HealthDecember 14, 2017

Why educators need to consider using EHRs with student nurses

Fact: Electronic health records are here to stay, and the EHR benefits to medical professionals and patients alike are growing every day.

With that being said, the use of EHRs and the positive impacts they make on the healthcare industry relies on the ability of nurses to use EHRs effectively and efficiently. Electronic health record technology - and the nursing informatics required to use them - drastically improve patient safety, reduce healthcare costs, and decrease facility expenditures for training. But, with so many nursing school graduates entering the workforce with minimal experience using EHRs, healthcare facilities are left dealing with higher levels of error, increased training costs, and lengthier transition periods for making good new nurses great.

In 2012, a quantitative descriptive study was conducted to identify what gaps existed between the informatics knowledge & skills self-reported by new/novice nurses and the informatics knowledge and skills demonstrated in acute-care settings by new/novice nurses as reported by nurse managers. In a shorter breath, how new nurses assess their knowledge and skills compared to how nursing managers view those same skills in short-term clinical settings. The survey responses revealed gaps in 13 of 28 knowledge and skill areas considered critical to effective EHR use. The purpose of pointing out these skill gaps was to help nursing educators and nursing directors develop a path to standardization and, therefore, better prepare nurses to use EHRs and integrate more seamlessly into the workplace.

Integrating EHR record training with nursing education programs has vast benefits and is something all healthcare educators need to consider. Below is a breakdown of common questions and answers to help you better understand the importance of getting nursing students comfortable with EHRs:

What is an EHR? Does the entire healthcare industry use them?

Electronic health records, in their simplest form, are a digital version of a patient's paper chart. They"re easy to find, search, and update, and provide tools like reminders, alarms, and automated processes that improve clinical accuracy. U.S. healthcare organizations have been transitioning from paper-based medical records to electronic health records for over a quarter of a century. They allow organizations to minimize the high rate of medical errors occurring throughout the healthcare industry and act as a tool for increasing patient safety and decreasing the overall cost of healthcare.

What is the government doing to aid in the transition and promotion of EHRs?

Transitioning decades of paper files over to digital combined with employee training and industry-wide acceptance doesn't come cheap. Luckily the government recognizes this. The Health Information Technology for Economic and Clinical Health (HITECH) Act was signed into law under the American Recovery and Reinvestment Act of 2009, which incentivized organizations to adopt and use electronic health records and other improved technology systems.

The HITECH Act provides $19 billion for reimbursement to healthcare facilities using the EHR correctly as defined by specific criteria. The goal is to get these systems in place and used effectively as quickly as possible to minimize costs.

How much EHR training is currently offered to nurses?

According to the 2012 study, 90% of new/novice nurses and 75% of nurse managers reported participating in EHR training at their jobs. While those may sound like solid figures, only 20% of new/novice nurses and a mere 7% of nurse managers said EHR was a part of their curriculum during nursing school. While that number surely has increased somewhat in the years since, they are still lower than they should be. How can healthcare organizations expect nurses to pick up on EHR technologies and best practices right away when their educators hardly touch on it? When EHR workplace training is offered, 39% of newer nurses reported receiving anywhere from 9 to 16 hours of training, and nurse managers reported receiving more than 24 hours of training. The 2012 study also concluded that over 60% of nurse managers agreed it took new nurses more than 2 months to be proficient using EHRs.

What are the 13 skill areas that were identified as gaps?

Thirteen may sound like a lot of gaps, but new/novice nurses and nurse managers agreed on quite a few strengths. Things like word processing, email use, online education, presentation development, and Internet and search engine usage - which shouldn't come as much of a surprise. However, nurse managers identified the following critical skills as areas in need of development:

  • Spreadsheet development
  • Data entry
  • Medication administration
  • Documentation
  • Treatment documentation
  • Graphics documentation and tracking
  • Patient education material retrieval
  • Patient education documentation
  • Lab results retrieval
  • Diagnostics results retrieval
  • Accessing electronic charts contents
  • Accessing prior admission data
  • Care plan development and updates
  • Discharge planning documentation and updates

This makes sense. Nursing students grasp the fundamental pieces required to use EHRs in the workplace, but lack the practical experience of the real nuts and bolts of the technology.

What kind of implications do these skill gaps have for employers and nursing education programs?

Employers should be prepared to provide new nurses with on-site training for the skills needed to use EHRs effectively on a daily basis, as well as have resources in place for continuous education. RNs within the organization who understand the informatics and, more importantly, know the facility's EHR technology inside and out should be available for support. Organizations should also consider adjusting the workload of training nurses until they fully understand the system.

We know we"re on the right path with incorporating EHR learning into nursing curriculum, because 20% of newer nurses were taught how to use EHRs and their benefits, compared to 7% of nurse managers who have been in the workforce and out of school for longer. Students -  nursing students specifically - learn deeper with greater practical connection when studying a topic, then actually doing what they learned in a “real-life" setting. Being a nurse is a delicate mixture of critical thinking and actual skill, so having educators and healthcare administrators on the same page not only helps create better nursing graduates, but it also helps organizations transition to a completely electronic system. As technology continues to drill down its position in healthcare, the curriculum used to teach the workforce must adapt, too.

Why is it so important for nurses to have experience with EHRs prior to graduation?

The exact technologies used may differ from organization to organization, but the time-tested skills in basic communication, concise writing, and general computer and database use hold true across formats. Nursing educators can teach concepts and theories all day long, but the real learning that"ll allow nurses to connect the dots between coursework and workplace situations comes from learning in a safe and structured clinical setting. An electronic health record is a legal document, and nursing students need to be familiar with common protocol and effective use when recording and dealing with patient information. Everything they"ll do in the workplace will be based around these systems. Preparing students with the foundational skills for using EHRs will set them up for success right off the bat - lowering healthcare costs, reducing error, and improving patient satisfaction the along the way.

Why should EHR training be focused in the classroom, rather than at the clinical site?

The healthcare industry and the technologies behind its advancements continue to evolve, and nursing educators are just beginning to understand the changing skillset and informatics expected of new nurses entering the workforce. This study gets them one step closer, as it identifies which areas new nurses could use the most improvement and creates a more defined path for designing coursework.

The industry shift to EHRs is meant to increase the efficiency and safety of patient care while lowering the costs of the organization. However, it's difficult to rely on clinical sites to provide standardized training across the board, putting those goals in jeopardy. Integrating EHR work into the current curriculum and setting the standard for how students should be trained to chart and analyze nursing documentation at the university level helps alleviate stress from healthcare organizations. Plus, students get to learn in a safe and nurturing environment. Be a positive influence in the career development of future nurses by incorporating Lippincott DocuCare - the leading EHR training solution - into your course curriculum. DocuCare enhances clinical learning by contextualizing realistic patient care scenarios with hands-on documentation, all in an easy-to-use program. Its intuitive educational experience lets you interact with your students, track their progress, and focus your teaching strategies using evaluation tools, pre-populated cases, and a unified simulation experience.


Incorporating electronic health records into nursing curriculum with clinical learning opportunities creates nursing graduates who can immediately contribute to improved patient safety, decreased training costs, and lower overall healthcare costs. The skill gaps identified in the study help pinpoint areas educators can focus on to improve the EHR literacy of new hires. Healthcare organizations should still use on-site training to bring new/novice nurses up to speed and get them feeling comfortable with the facilities specific technology, but nursing programs can begin to bridge the gaps nurse managers are still seeing in informatics and the critical skills needed for accurate electronic health record documentation.

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