Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jan 11, 2021
Date Accepted: Nov 10, 2021
Electronic health record implementations and insufficient training endanger nurses’ wellbeing: cross-sectional survey study
ABSTRACT
Background:
High expectations have been set for the implementations of health information systems (HIS) in health care. However, nurses have been dissatisfied after HIS implementations. Especially poorly functioning electronic health records (EHRs) have been found to induce stress and cognitive work load. Moreover, need to learn new systems may require a lot of effort from nurses. Thus, EHR implementations may have an effect on the wellbeing of nurses.
Objective:
To examine the associations of EHR implementations and sufficiency of related training with perceived stress related to information systems (SRIS), time pressure and cognitive failures among registered nurses. Moreover, we examined whether employment sector would have an effect on these associations.
Methods:
Cross-sectional survey study among 3610 Finnish registered nurses in 2020. EHR Implementation was measured by assessing whether respondents’ work unit had implemented or will implement a new electronic health record (EHR) a) within past 6 months, b) within past 12 months, c) forthcoming within next 12 months and 4) no past or forthcoming implementations within 12 months. The associations were examined using analyses of covariance adjusted for age, gender and employment sector.
Results:
Highest levels of SRIS and time pressure were experienced among those who had experienced a EHR implementation within past 6 months. Lowest levels of SRIS, time pressure and cognitive failures were among those who did not have any past or forthcoming implementations within 12 months. Nurses who perceived that they had received sufficient implementation-related training experienced less SRIS, time pressure and cognitive failures. Recent implementations and insufficient training were especially strongly associated with high levels of SRIS in hospitals.
Conclusions:
EHR implementations and insufficient training related to those implementations may endanger the wellbeing of nurses and even lead to errors. Thus, it would be utmost important that organizations would offer comprehensive training before, during and after implementations. Moreover, easy to use systems, allowing transition periods, re-engineering approach and user involvement might help nurses in the implementation process. Training and other improvements would be especially important at hospitals.
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