Nurse Educator Vol. 41, No. 1, pp. 46-48 Copyright * 2016 Wolters Kluwer Health, Inc. All rights reserved.
Nurse Educator
Electronic Health Records Describing Technological Stressors of Nurse Educators Mary S. Burke, PhD, RN, CNE & D. Michele Ellis, PhD, RN The purpose of this study was to describe the technological stressors that nurse educators experienced when using electronic health records while teaching clinical courses. Survey results indicated that educators had mild to moderate technological stress when teaching the use of electronic health records to students in clinical nursing courses. Keywords: clinical teaching; electronic health records; nurse educators; technology; technological stressors
T
he Institute of Medicine’s landmark document, The Future of Nursing, noted that health information technology will ‘‘fundamentally change the ways in which RNs plan, deliver, document, and review clinical care.’’1(p140) The American Association for Colleges in Nursing’s Essentials of Baccalaureate Education indicates that graduates of baccalaureate nursing programs should be competent in using information management systems. This includes electronic health records (EHRs) and emphasizes students’ use of data-gathering and decision-support features to aid in evidence-based practice.2 The National League for Nursing Competencies for Associate Degree Nursing Graduates also reflects the need for associate degree graduates to use information technology in the planning and delivery of nursing care.3 The passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act provided financial incentives for health care agencies and providers to implement EHRs.4 These incentives are encouraging health care facilities to implement EHRs at a rapid rate, but each facility is free to choose the system that meets their needs. Consequently, nurse educators may now be required to learn to use multiple EHR systems when teaching students in clinical settings. In addition, there are frequent updates and changes to learn after the initial training. These changes in health care technology can cause ‘‘technostress’’ (technological stress) in nurse educators. A review of the literature did not reveal any studies investigating the incidence of technological stress among educators teaching EHRs in clinical courses. Therefore, the purpose of this descriptive-correlational study was to describe the technological stressors that nurse eduAuthors Affiliations: Associate Professor (Dr Burke) and Instructor (Dr Ellis), Southeastern Louisiana University School of Nursing, Baton Rouge, Louisiana. The authors declare no conflicts of interest. Correspondence: Dr Burke, Southeastern Louisiana University School of Nursing, 4849 Essen Ln, Baton Rouge, LA 70809 ([email protected]). Accepted for publication: May 25, 2015 Published ahead of print: July 9, 2015 DOI: 10.1097/NNE.0000000000000196
46
cators experience using EHRs while teaching nursing clinical courses.
Theoretical Framework According to Lazarus and Folkman’s5 theory on stress and coping, stress is the result of the relationship between the individual and environment in which he/she interacts. Psychological stress develops when that relationship is perceived to be taxing or exceeding the individual’s resources, or a danger to the individual’s well-being. Based on this theory, a nurse educator might cognitively appraise a situation involving teaching EHR technology as stressful and use coping processes. However, if these processes are ineffective, technological stress or technostress may result.
Literature Review Electronic health records are a form of information technology developed to share patient information among health care providers.6 Newer systems share information not only among different providers and settings but also with the patient through the use of patient portals. The advantages of using EHRs include 3 types of outcomes: clinical, organization, and social benefits. Clinical outcomes are related to the quality of patient care. An EHR can increase the quality of care by providing immediate access to patient information. Organizational benefits include improved capture of medical billing, increased productivity of employees, and reimbursement from payers. Social benefits include the patient’s ability to communicate with providers and access health information via patient portals.6 The concept of technostress was first introduced in the 1980s when computers became more prevalent in the business and academic world. Technostress is defined as the inability of an individual to adapt to the use of new technology and to cope effectively with technology, including computers.6–8 Constant technology upgrades and continual re-learning as well as technical problems can cause technostress. A person may manifest physical symptoms such as repetitive strain injuries and psychological symptoms such
Volume 41 & Number 1 & January/February 2016
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Nurse Educator
as anxiety. However, the most prevalent symptom of technostress is anxiety.7 Widespread implementation of EHRs has been occurring for the past several years nationally, so the small number of published studies in the literature review is not surprising. Common factors associated with successful implementation of EHRs into the clinical setting with practicing nurses and physicians include training and how well the selected EHR system fits with the providers’ needs.9,10 Barriers include time required to document, frequent updates, and information overload from the large amount of available data. Barriers identified to EHR implementation in nursing programs are the shortage of health informatics specialists to help design educational EHR systems, difficulty and cost of internal development of EHRs for school use, need for students to develop skill with multiple types of EHRs, and faculty acceptance and willingness to implement EHRs in their courses.11–13 Nursing students need to be prepared to use EHRs, but the existence of many different electronic documentation systems in clinical agencies makes preparing students a challenge. Nurse educators should be competent in using information management systems themselves to teach students. What is missing in the literature is sufficient evidence describing the use of various types of EHRs and stress that this new technology may impose on nurse educators who are responsible for ensuring that students obtain some working knowledge and comfort level with EHRs.
Methods Baccalaureate nurse educators in a southern state in the United States were invited via e-mail to participate in the study. Two researcher-developed questionnaires, a demographic data sheet and the Nurse Educator Technostress Scale (Revised) (NETS), were used for data collection. The NETS, originally developed by Burke14,15 to measure technostress in traditional classroom settings, was modified to capture data related to nurse educators teaching in clinical settings. The revised NETS contains 16 items exploring nurse educators’ experiences with EHRs in teaching students in the clinical setting. Questions addressed stressors related to common issues with using EHRs such as computer hardware/software failure, lack of access to EHR technology, and students’ knowledge of EHR technology. Participants were asked to rate their severity of stressors of teaching and using EHRs in a clinical course on a modified anchored scale. The scale ranged from 0 (no stress) to 4 (severe stress). The modified instrument was reviewed by 3 PhD-prepared nurse educators to establish content validity. Cronbach’s ! of the revised NETS instrument was .95. A separate demographic data form was used to analyze data related to the participants’ demographics and development of technostress. In addition to collecting data on age, educational level, and employment status, questions were included to determine if participants had received any type of training on the EHR used in the clinical setting and if they worked in the agency used as a clinical teaching site. Data collection was completed through the use of an online survey. The link to the survey was e-mailed to the school e-mail address of 278 nurse educators. Seventy-four responded with 64 participants meeting inclusion criteria, which resulted in a 23% response rate. Approval for the study Nurse Educator
was obtained from the authors’ institutional review board. Descriptive and inferential statistics were used to analyze the data using SPSS version 20 (IBM, Armonk, New York).
Results The most frequently reported age range was 45 to 54 years (33.8%, n = 24). The majority of participants were MSN prepared (73.9%, n = 51). Seventy-nine percent (n = 56) did not work in the agency they used for clinical experiences, and 44% (n = 24) had no EHR system training. Means for each item on the NETS along with the overall mean were calculated to determine participants’ technostress scores. Nurse educators experienced mild to moderate technological stress while teaching clinical courses as indicated by a mean NETS score of 2.86 (SD, 0.93). Based on item means, the 5 highest items that could lead to technostress were identified (Table). The NETS item with the highest mean was ‘‘student access to EHR training materials’’ (mean, 3.31 [SD, 1.21]). The need to learn new EHRs was the second highest rated item causing technostress (mean, 3.16 [SD, 1.14]). A 1-way analysis of variance comparing the overall NETS mean to selected demographic variables yielded no statistical significance.
Discussion The findings indicated that technological stress related to EHRs was a problem for nurse educators. Although there are no other published studies on the concept of technostress related to teaching nursing students to use EHRs, the results are similar to other studies by Burke,14,15 who found a mean NETS score of 2.45 (SD, 0.76) for nurse educators using technology to teach nursing theory courses. Lack of student access to EHR training materials and the need for nurse educators to learn new EHRs were factors causing stress. More than half of nurse educators (56%) participated in EHR training; however, training had no significant relationship to their level of technostress as indicated by their NETS scores. The highest NETS item scores relate to some of the challenges of implementing EHRs into nursing curricula identified in the literature review: the need for students to develop experience with multiple types of EHRs and the difficulties in training and support.9–11,13 The participants also rated students’ knowledge of EHR computer technology as moderately stressful (mean, 3.12 [SD, 1.14]). This is consistent with Borycki et al,11 who found that the need for students to develop experience with multiple types of EHRs during their educational program was a barrier to full implementation of EHRs into the curriculum. The study found no significant relationships between the selected demographic variables and the development of technostress. This suggests there Table. Five Highest Sources of Technostress NETS Item
Mean
SD
Student access to training materials Need to learn new EHR system Availability of EHR tech support Students’ knowledge of EHR Access to EHR during clinical experiences
3.31 3.16 3.13 3.12 2.79
1.21 1.24 1.3 1.14 1.19
Volume 41 & Number 1 & January/February 2016
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
47
may be other variables that may increase the incidence of nurse educators developing technostress while teaching EHRs in clinical courses. Results from the study indicate the need to develop strategies to decrease technostress in nurse educators such as partnerships with clinical facilities to support access to EHR technology, resources for teaching EHRs, and more training for both faculty and students in biomedical technology. Schools of nursing should investigate means of acquiring commercial EHR products designed for student learning to increase students’ access to EHRs during their educational programs. However, as indicated in the literature, access by schools to commercially available EHRs can be cost-prohibitive and a barrier to implementation.12,13,16 Costs include not only the software but also hardware such as computers and tablets, electrical infrastructure, and technical support personnel. Development of cost-effective means to provide student and educator access to a variety of EHRs for training purposes would be a factor in reducing stress. Three of the 5 items with the highest scores in this study related to access to EHRs. While the HITECH Act provided incentives to medical practices and facilities to implement EHRs,4 funding for nursing schools to purchase EHRs is not yet abundant.
Implications Health information systems and EHRs can lead to improved patient outcomes and quality of care.17 In addition to documentation of patient care, students also need to be taught how to use health information systems and EHRs for data retrieval and clinical decision making to provide quality care. The 5 items on the NETS with the highest means all relate directly to the need for nurse educators to develop strong relationships with health information system personnel at health care agencies to receive training and support with the EHRs used in their clinical settings. One of the benefits of such partnerships could be realized if the facility hires the nursing school’s graduates. These new nurses would likely require less orientation time with the facility’s EHR because of familiarity from clinical courses, saving the facility time and money. Longitudinal placement of students within 1 health system to decrease the need to learn differing EHR platforms could reduce the development of technostress for faculty and students. Assigning students to 1 clinical setting for an entire semester decreases the need to teach the use of EHRs multiple times a semester and facilitates the students’ proficiency with 1 EHR system. Schools of nursing and health care agencies also could implement a clinical scholar model whereby clinical instructors are employees of the hospital with consistent assignment to a clinical course and unit. Those instructors would be proficient with the EHR, and this arrangement would provide improved access to resources within the clinical agency. Limitations This study surveyed nurse educators teaching in baccalaureate programs in 1 state; thus, the findings may not be generalizable to all nurse educators teaching in baccalaureate and associate degree programs. An additional limitation is related to the small sample size. The lack of significant relationships between the dependent variables and NETS mean may be related to the small sample size. 48
Conclusion As more health care providers race to meet the meaningful use criteria created by the HITECH Act, nurse educators will be impacted by the rapid change of technology in clinical teaching agencies. This research described the technological stressors experienced by nurse educators when teaching students the use of EHRs in clinical nursing courses. Nurse educators experienced moderate stress when teaching the use of EHRs.
References 1. Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: National Academies Press; 2010. 2. American Association of Colleges of Nursing. The essentials of baccalaureate education for professional nursing practice. 2008. Available at http://www.aacn.nche.edu/education-resources/ essential-series. Accessed January 27 2015. 3. National League for Nursing (NLN). Outcomes and Competencies for Graduates of Practical/Vocational, Diploma, Associate Degree, Baccalaureate, Masters, Practice Doctorate and Research Doctorate Programs in Nursing. Washington, DC: NLN Press; 2012. 4. Knudson J. Change for the best. For the Record. 2012;24(23): 14. Available at http://www.fortherecordmag.com/archives/ 121712p14.shtml. Accessed January 30, 2015. 5. Lazarus R, Folkman S. Stress, Appraisal, and Coping. New York: Springer; 2008. 6. McMullen PC, Howie WO, Philipsen N, et al. Electronic medical records and electronic health records: overview for nurse practitioners. J Nurse Pract. 2014;10(9):660-665. 7. Brod C. Technostress: The Human Cost of the Computer Revolution. Reading, MA: Addison-Wesley; 1984. 8. Tarafdar M, Tu Q, Ragu-Nathan T. Impact of technostress on end-user satisfaction and performance. J Manage Inform Syst. 2011;27(3):303-324. 9. Steiner BA. Electronic Medical Record Implementation in Nursing Practice: A Literature Review of the Factors of Success [master’s thesis]. Bozeman, MT: Montana State University; 2009 Available at http://scholarworks.montana.edu/xmlui/handle/1/ 2347. Accessed January 30, 2015. 10. Babbott S, Manwell LB, Brown R, et al. Electronic medical records and physician stress in primary care: results from the MEMO study. J Am Med Inform Assoc. 2014;21(e1):e100-e106. 11. Borycki A, Kushniruk A, Armstrong B, et al. Integrating electronic health records into health professional and health informatics education: a continuum of approaches. Acta Inform Med. 2010;18(1):20-24. 12. Griffin-Sobel JP, Acee A, Sharoff L, et al. A transdisciplinary approach to faculty development in nursing education technology. Nurs Educ Perspect. 2010;31(1):41-43. 13. Kowitlawakal Y, Wang L, Chan SW. Development of the electronic health records for nursing education (EHRNE) software program. Nurse Educ Today. 2012;33(12):1529-1535. 14. Burke M. Technological Stressors of Louisiana Baccalaureate Nurse Educators [dissertation]. Baton Rouge, LA: Louisiana State University; 2005. Available from Proquest Dissertations and Theses (No. 3199717) and at http://etd.lsu.edu/docs/available/etd-08312005163644/unrestricted/Burke_dis.pdf. Accessed January 30, 2015. 15. Burke M. The incidence of technological stress among baccalaureate nurse educators during course preparation and delivery. Nurse Educ Today. 2009;29(1):57-64. 16. Gardner CL, Jones SJ. Utilization of academic electronic medical records in undergraduate nursing education. Online J Nurs Inform. 2012;16(2). Accessed January 30, 2015. 17. Frimpong JA, Jackson BE, Stewart LM, et al. Health information technology capacity at federally qualified health centers: a mechanism for improving quality of care. BMC Health Serv Res. 2013; 13(1):1-12.
Volume 41 & Number 1 & January/February 2016
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Nurse Educator
Nurse Educator
Electronic Health Records Describing Technological Stressors of Nurse Educators Mary S. Burke, PhD, RN, CNE & D. Michele Ellis, PhD, RN The purpose of this study was to describe the technological stressors that nurse educators experienced when using electronic health records while teaching clinical courses. Survey results indicated that educators had mild to moderate technological stress when teaching the use of electronic health records to students in clinical nursing courses. Keywords: clinical teaching; electronic health records; nurse educators; technology; technological stressors
T
he Institute of Medicine’s landmark document, The Future of Nursing, noted that health information technology will ‘‘fundamentally change the ways in which RNs plan, deliver, document, and review clinical care.’’1(p140) The American Association for Colleges in Nursing’s Essentials of Baccalaureate Education indicates that graduates of baccalaureate nursing programs should be competent in using information management systems. This includes electronic health records (EHRs) and emphasizes students’ use of data-gathering and decision-support features to aid in evidence-based practice.2 The National League for Nursing Competencies for Associate Degree Nursing Graduates also reflects the need for associate degree graduates to use information technology in the planning and delivery of nursing care.3 The passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act provided financial incentives for health care agencies and providers to implement EHRs.4 These incentives are encouraging health care facilities to implement EHRs at a rapid rate, but each facility is free to choose the system that meets their needs. Consequently, nurse educators may now be required to learn to use multiple EHR systems when teaching students in clinical settings. In addition, there are frequent updates and changes to learn after the initial training. These changes in health care technology can cause ‘‘technostress’’ (technological stress) in nurse educators. A review of the literature did not reveal any studies investigating the incidence of technological stress among educators teaching EHRs in clinical courses. Therefore, the purpose of this descriptive-correlational study was to describe the technological stressors that nurse eduAuthors Affiliations: Associate Professor (Dr Burke) and Instructor (Dr Ellis), Southeastern Louisiana University School of Nursing, Baton Rouge, Louisiana. The authors declare no conflicts of interest. Correspondence: Dr Burke, Southeastern Louisiana University School of Nursing, 4849 Essen Ln, Baton Rouge, LA 70809 ([email protected]). Accepted for publication: May 25, 2015 Published ahead of print: July 9, 2015 DOI: 10.1097/NNE.0000000000000196
46
cators experience using EHRs while teaching nursing clinical courses.
Theoretical Framework According to Lazarus and Folkman’s5 theory on stress and coping, stress is the result of the relationship between the individual and environment in which he/she interacts. Psychological stress develops when that relationship is perceived to be taxing or exceeding the individual’s resources, or a danger to the individual’s well-being. Based on this theory, a nurse educator might cognitively appraise a situation involving teaching EHR technology as stressful and use coping processes. However, if these processes are ineffective, technological stress or technostress may result.
Literature Review Electronic health records are a form of information technology developed to share patient information among health care providers.6 Newer systems share information not only among different providers and settings but also with the patient through the use of patient portals. The advantages of using EHRs include 3 types of outcomes: clinical, organization, and social benefits. Clinical outcomes are related to the quality of patient care. An EHR can increase the quality of care by providing immediate access to patient information. Organizational benefits include improved capture of medical billing, increased productivity of employees, and reimbursement from payers. Social benefits include the patient’s ability to communicate with providers and access health information via patient portals.6 The concept of technostress was first introduced in the 1980s when computers became more prevalent in the business and academic world. Technostress is defined as the inability of an individual to adapt to the use of new technology and to cope effectively with technology, including computers.6–8 Constant technology upgrades and continual re-learning as well as technical problems can cause technostress. A person may manifest physical symptoms such as repetitive strain injuries and psychological symptoms such
Volume 41 & Number 1 & January/February 2016
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Nurse Educator
as anxiety. However, the most prevalent symptom of technostress is anxiety.7 Widespread implementation of EHRs has been occurring for the past several years nationally, so the small number of published studies in the literature review is not surprising. Common factors associated with successful implementation of EHRs into the clinical setting with practicing nurses and physicians include training and how well the selected EHR system fits with the providers’ needs.9,10 Barriers include time required to document, frequent updates, and information overload from the large amount of available data. Barriers identified to EHR implementation in nursing programs are the shortage of health informatics specialists to help design educational EHR systems, difficulty and cost of internal development of EHRs for school use, need for students to develop skill with multiple types of EHRs, and faculty acceptance and willingness to implement EHRs in their courses.11–13 Nursing students need to be prepared to use EHRs, but the existence of many different electronic documentation systems in clinical agencies makes preparing students a challenge. Nurse educators should be competent in using information management systems themselves to teach students. What is missing in the literature is sufficient evidence describing the use of various types of EHRs and stress that this new technology may impose on nurse educators who are responsible for ensuring that students obtain some working knowledge and comfort level with EHRs.
Methods Baccalaureate nurse educators in a southern state in the United States were invited via e-mail to participate in the study. Two researcher-developed questionnaires, a demographic data sheet and the Nurse Educator Technostress Scale (Revised) (NETS), were used for data collection. The NETS, originally developed by Burke14,15 to measure technostress in traditional classroom settings, was modified to capture data related to nurse educators teaching in clinical settings. The revised NETS contains 16 items exploring nurse educators’ experiences with EHRs in teaching students in the clinical setting. Questions addressed stressors related to common issues with using EHRs such as computer hardware/software failure, lack of access to EHR technology, and students’ knowledge of EHR technology. Participants were asked to rate their severity of stressors of teaching and using EHRs in a clinical course on a modified anchored scale. The scale ranged from 0 (no stress) to 4 (severe stress). The modified instrument was reviewed by 3 PhD-prepared nurse educators to establish content validity. Cronbach’s ! of the revised NETS instrument was .95. A separate demographic data form was used to analyze data related to the participants’ demographics and development of technostress. In addition to collecting data on age, educational level, and employment status, questions were included to determine if participants had received any type of training on the EHR used in the clinical setting and if they worked in the agency used as a clinical teaching site. Data collection was completed through the use of an online survey. The link to the survey was e-mailed to the school e-mail address of 278 nurse educators. Seventy-four responded with 64 participants meeting inclusion criteria, which resulted in a 23% response rate. Approval for the study Nurse Educator
was obtained from the authors’ institutional review board. Descriptive and inferential statistics were used to analyze the data using SPSS version 20 (IBM, Armonk, New York).
Results The most frequently reported age range was 45 to 54 years (33.8%, n = 24). The majority of participants were MSN prepared (73.9%, n = 51). Seventy-nine percent (n = 56) did not work in the agency they used for clinical experiences, and 44% (n = 24) had no EHR system training. Means for each item on the NETS along with the overall mean were calculated to determine participants’ technostress scores. Nurse educators experienced mild to moderate technological stress while teaching clinical courses as indicated by a mean NETS score of 2.86 (SD, 0.93). Based on item means, the 5 highest items that could lead to technostress were identified (Table). The NETS item with the highest mean was ‘‘student access to EHR training materials’’ (mean, 3.31 [SD, 1.21]). The need to learn new EHRs was the second highest rated item causing technostress (mean, 3.16 [SD, 1.14]). A 1-way analysis of variance comparing the overall NETS mean to selected demographic variables yielded no statistical significance.
Discussion The findings indicated that technological stress related to EHRs was a problem for nurse educators. Although there are no other published studies on the concept of technostress related to teaching nursing students to use EHRs, the results are similar to other studies by Burke,14,15 who found a mean NETS score of 2.45 (SD, 0.76) for nurse educators using technology to teach nursing theory courses. Lack of student access to EHR training materials and the need for nurse educators to learn new EHRs were factors causing stress. More than half of nurse educators (56%) participated in EHR training; however, training had no significant relationship to their level of technostress as indicated by their NETS scores. The highest NETS item scores relate to some of the challenges of implementing EHRs into nursing curricula identified in the literature review: the need for students to develop experience with multiple types of EHRs and the difficulties in training and support.9–11,13 The participants also rated students’ knowledge of EHR computer technology as moderately stressful (mean, 3.12 [SD, 1.14]). This is consistent with Borycki et al,11 who found that the need for students to develop experience with multiple types of EHRs during their educational program was a barrier to full implementation of EHRs into the curriculum. The study found no significant relationships between the selected demographic variables and the development of technostress. This suggests there Table. Five Highest Sources of Technostress NETS Item
Mean
SD
Student access to training materials Need to learn new EHR system Availability of EHR tech support Students’ knowledge of EHR Access to EHR during clinical experiences
3.31 3.16 3.13 3.12 2.79
1.21 1.24 1.3 1.14 1.19
Volume 41 & Number 1 & January/February 2016
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
47
may be other variables that may increase the incidence of nurse educators developing technostress while teaching EHRs in clinical courses. Results from the study indicate the need to develop strategies to decrease technostress in nurse educators such as partnerships with clinical facilities to support access to EHR technology, resources for teaching EHRs, and more training for both faculty and students in biomedical technology. Schools of nursing should investigate means of acquiring commercial EHR products designed for student learning to increase students’ access to EHRs during their educational programs. However, as indicated in the literature, access by schools to commercially available EHRs can be cost-prohibitive and a barrier to implementation.12,13,16 Costs include not only the software but also hardware such as computers and tablets, electrical infrastructure, and technical support personnel. Development of cost-effective means to provide student and educator access to a variety of EHRs for training purposes would be a factor in reducing stress. Three of the 5 items with the highest scores in this study related to access to EHRs. While the HITECH Act provided incentives to medical practices and facilities to implement EHRs,4 funding for nursing schools to purchase EHRs is not yet abundant.
Implications Health information systems and EHRs can lead to improved patient outcomes and quality of care.17 In addition to documentation of patient care, students also need to be taught how to use health information systems and EHRs for data retrieval and clinical decision making to provide quality care. The 5 items on the NETS with the highest means all relate directly to the need for nurse educators to develop strong relationships with health information system personnel at health care agencies to receive training and support with the EHRs used in their clinical settings. One of the benefits of such partnerships could be realized if the facility hires the nursing school’s graduates. These new nurses would likely require less orientation time with the facility’s EHR because of familiarity from clinical courses, saving the facility time and money. Longitudinal placement of students within 1 health system to decrease the need to learn differing EHR platforms could reduce the development of technostress for faculty and students. Assigning students to 1 clinical setting for an entire semester decreases the need to teach the use of EHRs multiple times a semester and facilitates the students’ proficiency with 1 EHR system. Schools of nursing and health care agencies also could implement a clinical scholar model whereby clinical instructors are employees of the hospital with consistent assignment to a clinical course and unit. Those instructors would be proficient with the EHR, and this arrangement would provide improved access to resources within the clinical agency. Limitations This study surveyed nurse educators teaching in baccalaureate programs in 1 state; thus, the findings may not be generalizable to all nurse educators teaching in baccalaureate and associate degree programs. An additional limitation is related to the small sample size. The lack of significant relationships between the dependent variables and NETS mean may be related to the small sample size. 48
Conclusion As more health care providers race to meet the meaningful use criteria created by the HITECH Act, nurse educators will be impacted by the rapid change of technology in clinical teaching agencies. This research described the technological stressors experienced by nurse educators when teaching students the use of EHRs in clinical nursing courses. Nurse educators experienced moderate stress when teaching the use of EHRs.
References 1. Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: National Academies Press; 2010. 2. American Association of Colleges of Nursing. The essentials of baccalaureate education for professional nursing practice. 2008. Available at http://www.aacn.nche.edu/education-resources/ essential-series. Accessed January 27 2015. 3. National League for Nursing (NLN). Outcomes and Competencies for Graduates of Practical/Vocational, Diploma, Associate Degree, Baccalaureate, Masters, Practice Doctorate and Research Doctorate Programs in Nursing. Washington, DC: NLN Press; 2012. 4. Knudson J. Change for the best. For the Record. 2012;24(23): 14. Available at http://www.fortherecordmag.com/archives/ 121712p14.shtml. Accessed January 30, 2015. 5. Lazarus R, Folkman S. Stress, Appraisal, and Coping. New York: Springer; 2008. 6. McMullen PC, Howie WO, Philipsen N, et al. Electronic medical records and electronic health records: overview for nurse practitioners. J Nurse Pract. 2014;10(9):660-665. 7. Brod C. Technostress: The Human Cost of the Computer Revolution. Reading, MA: Addison-Wesley; 1984. 8. Tarafdar M, Tu Q, Ragu-Nathan T. Impact of technostress on end-user satisfaction and performance. J Manage Inform Syst. 2011;27(3):303-324. 9. Steiner BA. Electronic Medical Record Implementation in Nursing Practice: A Literature Review of the Factors of Success [master’s thesis]. Bozeman, MT: Montana State University; 2009 Available at http://scholarworks.montana.edu/xmlui/handle/1/ 2347. Accessed January 30, 2015. 10. Babbott S, Manwell LB, Brown R, et al. Electronic medical records and physician stress in primary care: results from the MEMO study. J Am Med Inform Assoc. 2014;21(e1):e100-e106. 11. Borycki A, Kushniruk A, Armstrong B, et al. Integrating electronic health records into health professional and health informatics education: a continuum of approaches. Acta Inform Med. 2010;18(1):20-24. 12. Griffin-Sobel JP, Acee A, Sharoff L, et al. A transdisciplinary approach to faculty development in nursing education technology. Nurs Educ Perspect. 2010;31(1):41-43. 13. Kowitlawakal Y, Wang L, Chan SW. Development of the electronic health records for nursing education (EHRNE) software program. Nurse Educ Today. 2012;33(12):1529-1535. 14. Burke M. Technological Stressors of Louisiana Baccalaureate Nurse Educators [dissertation]. Baton Rouge, LA: Louisiana State University; 2005. Available from Proquest Dissertations and Theses (No. 3199717) and at http://etd.lsu.edu/docs/available/etd-08312005163644/unrestricted/Burke_dis.pdf. Accessed January 30, 2015. 15. Burke M. The incidence of technological stress among baccalaureate nurse educators during course preparation and delivery. Nurse Educ Today. 2009;29(1):57-64. 16. Gardner CL, Jones SJ. Utilization of academic electronic medical records in undergraduate nursing education. Online J Nurs Inform. 2012;16(2). Accessed January 30, 2015. 17. Frimpong JA, Jackson BE, Stewart LM, et al. Health information technology capacity at federally qualified health centers: a mechanism for improving quality of care. BMC Health Serv Res. 2013; 13(1):1-12.
Volume 41 & Number 1 & January/February 2016
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Nurse Educator
