Motivation to change a person’s behaviour, such as use of a new technology at work, is affected by intrinsic and extrinsic factors, as well as their autonomy and self-efficacy. However, the role of individual nurse factors such as motivation, engagement, well-being, burnout, and job satisfaction are not often considered. Factors that influence nurses’ adoption, and therefore EMR effectiveness, include system factors (e.g., type and scope of the system), organisational leadership and local work culture. Changes to nurses’ work and workflows, inter- disciplinary and intra-disciplinary communication, and nurses’ well-being may have negative impacts on quality-of-care delivery and patient safety outcomes. EMR systems are expected to improve nurses’ work by making it more streamlined and efficient, however technology-related changes to nurses’ work and workflows have a wide range of impacts. EMRs do more than digitise pre-existing paper forms they alter nursing work and workflows for when, where and how care delivery is documented. Recently, EMR systems are a key facilitator for clinical documentation, clinical decision-making and information management in healthcare organisations. 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.ĮMR systems are replacing paper-based systems worldwide for recording patient care. 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. 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. 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. Nearly half ( n = 250, 46.3%) reported intrinsic motivation towards EMR use. 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. Survey findings revealed 32.2% ( n = 174) of nurses reported low well-being scores and 28.7% ( n = 155) were experiencing burnout symptoms. 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. Understanding nurses’ key concerns can inform EMR implementation and ongoing optimisation strategies to increase the likelihood of nurses remaining in the nursing workforce. Implementation of an electronic medical record (EMR) is a significant workplace event for nurses in hospitals.
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