The impact of electronic health records on nursing burnout in a hospital setting in Saudi Arabia: mixed-methods study

BACKGROUND: There is growing evidence suggesting that electronic health records (EHRs) can be associated with clinicians’ burnout, which may hamper the effective use of EHRs and introduce risks to patient safety and quality of care. Nursing research in this area is minimal in comparison with studies conducted on burnout among physicians. In addition, although the majority of research on the impact of EHR use on nursing burnout was conducted in Western contexts, this study fills the gap by exploring this prevalent issue within the context of Saudi Arabia. AIM: The research aim was to examine the association between nursing burnout and EHR use and to explore the contributing factors to nursing burnout related to EHR use in a hospital setting in Saudi Arabia. METHODS: The study used a mixed-methods approach with an explanatory sequential design: a quantitative study followed by a qualitative study. The study was conducted in a hospital that was adopting an advanced EHR system, in Riyadh, Saudi Arabia. Using a purposive sampling method, registered nurses working in inpatient units using an EHR system on a daily basis were included in the study. Two validated instruments were used in the online survey, the Mini-Z and EHR perceptions, to examine the association between nursing burnout and EHR-related factors. Qualitative interviews, undertaken both online and in-person, were used to gain an in-depth understanding of factors associated with nursing burnout and hospital EHR use. Survey data were analysed using regression analysis. Thematic analysis was utilised for the interview data. The study was informed by a sociotechnical approach to understanding the relationship between the social system (nurses) and the technical system (EHR use) in a given context (a hospital in Saudi Arabia). RESULTS: A total of 282 completed survey responses were included in the study, and a total of 21 nurses participated in the interviews. Participants were predominantly female and worked in acute and critical care units. Most survey respondents were from the Philippines (53%), Malaysia (21%), and Saudi Arabia (11.7%), with South African and European nurses accounting for about 5% each. Interviewees were primarily from the Philippines and Saudi Arabia (33% each), and 24% from Malaysia. The findings indicated that despite the overall acceptance of the EHR among the nurse participants being relatively high, negative perceptions of the EHR and stress related to EHR use were found. There was a slight inconsistency between the quantitative and qualitative results regarding the perceived burnout outcome. The survey statistics showed that the minority of nurses who reported negative perceptions about the EHR were likely to be burnt out while the interviews showed that all participants who reported stress related to the EHR did not think that EHR-related stress would lead to burnout. This inconsistency suggests there is a weak link between EHR use and burnout may exist, possibly indicating the mitigating role of resilience identified in the qualitative study. In this qualitative study, I identified specific perceived organisational stressors associated with EHR use, such as high EHR documentation workload creating a conflict between organisational requirements and direct patient care. Technological stressors were also identified, including usability issues causing disruption to nurses’ workflow, and concerns about data privacy through unauthorised access by healthcare workers at the hospital. Despite these stressors, resilience was demonstrated at both individual and organisational levels, which emerged as a protective factor from EHR-related burnout. Factors like computer literacy, perceived usefulness of the EHR, and nurses’ adaptability to change were key contributors to individual resilience that aided nurses in navigating EHR stressors and adjusting to the EHR system. At the organisational level, health information infrastructure facilitated smoother interaction with the EHR system, reducing potential stressors while supportive organisational culture fostered teamwork, work–life balance, continuous learning, and iterative improvement, thereby bolstering resilience among nurses. CONCLUSION: EHR did not significantly contribute to nursing burnout in a specific Saudi Arabian hospital context. The resilience mechanisms in place at both individual and organisational levels mitigated the potential impact of EHR-related stress on nurses’ burnout. The unique contribution of this research is the introduction of a novel conceptual model elucidating the impact of EHR on nursing burnout. This renewed perspective emphasises the role of resilience at both individual and organisational levels and their collective influence on mitigating EHR-related burnout among nurses. This model has the potential for further development and application both locally and globally. This study signals a need for healthcare organisations to foster resilience-building strategies in their EHR implementation processes and usability that should be tailored to the specific needs and circumstances of each organisation, to effectively manage EHR-related stress and prevent potential burnout. These include encouraging self-care practices among nurses, promoting work–life balance, fostering supportive workplace culture, improving health information infrastructure, providing training and continuous learning, and improving EHR usability through regular feedback sessions from EHR users. Additional research is needed to corroborate this finding with different types of clinicians in the same hospital, and in other hospital settings within Saudi Arabia

Electronic Health Record Stress and Burnout Among Clinicians in Hospital Settings: A Systematic Review

Background There is growing evidence to suggest that EHRs may be associated with clinician stress and burnout, which could hamper their effective use and introduce risks to patient safety. Objective This systematic review aimed to examine the association between EHR use and clinicians’ stress and burnout in hospital settings, and to identify the contributing factors influencing this relationship. Methods The search included peer-reviewed published studies between 2000 and 2023 in English in CINAHL, Ovid Medline, Embase, and PsychINFO. Studies that provided specific data regarding clinicians’ stress and/or burnout related to EHRs in hospitals were included. A quality assessment of included studies was conducted. Results Twenty-nine studies were included (25 cross-sectional surveys, one qualitative study, and three mixed methods), which focused on physicians (n = 18), nurses (n = 10) and mixed professions (n = 3). Usability issues and the amount of time spent on the EHR were the most significant predictors, but intensity of the working environment influenced high EHR-related workload and thereby also contributed to stress and burnout. The differences in clinicians’ specialties influenced the levels of stress and burnout related to EHRs. Conclusions This systematic review showed that EHR use was a perceived contributor to clinicians’ stress and burnout in hospitals, primarily driven by poor usability and excessive time spent on EHRs. Addressing these issues requires tailored EHR systems, rigorous usability testing, support for the needs of different specialities, qualitative research on EHR stressors, and expanded research in Non-Western contexts