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Kimberly Velez

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Jaimy John

New nurses have a lot to acclimate to when they embark on their careers. Unfortunately, they are not getting adequate exposure to electronic health records (EHRs) during their nursing education. This lack of familiarity with EHRs increases the burden on new nurses. With hospitals expected to meet various regulatory standards, it is crucial that comprehensive, efficient, and accurate documentation of patient care is completed within the EHR. New nurses who haven't received thorough training in using EHRs find this task challenging, with the greatest hurdle time management between patient care and electronic documentation.

We have been working as nursing informaticists onboarding over 200 new hires per month on the EHR application for a large health care system with more than 10 years between us. Together we have over 30 years of clinical experience. We have noticed that newly hired nurses often feel unprepared to document patient care electronically. Orientee feedback has made it clear that this lack of preparation is due to the inadequate integration of EHRs into the nursing curriculum. During their clinical rotations, nursing students have limited opportunities to access and document in the patients' electronic charts. Students may be given view-only access, or only the clinical instructor is allowed access based on hospital policy. As a result, students do not achieve an adequate understanding of how to retrieve patient labs, treatment plans, and education materials or how to complete patient assessments and medication documentation.

New nurses in our trainings have said that they wish they had been given the opportunity to document patient interactions electronically, whether in school simulation laboratories or hospital clinical rotations. As one student said, “I feel really unprepared for my new grad job because I have little to no EHR experience and it should be a course required for each nursing program.” This type of hands-on experience would have given students the opportunity to develop the time management skills they need to incorporate documentation into their workflow. The lack of this experience often leaves new nurses feeling overwhelmed at exactly the time when they could be applying these skills to develop an effective and efficient process.

As nursing informaticists, we pay close attention to the readiness of adult learners to master this content. We assess their prior knowledge at the beginning of class and adjust the content. Given our responsibility to successfully onboard new nurses, we feel compelled to address the gaps we've observed. By asking a few questions, we can uncover specific layers or barriers and discover possible solutions.

Questions we believe need asking include: How is EHR documentation covered in each nursing school? What is the comfort level of the faculty teaching this subject? Is there physical equipment or documentation samples available for the students to practice?

With such a large nursing workforce and differing EHR systems between hospitals, EHR documentation training is an essential part of the onboarding process. Over the years, we have surveyed new nurse hires' concerns, and our recommendations include the following:

Explore free applications specially designed for academia if budget is a concern for the education institution. Inspire educators to be innovative and develop an in-house academia EHR using simple tools. Prioritize and budget to support students learning with synchronous documentation as skills are performed in the simulation lab. Encourage educators to utilize online resources available postpandemic and foster student participation in providing feedback on their comfort and confidence in using the EHR.

Providing nurses with a solid foundation in using EHRs throughout their nursing education will give them greater confidence as they begin their nursing careers.