The Impact of Electronic Health Record Training: How Students Utilize the Electronic Record to Inform Clinical Judgment

Nurses practice within a complex healthcare environment and must make well-informed judgments about their patients to provide safe, quality care. The electronic health record (EHR) is a piece of healthcare and informatics technology which houses important patient information that nurses utilize frequently while making clinical judgments surrounding patient care. The importance of entry-level nurse competency with the EHR and similar healthcare and informatics tools has been outlined by the American Association of Colleges of Nursing (AACN) Essentials and other nursing organizations concerned with the preparation of future nurses (AACN 2021; QSEN, 2020). Currently, there are limited established best practices for schools of nursing to follow to determine to appropriately prepare their students to utilize the EHR as a clinical judgment tool within their nursing practice. In addition, there is a lack of guidance on how the EHR should be integrated within pre-licensure nursing curricula. The purpose of this study was to 1) describe how pre-licensure, direct-entry master (DE-MSN) nursing students utilize their patient’s EHR to inform clinical judgment while providing nursing care and 2) understand the relationship between EHR training and implementation of patient care. A qualitative descriptive study was conducted with a purposive, convenience sample of nursing faculty and nursing students in one DE-MSN, pre-licensure program. Data was collected from participants via surveys and one-on-one interviews. Survey findings indicated that both nursing faculty and students felt that EHR training within the curriculum was inadequate to meet students’ learning needs. One-on-one interviews demonstrated that nursing students utilized the EHR throughout all phases of Tanner’s Clinical Judgment Model (CJM) during their off-campus clinical practicums: noticing, interpreting, responding, and reflecting. The medication administration record (MAR) was a large component of EHR utilization for participants as well. Nurse educators must partner with off-campus clinical practicum sites to ensure that students are prepared for clinical judgment using the EHR in alignment with the competencies outlined by the AACN Essentials. Further research is needed to determine how best to integrate EHR-related curriculum within pre-licensure nursing education.