Perceptions of impact of electronic health records on nurses' work.

This study addresses how community hospital nurses use Electronic Health Records (EHRs) during patient care and their views of its impact on their job performance. Questionnaire, interview and observation data from 46 nurses in medical-surgical and intensive care units at two community hospitals within a regional healthcare system (second year of EHR implementation) were analyzed for themes and compared across hospital and unit dimensions. Nurses preferred EHRs to paper charts and were comfortable with technology. They felt EHR use enhanced nursing work through increased information access, improved organization and efficiency, and alert screens. They felt it hindered nursing work through increased documentation time (slow system response, multiple screens), decreased interdisciplinary communication and impaired critical thinking through overuse of checkboxes and "copy and paste" documentation. 73% spent at least half their work time using EHRs, and felt use enabled them to provide safer care but decreased quality of care. Administrative implications include streamlining EHR work processes, developing guidelines to improve consistency in documentation quality and location, increasing system speed, and choosing hardware that encourages bedside use.