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Nurse practitioner students who receive electronic health record (EHR) training before beginning clinical rotations may be better prepared for practice while easing technology-related stress for the experienced clinicians who supervise them, according to new research from The University of Texas at Arlington (UTA).
Published in The Nurse Practitioner, the study found that students with early exposure to EHRs reported greater confidence entering clinical rotations. Researchers say earlier EHR education may ease the instructional burden on preceptors as healthcare organizations work to reduce clinician burnout.
Electronic health records have become a routine part of patient care, yet many nurse practitioner students do not gain hands-on experience until they begin clinical placements. Researchers said the lack of consistent EHR training before clinical rotations can increase demands on preceptors.
Preceptors play a critical role in preparing the next generation of nurse practitioners, making their workload and retention important concerns for nursing education programs.
For nurse educators, preceptors, and healthcare organizations facing staffing shortages, reducing the amount of EHR instruction required during clinical rotations could allow preceptors to focus more on clinical teaching.
“By introducing students to electronic health records earlier, they feel more confident going into their clinical rotations and know what to expect,” said Rhonda Winegar, a practicing nurse practitioner and assistant professor in the family nurse practitioner graduate program at UT Arlington. “That helps reduce burnout for both students and the preceptors who supervise their clinical training.”
Students Reported Greater Confidence After Early EHR Exposure
Winegar coauthored the study with Mari Tietze, the Myrna R. Pickard Endowed Professor at UTA’s College of Nursing and Health Innovation, who also serves as the university’s interim chief nurse officer and chair of graduate nursing.
Researchers followed 121 graduate students enrolled in two family nurse practitioner courses, Family I and Family II. Students with prior EHR experience reported significantly greater confidence and felt better prepared for clinical practice. Overall satisfaction with the integrated EHR curriculum was moderate, averaging 3.7 out of 5.
“We feel like we’re bringing the students into the real world as opposed to having their first experience with electronic health records be after graduation,” Tietze said.
Preparing Future Nurse Practitioners for Practice
The findings come as healthcare organizations continue working to reduce clinician burnout.
The U.S. surgeon general’s 2022 advisory on healthcare worker burnout identified electronic health records as one contributor to workplace stress. Researchers also noted that burnout affects one in five nursing students globally. Separate research shows that one in three nurses leave their first position within a year.
For nursing educators, those statistics reinforce the need to better prepare students before they begin practicing.
“We’re either burning them out, or we haven’t prepared them,” Tietze said. “Hospitals are telling us, ‘You’ve got to graduate nurses who are prepared for transition to practice.’”
Clinical Rotations Don’t Always Teach EHR Skills
Researchers said relying on clinical placements to teach EHR documentation can leave gaps, as workflows vary widely across healthcare settings.
“We assumed that when students got to their clinical site, that’s where they were going to gain their knowledge of how to use an electronic health record. Well, guess what? That doesn’t happen all the time,” Tietze said. “It depends on the clinic. It depends on the preceptor. It was not a consistent process.”
Winegar said students also may not observe the full documentation process during patient visits.
“The preceptor may be seeing patients and then later putting in all the orders, so the student may not see that,” she said.
Students enrolled in Family I, who were using EHRs for the first time, reported lower preparedness and greater frustration than Family II students, who had previous exposure to the technology.
Healthcare Technology Continues to Evolve
The researchers said nursing education must continue evolving as healthcare technology advances.
Tietze pointed to emerging tools, such as ambient listening systems that use artificial intelligence to capture patient-provider conversations and generate clinical documentation, as an example of how quickly clinical workflows are changing.
Future research will examine larger groups of students to better determine the long-term impact of introducing EHR education earlier in nurse practitioner programs.
