Nurses' perceptions of the impact of electronic health records on work and patient outcomes.

This study addresses community hospital nurses' use of electronic health records and views of the impact of such records on job performance and patient outcomes. Questionnaire, interview, and observation data from 46 nurses in medical-surgical and intensive care units at two community hospitals were analyzed. Nurses preferred electronic health records to paper charts and were comfortable with technology. They reported use of electronic health records enhanced nursing work through increased information access, improved organization and efficiency, and helpful alert screens. They thought use of the records hindered nursing work through impaired critical thinking, decreased interdisciplinary communication, and a high demand on work time (73% reported spending at least half their shift using the records). They thought use of electronic health records enabled them to provide safer care but decreased the quality of care. Administrative implications include involving bedside nurses in system choice, streamlining processes, developing guidelines for consistent documentation quality and location, increasing system speed, choosing hardware that encourages bedside use, and improving system information technology support.