Background Digital health technologies are changing the context of nursing and midwifery practice. There are varying degrees of knowledge and adoption of digital health technologies in Australian healthcare systems. While nursing and midwifery informatics is an emerging specialty within Australia, little is known about the scope, roles, and benefits of informatics roles in Australia. Review question What are the scope, responsibilities, benefits, and limitations of nursing and midwifery informatics roles throughout Australia? Methods A scoping review was used to address the review question, and the mixed-methods appraisal tool was used to guide generalisability and interpretation of included records. Five healthcare and digital health databases, as well as grey literature, reference lists, and published resources related to nursing and midwifery informatics between 2010 and 2024 were searched. Findings Four records were identified that partially addressed the review question. The scope, roles, and responsibilities of nursing and midwifery informaticians remain poorly understood. Discussion Nurses and midwives need further education about digital health technologies and their place in an ever-changing work environment. Professional development activities that enhance understanding about digital health and informatics would be beneficial to address this gap, regardless of nurses’ and midwives’ current educational level or role. A standardised approach to defining Australian nursing and midwifery informatics, including the scope, roles, and responsibilities of informaticians, would support better understanding, applicability, and usability within the workforce. Conclusion Despite literature supporting the need for dedicated nursing and midwifery informatics roles, the evidence and value of these roles are yet to be defined and quantified.

The implementation of an organisation-wide EMR system in 2019 included single sign-on technology for nurses and midwives. This first-in-Australia study extended the use of this technology to enable nurses and midwives to tap-to-witness for high-risk medications, blood and blood products, and expressed breast milk. A saving of 7 seconds per interaction was observed with nurses and midwives reporting appreciation for ongoing EMR enhancement to reduce EMR-related documentation burden.

Standardised nursing terminologies (SNTs) support the visibility of nursing work and documentation, enabling data sharing and comparison. An online survey assessed the knowledge and use of SNTs and revealed barriers and enablers to their use by Australian nurses. Just over half of the respondents were familiar with SNTs before the survey, a quarter reported a reasonable understanding of SNTs, just under half reported previous use of a SNT, and less than 14% indicated a current use of a SNT in their workplace. Perceived benefits to SNTs identified by respondents included a reduction in variation and the ability to evaluate the effectiveness of nursing care by measuring outcomes. Both barriers and enablers to the use of SNTs included education and training, standardisation and contextualisation across Australia, and integration into any electronic medical record system. Nurses are poorly informed on what SNTs are and how they can be leveraged to support their work and documentation. There is a need for an Australia-wide strategic approach to ensure the future of nurses’ work is visible, and SNTs are purposefully and correctly implemented across the country.

A National Nursing and Midwifery Digital Health Capability Framework was developed in 2020 to define and complement digital health knowledge and skills for professional practice. This mixed-methods study explored nurses’ and midwives’ Framework knowledge and its applicability, types and extent of nursing and midwifery informatics roles, and barriers and enablers to working in informatics. Survey respondents reported familiarity with the Framework, with content analysis identifying three themes - informatics as part of nursing or midwifery roles, descriptions and variability of informatics roles, and the need for informatics role development and recognition. Framework knowledge can be improved through standardised and defined roles and a career pathway that includes national, organisational, local, and individual support.

Background Standardised Nursing Terminologies (SNTs) provide a set of agreed terms that are aligned to nurses’ assessments, interventions, and nurse-sensitive patient care outcomes. The use of such a terminology allows for improved visibility of nursing care and comparisons of interventions and outcomes to support and assess evidence-based practice. Whilst SNTs have been in use internationally for decades, there is a gap in practice and literature related to SNTs throughout Australia. Purpose The objectives of this review were to explore recent literature to identify and understand (i) the benefits of SNTs, (ii) the limitations of SNTs, and (iii) the potential scope of SNTs for the Australian context. Methods A scoping review was undertaken to search relevant literature in CINAHL, Cochrane Review, EMBASE, IEEE Xplore, Medline Complete, and Scopus databases using a date range of 2015–2023. Findings A total of 36 studies were reviewed, none of which were Australian. Main benefits associated with integrating SNTs into health records include improved nursing documentation quality, facilitate visibility of nursing care, and enable nursing practice quality improvement. Key limitations identified were the lack of evidence about correlation between nurses’ knowledge level and the use of SNT in practice, lack of strong evidence related to benefits in terms of patient outcomes, workflow efficiencies or enhanced communication, poor representation of nursing practice in SNTs, and mapping limitations to achieve interoperability. Conclusions In order to support SNT implementation and adoption throughout Australia, there is a need for Australian research as well as a national strategy for the adoption of an SNT taxonomy in Australia. This requires stakeholder policy development, government support to ensure standardisation, and broad education at academic and local level to enable comprehensive systems’ integration.

AIM:To examine current literature for causal explanations on how, why and under what circumstances, implementation of a new hospital electronic medical record system or similar technology impacts nurses' work motivation, engagement, satisfaction or well-being. BACKGROUND:Implementation of new technology, such as electronic medical record systems, affects nurses and their work, workflows and inter-personal interactions in healthcare settings. Multiple individual and organisational-level factors can affect technology adoption by nurses and may have negative consequences for nurses and patient safety. DESIGN:Five-step realist review method and Realist And Meta-narrative Evidence Syntheses: Evolving Standards checklist was used to guide this review. Eight initial theories (programme theories) were used as the basis to explore, examine and refine literature from a range of sources. DATA SOURCES:Literature from five databases (APA PsycInfo, CINAHL, Embase, IEEE Xplore and MEDLINE Complete) and grey literature (from 1 January 2000 to 31 October 2021) were systematically searched and retrieved on 4 November 2021. RESULTS:In all, 8980 records were screened at the title and abstract level, of which 1027 full texts were screened and 10 were included in the review. Seven studies assessed concepts in both pre- and post-technology implementation. Most common contexts related to knowledge, rationale and skills to use new technology. Mechanisms that impacted nurses or nursing care delivery included: nurses' involvement in technology implementation processes; nurses' perceptions, understanding and limitations of technology impact(s) on patient care delivery; social supports; skills; implementation attitude and hardware. Work satisfaction was the most frequently examined outcome. An analysis led to nine final programme theories (including two original, six revised and one new programme theory). CONCLUSION:Nurses must be informed about the rationale for new technology and have the knowledge and skills for its use. Understanding nurses' work motivation and attitudes related to technology adoption in the workplace can support work engagement, satisfaction and well-being. IMPLICATIONS FOR THE PROFESSION:Complex contexts and mechanisms play a role in nurses' work motivation, engagement, satisfaction and well-being with the implementation of new technology into healthcare settings. RELEVANCE TO CLINICAL PRACTICE:Nurses, their work and workflows are all influenced by the implementation of new technologies (such as electronic medical records), which in turn has consequences for patient safety and quality of care. PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution. PROSPERO REGISTRATION NUMBER:CRD42020131875 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=131875).

BACKGROUND:Health informatics competency standards for nurses are required to ensure the use and management of health information technologies contributes to the delivery and management of safe, quality care delivery. Historically, these competencies have been identified for nurses as a general group and specifically for undergraduate nursing students but not to the same extent for nurse leaders.AIM:The aim of this study was to validate and prioritise health informatics competencies for Australian nurse leaders.METHOD:This study utilised a modified Delphi technique to validate and prioritise 26 health informatics competencies for the Australian setting. The competencies were previously developed for Canadian nurses through literature review and consulation with experts. This modified Delphi study included invitations to 20 Australian Chief Nursing Information Officers who were then asked to extend the invitation to nurse leaders in their corresponding organisations.RESULTS:Eleven Chief Nursing Information Officers and seven Nurse Leaders completed the study including 3 rounds of informatics competencies consensus surveys. As a result, 22 revised competency statements were agreed to by the study participants. The top priority competency (Nursing and Midwifery leaders support clinicians to adopt and use information and communication technologies that support safe, quality care delivery) was also the highest ranked in the Canadian team's initial work. This reflects a common objective of nurses' need to ensure technology is fit for purpose, not only for nurses and midwives, but for patient safety and quality of care.CONCLUSION:Knowledge is required in the digital health landscape in order for nursing leaders to increase their capability in decision-making in the current and future digital healthcare environments. Differences in the competencies validated and prioritised by Australian nurse leaders and previous work by Canadian nurse leaders support the need to examine context-specific factors for nurse leaders to utilise these competencies.

British Journal of Cardiac NursingVol. 18, No. 9 CommentThe role of CONNECT: the importance of collaboration and supporting nurses and allied professionals in researchJulie Sanders, Suzanne Fredericks, Sheila O'Keefe-McCarthy, Rosalie Magboo, Maria Hayes, Rebecca Jedwab, Rochelle WynneJulie SandersCorrespondence to: Julie Sanders; E-mail Address: [email protected]St Bartholomew's Hospital, Barts Health NHS Trust, London, UKCardiovascular Nursing, William Harvey Research Institute, Queen Mary University of London, London, UK, Suzanne FredericksToronto Metropolitan University, Toronto, ON, Canada, Sheila O'Keefe-McCarthyFaculty of Applied Health Sciences, Department of Nursing, Brock University, CanadaSocial Justice Research Institute, the Centre for Research Across the Life Span, and the Brock Functional Inclusive Training (Bfit) Centre, Saint Catharines, ON, Canada, Rosalie MagbooWilliam Harvey Research Institute, Queen Mary University of London, London, UKAdult Critical Care Unit, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, Maria HayesSchool of Nursing and Midwifery, University College Dublin, Dublin, IrelandIrish Nurses Cardiovascular Association, Dublin, Ireland, Rebecca JedwabCardiothoracic Surgery Unit, Blackrock Clinic, Dublin, IrelandNursing and Midwifery Informatics, EMR and Informatics Program, Monash Health, Clayton, Victoria, Australia, Rochelle Wynne(On behalf of) CONNECT, Royal Melbourne Hospital, Melbourne, Victoria, AustraliaFaculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, AustraliaJulie Sanders; Suzanne Fredericks; Sheila O'Keefe-McCarthy; Rosalie Magboo; Maria Hayes; Rebecca Jedwab; Rochelle WynnePublished Online:1 Sep 2023https://doi.org/10.12968/bjca.2023.0055AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Al-Nawafleh A, Zeilani RS, Evans C. 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BACKGROUND:Timely multidisciplinary communication is crucial to prevent patient harm related to miscommunication of clinical information. Many health care organizations provide secure communications systems; however, clinicians often use unapproved platforms on personal devices to communicate asynchronously. OBJECTIVE:The aim of the study is to assess clinical communication behaviors by clinicians in a hospital setting. METHODS:Medical, nursing and allied health staff working across seven hospital sites of a large health care organization were invited to complete an anonymous survey on the methods, behaviors, and rationale for clinical communication technology use. The survey included questions on communication methods used by clinicians for intra- and inter-disciplinary communication and sending and receiving clinical information or images. Demographics and qualitative comments were also collected. RESULTS:A total of 836 surveys were completed (299 medical, 317 nursing, and 220 allied health staff). Staff in all clinical groups reported using an unapproved messaging platform to communicate patient information more than three times per day (medical staff n = 167, 55.9%; nursing staff n = 106, 33.4%; allied health staff n = 67, 30.5%). Not one medical staff member indicated they only use the approved methods (n = 0, 0%) while one-third of nursing and allied health respondents only used approved methods (n = 118, 37.2% and n = 64, 29.1%, respectively). All clinician groups reported wasted time from communications sent with missing information, or time spent waiting for responses for further information. Qualitative comments expressed dissatisfaction and frustration with current clinical communication methods and a desire for improved systems. CONCLUSION:Workarounds are being used by all clinician groups to send text and image clinical communications. There are high levels of dissatisfaction with this situation and clinicians are keen for consistency and to have the right tools available. There is a need to ensure standardized clinical communication methods and approved digital platforms are in place and utilized to provide safe, high-quality patient care.

BACKGROUND:Introducing an electronic medical record (EMR) system into a complex health care environment fundamentally changes clinical workflows and documentation processes and, hence, has implications for patient safety. After a multisite "big-bang" EMR implementation across our large public health care organization, a quality improvement program was developed and implemented to monitor clinician adoption, documentation quality, and compliance with workflows to support high-quality patient care.OBJECTIVE:Our objective was to report the development of an iterative quality improvement program for nursing, midwifery, and medical EMR documentation.METHODS:The Model for Improvement quality improvement framework guided cycles of "Plan, Do, Study, Act." Steps included design, pre- and pilot testing of an audit tool to reflect expected practices for EMR documentation that examined quality and completeness of documentation 1-year post-EMR implementation. Analysis of initial audit results was then performed to (1) provide a baseline to benchmark comparison of ongoing improvement and (2) develop targeted intervention activities to address identified gaps.RESULTS:Analysis of 1,349 EMR record audits as a baseline for the first cycle of EMR quality improvement revealed five out of nine nursing and midwifery documentation components, and four out of ten medical documentation components' completion and quality were classified as good (>80%). Outputs from this work also included a framework for strategies to improve EMR documentation quality, as well as an EMR data dashboard to monitor compliance.CONCLUSION:This work provides the foundation for the development of quality monitoring frameworks to inform both clinician and EMR optimization interventions using audits and feedback. Discipline-specific differences in performance can inform targeted interventions to maximize the effective use of resources and support longitudinal monitoring of EMR documentation and workflows. Future work will include repeat EMR auditing.

BACKGROUND:Reports on the impact of electronic medical record (EMR) systems on clinicians are mixed. Currently, nurses' experiences of adopting a large-scale, multisite EMR system have not been investigated. Nurses are the largest health care workforce; therefore, the impact of EMR implementation must be investigated and understood to ensure that patient care quality, changes to nurses' work, and nurses themselves are not negatively impacted. OBJECTIVE:This study aims to explore Australian nurses' postimplementation experiences of an organization-wide EMR system. METHODS:This qualitative descriptive study used focus group and individual interviews and an open-ended survey question to collect data between 12 and 18 months after the implementation of an EMR across 6 hospital sites of a large health care organization in Victoria, Australia. Data were collected between November 2020 and June 2021, coinciding with the COVID-19 pandemic. Analysis comprised complementary inductive and deductive approaches. Specifically, reflexive thematic analysis was followed by framework analysis by the coding of data as barriers or facilitators to nurses' use of the EMR using the Theoretical Domains Framework. RESULTS:A total of 158 nurses participated in this study. The EMR implementation dramatically changed nurses' work and how they viewed their profession, and nurses were still adapting to the EMR implementation 18 months after implementation. Reflexive thematic analysis led to the development of 2 themes: An unintentional divide captured nurses' feelings of division related to how using the EMR affected nurses, patient care, and the broader nursing profession. This time, it's personal detailed nurses' beliefs about the EMR implementation leading to bigger changes to nurses as individuals and nursing as a profession than other changes that nurses have experienced within the health care organization. The most frequent barriers to EMR use by nurses were related to the Theoretical Domains Framework domain of environmental context and resources. Facilitators of EMR use were most often related to memory, attention, and decision processes. Most barriers and facilitators were related to motivation. CONCLUSIONS:Nurses perceived EMR implementation to have a mixed impact on the provision of quality patient care and on their colleagues. Implementing technology in a health care setting was perceived as a complex endeavor that impacted nurses' perceptions of their autonomy, ways of working, and professional roles. Potential negative consequences were related to nursing workforce retention and patient care delivery. Motivation was the main behavioral driver for nurses' adoption of EMR systems and hence a key consideration for implementing interventions or organizational changes directed at nurses.

BACKGROUND:The impacts of electronic medical record implementation on nurses, the largest healthcare workforce, have not been comprehensively examined. Negative impacts on nurses have implications for quality of patient care delivery and workforce retention. OBJECTIVE:To investigate changes in nurses' well-being, intention to stay, burnout, work engagement, satisfaction, motivation and experience using technology pre- and post-implementation of an organisation-wide electronic medical record in Victoria, Australia. METHODS:The natural experiment comprised an electronic medical record system implementation across six hospitals of a large tertiary healthcare organisation. Cross-sectional surveys were collected pre-electronic medical record implementation prior to the SARS-CoV-2 pandemic in 2019, and 18-months post-electronic medical record implementation during the pandemic in 2020, and findings compared. RESULTS:A total of 942 surveys were analysed (550 pre-electronic medical record (response rate 15.52%) and 392 post-electronic medical record (response rate 9.50%)). Post-electronic medical record, nurses' work satisfaction (r = 0.23, p=<0.001), intention to stay (r = 0.11, p = 0.001) and well-being (r = 0.17, p=<0.001) decreased. Nurses' perceived competence increased (r = 0.10, p = 0.002) despite decreased autonomy (r = 0.10, p = 0.003). Two of three dimensions of work engagement worsened (vigour r = 0.13, p=<0.001; dedication r = 0.13, p=<0.001) and all dimensions of burnout increased (exhaustion r = 0.08, p = 0.012, cynicism r = 0.07, p = 0.04 and reduced efficiency r = 0.32, p=<0.001). Nurses reported more burnout symptoms (95% CI 4.6-4.7%, p = 0.036), were less engaged (95% CI 49.6-49.9%, p=<0.001) and career trajectory satisfaction decreased (r = 0.15, p=<0.001). Matched data from 52 nurses showed changes in the same direction for all items except career trajectory satisfaction, hence validated findings from the larger unmatched sample. CONCLUSIONS:Implementation of an electronic medical record immediately followed by the SARS-CoV-2 pandemic was associated with negative changes in nurses' well-being, intention to stay, burnout, work engagement and satisfaction.

Introduction Electronic medical record (EMR) systems are used worldwide as repositories for patients’ clinical information, providing clinical decision support and increasing visibility of and access to clinical information. While EMR systems facilitate improved healthcare delivery, emerging reports suggest potential detrimental effects on clinician well-being. EMR system implementation influences on nurses’ work motivation, engagement, satisfaction and well-being (including burnout) are not well understood, nor have they been examined in relation to contextual factors and mechanisms of action. This paper presents a realist review protocol to examine causal explanations to address the question: How, why and under what circumstances does the implementation of a new hospital EMR system or similar technology impact nurses’ work motivation, engagement, satisfaction or well-being? Methods and analysis The five-step method for realist review will be used to identify causal relationships, how the relationships work, for whom and under what circumstances: (1) defining the review scope; (2) developing initial program theories; (3) searching the evidence; (4) selecting and appraising the evidence; (5) extracting and synthesising the data. Initial program theories were developed using scoping review findings and qualitative data collected from nurses pre-EMR and post-EMR. Five databases will be systematically searched from 1 January 2000 to 31 October 2021 (APA PsycInfo, CINAHL, Embase, IEEE Xplore and MEDLINE Complete), and forward and backward citation searching, grey literature searching and literature recommended by the research team. Search results will be screened by two research team members. Data extracted will assist in refining program theories to develop a conceptual model that synthesises how work motivation, engagement, satisfaction and well-being may influence, or be influenced by, an EMR implementation. Ethics and dissemination The larger project has previously obtained low-risk ethics approval. The review will be published in a peer-reviewed journal and reported as per RAMESES guidelines. PROSPERO registration number CRD42020131875.

The past decade has seen the implementation of electronic medical record (EMR) systems being implemented across large-scale healthcare organisations throughout Australia. A first-time implementation of an organisational-wide EMR system required a multi-modal approach to the development of new nursing workflows and appropriate selection of hardware devices to ensure acceptance and adoption of the EMR. The aim of this work was to develop new nursing workflows and associated device requirement principles to allow for continuation of safe, high quality nursing care with an EMR implementation. The incorporation of multi-disciplinary consultations, an audit, observational study and clinical and governance stakeholder engagement was used to develop device requirement principles. This ensured development of standardised nursing workflows were successfully adopted throughout the organisation with the EMR implementation.

Introducing new technology, such as an electronic medical record (EMR) into an Intensive Care Unit (ICU), can contribute to nurses' stress and negative consequences for patient safety. The aim of this study was to explore ICU nurses' perceptions of factors expected to influence their adoption of an EMR in their workplace. The objectives were to: 1) measure psychological factors expected to influence ICU nurses' adoption of EMR, and 2) explore perceptions of facilitators and barriers to the implementation of an EMR in their workplace. Using an explanatory sequential mixed method approach, data were collected using surveys and focus groups. ICU nurses reported high scores for motivation, work engagement and wellbeing. Focus group analyses revealed two themes: Hope the EMR will bring a new world and Fear of unintended consequences. Recommendations relate to strategies for education and training, environmental restructuring and enablement. Overall, ICU nurses were optimistic about EMR implementation.

The use of electronic medical record (EMR) systems is transforming health care delivery in hospitals. Perioperative nurses work in a unique high-risk health setting, hence require specific considerations for EMR implementation. This research explored perioperative nurses' perceptions of facilitators and barriers to the implementation of an EMR in their workplace to make context-specific recommendations about strategies to optimise EMR adoption. Using a qualitative exploratory descriptive design, focus group data were collected from 27 perioperative nurses across three hospital sites. Thematic analyses revealed three themes: 1) The world is going to change; 2) What does it mean for me? and 3) We can do it, but we have some reservations. Mapping coded data to the Theoretical Domains Framework identified prominent facilitators and barriers, and informed recommended implementation strategies for EMR adoption by perioperative nurses.

In Australia, almost 40% of nurses are aged 50 years and older. These nurses may be vulnerable to leaving the workforce due to challenges experienced during electronic medical record (EMR) implementations. This research explored older nurses' perceptions of factors expected to influence their adoption of an EMR, to inform recommendations to support implementation. The objectives were to: 1) measure psychological factors expected to influence older nurses' adoption of the EMR; and 2) explore older nurses' perceptions of facilitators and barriers to EMR adoption. An explanatory sequential mixed methods design was used to collect survey and focus group data from older nurses, prior to introducing an EMR system. These nurses were highly engaged with their work; 79.3% reported high wellbeing scores. However, their motivation appeared to be predominantly governed by external rather than internal influences. Themes reflecting barriers to EMR and resistance to adoption emerged in the qualitative data.

BACKGROUND:Electronic medical record system implementations impact nurses, their work and workflows. The aim of this study was to understand nurses' perceptions of barriers and enablers to using a new electronic medical record in an acute hospital environment. METHODS:Data were collected just prior to an organisation-wide new electronic medical record implementation at a large tertiary healthcare organization in Victoria, Australia. Sixty-three nurses from five hospital sites participated in 12 focus group interviews. Transcripts were transcribed and deductive content analysis used the 14-domain Theoretical Domains Framework to identify barriers and enablers. RESULTS:Coded data mapped to 13 of the 14 domains. Nurse motivation emerged as a dominant theme among both barriers and enablers. Nurses' most common perceived barriers related to emotions (24.1%) and environmental context and resources (21.3%). Conversely, the most common enablers related to social influences (21%) and reinforcement (20.8%). DISCUSSION:In addition to effecting changes in their work and workflows, the dominance of nurses' emotional responses reveals the potential for implementation of a new electronic medical record to negatively affect nurses' psychological well-being. Using data aligned to the Theoretical Domains Framework assisted identification of behavior change strategies to target the barriers and enablers perceived by nurses. Strategies aligned with nine behavioral intervention categories are recommended for successful implementation and optimization of an electronic medical record by nurses. CONCLUSIONS:Multifaceted strategies targeting multiple behaviors are required to support adoption of the electronic medical record by nurses, and reduce the risk for nurse attrition in the workforce.

Implementation of an electronic medical record (EMR) is a significant workplace event for nurses in hospitals. Understanding nurses’ key concerns can inform EMR implementation and ongoing optimisation strategies to increase the likelihood of nurses remaining in the nursing workforce. 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. Survey findings revealed 32.2% (n = 174) of nurses reported low well-being scores and 28.7% (n = 155) were experiencing burnout symptoms. 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. Nearly half (n = 250, 46.3%) reported intrinsic motivation towards EMR use. 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. 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.