Most third-year undergraduate nursing students taught to use only paper-based documentation during their education do not feel prepared to use patient electronic medical records (EMR) when thrust into the clinical setting, a new study has found.
Nearly all students who took part in the study believed they would be more confident using EMR while on clinical placement if they had been given the opportunity to practice it in university simulation labs. They also felt prior training would help them be work ready and hit the ground running as registered nurses.
Led by a team of researchers at the University of Newcastle’s School of Nursing and Midwifery, the study, Nursing undergraduates’ perception of preparedness using patient electronic medical records in clinical practice, surveyed 70 third-year students, from 1 March to 31 May 2019, enrolled in the undergraduate nursing program at a regional metropolitan university in New South Wales.
Published in the March-May 2021 issue of the Australian Journal of Advanced Nursing (AJAN), the study set out to investigate third-year undergraduate nursing students’ perceptions and views on being prepared for using patient EMR on clinical placement after using only paper-based documentation, and their opinion on introducing EMR in university simulation labs.
Contemporary clinical practice in many countries requires nurses to competently use patient EMR, the study notes, yet, Australia has been slow in introducing this learning into its undergraduate nursing programs.
The study found most respondents (71.1%) did not feel prepared to use EMR in the clinical setting after only learning paper-based documentation and 81.7% did not feel confident accessing patients EMR the first time. Nearly all students (98.5%) believed they would be more confident using EMR initially in their clinical placements if there had been an opportunity to practice it in university simulation labs.
Over half of the student (55.7%) had received some basic training in EMR at a hospital, yet did not feel confident accessing or documenting patients’ EMR. Barriers cited by students included lack of access to EMR on the wards, and mentors and supervising nurses having difficulty finding time to teach students to use EMR in busy wards.
The study also asked students to reveal the impact of only learning to use paper-based documentation at university on their preparedness to use EMR on their first clinical placement.
Four main themes emerged – paper based learning provides a foundation for using EMR in clinical practice; feeling unprepared for using EMR; the need to learn both paper-based and EMR; and the paper-based system being outdated.
Participating students used words such as “inadequate” and “nervous and unsure” to describe their feelings when attending clinical placement where EMR was the norm.
“I was not prepared. I felt out of my depth. It was like I had spent a solid amount of time learning something that would not be applied,” one participant said.
According to the study, both public and private healthcare facilities are introducing EMR in the clinical setting and it is recognised that student nurses need to be able to access and use EMR programs and become skilled in the use of electronic healthcare systems.
Researchers say the study highlights the importance of preparing nursing students for entering the workforce as confident and competent new graduate registered nurses and integrating health informatics and digital health technologies in undergraduate nursing programs in Australia.
Study findings demonstrated that students recommended EMR learning should commence in the first year of their education program. Researchers agree this approach would help students learn in a supportive scaffolded educational environment, rather than on clinical placement when nursing staff have limited time to provide teaching, and students feel they are a burden.
“As nursing clinical practice shifts from paper-based patient record documentation to electronic record-keeping worldwide, there is an imperative need to include EMR in Australian nursing undergraduate education,” authors concluded.
“Students are understandably anxious when they attend their first and arguably other clinical experiences, as the experience is time-limited. One could suggest that their anxiety about not knowing how to use EMR, is also a reflection on their overall anxiety about preparedness for clinical practice generally.”
To read the full study click here