Restricted Electronic Health Record Access in Clinical Leads to Gaps in Student Learning

Background: Restricted access to clinical sites for training and limitations on students’ experiences threaten the quality of nursing students’ clinical preparation. Nursing school faculty anecdotally report restrictions on student direct care experiences and access to essential patient information through the electronic healthcare records (EHRs) and medication administration records (eMARs). Health care organizations (HCO) guard the integrity of these complex systems, in part, by controlling access. For this reason, students may have no or limited access to patient information, impeding their ability to deliver safe patient care, or to document care. Incomplete health care records and insufficiently prepared nursing students who have limited technology and informatics competency may result. Additionally, direct patient care clinical experiences may be diminished by receiving more observation assignments.

Purpose:

This study was undertaken to describe the current state of student nurses’ clinical education from the view of nursing clinical faculty.

Methods:

Snowball sampling reached potential respondents through the researchers’ professional organization networks and schools of nursing. 308 faculty, from 25 states, who teach students at a clinical site responded to the survey invitation. 208 completed the survey. 57% teach in BSN or ABSN programs; 31% in ADN programs.

Results:

There was wide variance in the type of clinical experience: a mean of 74% (SD ± 18.57) of clinical hours were in direct patient care; 16% (SD ± 12.97) were in skills laboratory or simulation; 10% (SD ± 11.70) were in observation-only. Most (76%) initial patient information was obtained in the hour before or during shift report. Most students have access to view the EHR but are limited in documentation by any mode (e.g., only 80% document vital signs). 82% use an eMAR with 70% faculty access. 94% administer medications with limitations (e.g., 73% to 80% administer using the most common routes).

Conclusion:

These data demonstrate the limited access students have to health care records and direct patient care experiences, which in turn produce gaps in student learning. Schools of nursing must undertake critical reviews of program pedagogy and utilize alternatives beyond the long-standing clinical-dependent teaching model, to prepare nursing students despite the barriers in the clinical environment.