Abstract
Implementation of an electronic medical record (EMR) is a significant workplace event for nurses in hospitals. Understanding nurses’ key concerns can inform EMR implementation and ongoing optimisation strategies to increase the likelihood of nurses remaining in the nursing workforce. This concurrent mixed-methods study included surveys from 540 nurses (response rate 15.5%), and interviews with 63 nurses to examine their perceptions of using a new EMR prior to implementation at a single healthcare organisation. Survey findings revealed 32.2% (n = 174) of nurses reported low well-being scores and 28.7% (n = 155) were experiencing burnout symptoms. In contrast, 40.3% (n = 216) of nurses reported high work satisfaction, 62.3% (n = 334) had high intentions of staying in their role, and 34.3% (n = 185) were engaged in their work. Nearly half (n = 250, 46.3%) reported intrinsic motivation towards EMR use. Thematic analysis of focus group interviews revealed two themes, each with three subthemes: (1) Us and Them, detailed the juxtaposition between nurses’ professional role and anticipated changes imposed on them and their work with the EMR implementation; and (2) Stuck in the middle, revealed nurses’ expectations and anticipations about how the EMR may affect the quality of nurse-patient relationships. In conclusion, anticipation of the EMR implementation emerged as a stressor for nursing staff, with some groups of nurses particularly vulnerable to negative consequences to their well-being.
Highlights
The engagement, motivation and well-being of nurses is critical for successful electronic medical record (EMR) implementation, and a high-performing nursing workforce to deliver safe, high quality patient care
The novel mixing of qualitative and quantitative data used in this study provided a broad context to examine the key concepts, was expected to provide comprehensive understanding of how nurse motivation, engagement and well-being are associated with an EMR implementation
Despite satisfaction in their work, the addition of a new healthcare technology in the form of an EMR system is another stressor for nursing staff, even when it has not yet been implemented
Summary
Implementation of a new healthcare technology, such as an electronic medical record (EMR) system is a significant investment for healthcare organisations and systems, that may pose risks for the quality of healthcare delivery and workers themselves. The engagement, motivation and well-being of nurses is critical for successful EMR implementation, and a high-performing nursing workforce to deliver safe, high quality patient care. EMR systems are replacing paper-based systems worldwide for recording patient care [1]. EMR systems are a key facilitator for clinical documentation, clinical decision-making and information management in healthcare organisations.
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