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UID:HFESHCS_2026 International Symposium on Human Factors and Ergonomics i
 n Health Care_sess127_LEC110@linklings.com
SUMMARY:A Needs Assessment for Improving EHR Training in Nursing School
DESCRIPTION:Miad Alfaqih, Hwayoung Cho, Nicole Hammer, Philipp Haessner, O
 nyekachi Ike-Okpe, Jennifer R. Dungan, Carma Bylund, and Megan E. Gregory 
 (University of Florida)\n\nIntroduction\nThe electronic health record (EHR
 ) is a central tool in nurses’ work, with up to 27% of their time spent wo
 rking in the EHR1. EHRs are complex, with numerous features, multifaceted 
 interfaces, nuances inherent to various EHR vendors, and several EHR-based
  tasks required to be completed in any given nursing shift. As a result, t
 raining is needed for nurses to effectively use the EHR. EHR training prov
 ided during nursing programs (before clinical practice) promotes patient s
 afety by avoiding the cognitive overload of learning a complex system in t
 he context of a fast-paced, high-stakes job environment.2 While some forma
 l training programs exist (e.g., EHR Go, Shadow Health), it is unclear how
  often they are implemented and how they can best meet the needs of nursin
 g students; prior work suggests that few nursing programs provide formal t
 raining to students on the EHR.3 This ultimately leaves new nurses with a 
 steep learning curve to adjust to using an EHR on the job, exacerbating hi
 gh cognitive load in the context of a work setting that is already associa
 ted with heavy cognitive burdens. To this end, we sought to conduct a need
 s assessment to better understand the greatest areas of need for EHR train
 ing in nursing school.\nToward the goal of educating nursing students in s
 kills to be used in their future jobs, we followed the Transfer of Trainin
 g framework by Baldwin and Ford.4,5 This framework posits that in order to
  apply knowledge, skills, and attitudes learned in a training context to a
  job, learning must be generalized to the job context and retained over a 
 period of time. The framework further suggests that three categories of in
 puts can influence learning, retention, and ultimately training transfer: 
 (1) characteristics of the trainees (e.g., cognitive ability, motivation);
  (2) design of the training (spaced practice, using multiple learning stra
 tegies, testing during training); and (3) the work environment (e.g., supe
 rvisor support, opportunity to use trained skills). Given our goal, we emp
 hasize the training design category in this study.\n\nMethods\nStudy Desig
 n\nThis is a qualitative study leveraging semi-structured interviews, appr
 oved by the IRB.\nParticipants and Recruitment\nWe are recruiting two grou
 ps: (1) new nurses (licensed for 6 months-2 years) who work in the inpatie
 nt setting, (2) nursing faculty members who teach EHR-related content. We 
 are recruiting 10 nurses and 5 faculty via flyers in inpatient settings, e
 mail listservs, and word-of-mouth. Participants receive a $50 gift card af
 ter the interview. \nProcedure\nPotential participants complete an eligibi
 lity questionnaire. If eligible, a study team member schedules a virtual, 
 45-minute semi-structured interview. A verbal informed consent process is 
 conducted at the beginning, and interviews are conducted by members of the
  study team who do not work with or supervise nurses, nursing faculty, or 
 nursing students. Interviews are audio recorded and transcribed, then de-i
 dentified. Topics on the nurse interview guide include perceptions of adeq
 uacy of EHR training during nursing school, challenges faced with using th
 e EHR during their first months and years on the job, and recommendations 
 to improve EHR training in nursing school. Topics on the faculty guide inc
 lude how EHR content is integrated into curricula, teaching strategies to 
 address EHR competencies, perceived gaps in EHR training, student readines
 s to use the EHR, and recommendations for improving EHR preparation in nur
 sing school.\nAnalysis \nTwo study team members will independently code th
 e transcripts using a combined inductive-deductive approach based on the f
 rameworks, and the coded data will be analyzed using thematic analysis to 
 identify common themes related to EHR training gaps and challenges.\n\nRes
 ults\nThus far, we have interviewed four nurses and three nursing faculty 
 members, with several other interviews scheduled. The nurses in our sample
  work in an ICU (n=1) and medical-surgical units (n=3). The nursing facult
 y members have taught undergraduate (BSN) nursing courses, including skill
 s and clinical classes.\nExperiences with Training in Nursing School and P
 erceived Job Readiness to Use the EHR\nThree nurses (75%) indicated that t
 hey received no formal training on the EHR during nursing school. For exam
 ple, Nurse Participant 1 said “We literally opened [the EHR] just to see w
 hat it looks like, and that's the extent of our training.” Instead, their 
 EHR experience prior to their first nursing job was limited to quick views
  of the EHR during clinical rotations. They indicated feeling ill-prepared
  to use the EHR in their roles as nurses. Nurse Participant 2 stated that 
 their lack of knowledge on the EHR “was definitely slowing [my practice] d
 own… It was slowing me down a lot.” Nurse Participant 1 conveyed a similar
  experience, indicating that “initially, it's very overwhelming, because i
 t's a lot to grasp.”\nThe nurse participants indicated they wished for mor
 e EHR training during nursing school, e.g., “Before going in, um, I wish t
 hey would have showed us how to, like, navigate [the EHR], even if taking 
 just… you know, a class, or just, you know, a one-hour lecture of just sho
 wing us, like, a general one… Because that's the main part of my job, is d
 ocumenting, you know?”- Nurse Participant 1.\nAlternatively, Nursing Facul
 ty 1 and 2 indicated that, in their program, nursing students do get the o
 pportunity to learn and practice on the EHR using the Epic Playground, by 
 assessing a simulated patient or task trainer, and documenting findings in
  the Playground. This is combined with a lecture component of Epic trainin
 g to show nursing students the various components of the Epic EHR. This di
 fferent experience may be due to different institutions, differences in tr
 aining for Associate vs. Bachelor nursing programs, very recent changes in
  the curriculum, or some combination of these factors. \nMost Used EHR Fun
 ctions\nWe are also examining which functions in the EHR new nurses purpor
 t to use most frequently, to help target where to focus EHR training in nu
 rsing school. While participants indicated that this varies by clinical ar
 ea, some functions are emerging as frequent tasks that are potentially gen
 eralizable between specialties, such as the medication administration reco
 rd (MAR), assessments, reviewing history, documenting vitals and “ins and 
 outs”, writing clinically-relevant notes, and reviewing orders.\nPrelimina
 ry Recommendations for Training\nThe nurse participants indicated a desire
  for more EHR training during nursing school. All participants so far have
  stated a preference for demonstration- and practice-based training. Nurse
  Participant 2 indicated she would like to see “a little video, and then I
  perform the task… If you're just showing me slides… doing lectures, peopl
 e won't pay attention after 10 minutes.” Another suggestion by Nurse Parti
 cipant 1 was “but even just bringing, like a, practice patient, like a Joh
 n Doe patient, just so that we can see the way [the EHR] looks. See what n
 urses are actually utilizing in the EHR system, and so that way it can, li
 ke, really prepare.”\nIn terms of timing, all nurses thus far have suggest
 ed that the training should be done closer to the end of a nursing program
 , to promote retention. Further, they suggested that integrating the train
 ing into other existing required learning experiences, such as simulation 
 labs, would ensure students complete the training, as compared to setting 
 it as an extra, optional opportunity. Nurse Faculty 1 suggested that “repe
 tition might help them, because there's so many different ways in the EHR 
 you can chart, and I think they get confused”.\nThese findings thus far al
 ign with recommendations proposed for training design by the transfer of t
 raining framework,4 in that more active instructional strategies (demonstr
 ation, practice), repetition, and feedback are key for learning, retention
 , and transfer.\n\nTrack: Simulation and Education\n\nSession Chair: Micha
 el Boyce (Yale New Haven Health, Yale University)\n\n
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