The Association Between Using a Mobile Version of an Electronic Health Record and the Well-Being of Nurses: Cross-sectional Survey Study (Preprint)
Authors: Heponiemi Tarja , Kaihlanen Anu-Marja , Gluschkoff Kia , Saranto Kaija , Nissinen Sari , Laukka Elina , Vehko Tuulikki 
Published: March 2021

BACKGROUND

Mobile devices such as tablets and smartphones are increasingly being used in health care in many developed countries. Nurses form the largest group in health care that uses electronic health records (EHRs) and their mobile versions. Mobile devices are suggested to promote nurses’ workflow, constant updating of patient information, and improve the communication within the health care team. However, little is known about their effect on nurses’ well-being.

OBJECTIVE

This study aimed to examine the association between using a mobile version of the EHR and nurses’ perceived time pressure, stress related to information systems, and self-rated stress. Moreover, we examined whether mobile device use modifies the associations of EHR usability (ease of use and technical quality), experience in using EHRs, and number of systems in daily use with these well-being indicators.

METHODS

This was a cross-sectional population-based survey study among 3610 Finnish registered nurses gathered in 2020. The aforesaid associations were examined using analyses of covariance and logistic regression adjusted for age, gender, and employment sector (hospital, primary care, social service, and other).

RESULTS

Nurses who used the mobile version of their EHR had higher levels of time pressure (<i>F</i><sub>1,3537</sub>=14.96, <i>P</i>&lt;.001) and stress related to information systems (<i>F</i><sub>1,3537</sub>=6.11, <i>P</i>=.01), compared with those who did not use mobile versions. Moreover, the interactions of mobile device use with experience in using EHRs (<i>F</i><sub>1,3581</sub>=14.93, <i>P</i>&lt;.001), ease of use (<i>F</i><sub>1,3577</sub>=10.16, <i>P</i>=.001), and technical quality (<i>F</i><sub>1,3577</sub>=6.45, <i>P</i>=.01) were significant for stress related to information systems. Inexperience in using EHRs, low levels of ease of use, and technical quality were associated with higher stress related to information systems and this association was more pronounced among those who used mobile devices. That is, the highest levels of stress related to information systems were perceived among those who used mobile devices as well as among inexperienced EHR users or those who perceived usability problems in their EHRs.

CONCLUSIONS

According to our results, it seems that at present mobile device use is not beneficial for the nurses’ well-being. In addition, mobile device use seems to intensify the negative effects of usability issues related to EHRs. In particular, inexperienced users of EHRs seem to be at a disadvantage when using mobile devices. Thus, we suggest that EHRs and their mobile versions should be improved such that they would be easier to use and would better support the nurses’ workflow (eg, improvements to problems related to small display, user interface, and data entry). Moreover, additional training on EHRs, their mobile versions, and workflow related to these should be provided to nurses.