describe how nurses use EHRs during patient care and their views of its impact on nurses’ work and patient outcomes.

This descriptive qualitative study used questionnaire, interview and observation data from 41 nurses in medical-surgical and intensive care units attwo hospitals (157 bed, urban; 47 bed, rural) within a regional healthcare system, in the second year of EHR implementation. The study is guided by Doran’s nursing role effectiveness model. Data were analyzed for themes and compared across hospital and unit dimensions. Findings are:

  1. High acceptance of EHRs; preferred to paper charts
  2. High comfort level with technology use
  3. Typing skill affects overall satisfaction
  4. Nurses feel EHR use:

represents a significant time commitment; 82% spent at least half their work time using EHRs

enhances nursing work through increased information access, improved organization and efficiency, and alert screens

hinders nursing work by increased documentation time (slow system response, multiple screens), decreased interdisciplinary communication

Can impair critical thinking through overuse of checkboxes, “copy and paste” assessments

positively affects patient safety but negatively affects quality of care

Implications for improving communication, critical thinking, time management and quality care are : involve bedside nurses in system design, streamline EHR work processes to allow fewer screens and automatic data population,develop guidelines to improve consistency in documentation quality and location,increase system speed, and choose hardware that encourages use at bedsides.