NURS 630 Week 4 Discussion Board Forum 2 on EHR Usability and Nurses' Cognitive Load Example

Discussion Board Forum 2: The Human-Technology Interface and Nursing Workload

NURS 630 Nursing Informatics Capstone, Discussion Board Forum 2

Thread by [Student Name]

The practicum observations and the classmates replied to are composites written for a model discussion.

At 6:45 a.m. last Thursday, I watched a night nurse on my practicum unit prepare to hand off a patient with a new insulin infusion. To tell the day nurse the last three glucose values, the current rate, the most recent potassium and whether the patient had eaten, she opened eleven sections of the flowsheet and the results tab, scrolling back and forth while the day nurse waited. None of the information was missing. It was simply scattered across a record organized by data type rather than by the questions a nurse asks about a patient. Afterward she said, "I know this patient. I just can't find him in here." The day nurse, who was new to the unit, admitted later that she had stopped listening halfway through because she was trying to write the numbers down before they scrolled away.

That moment is what our reading means by the human-technology interface. McGonigle and Mastrian (2018) describe how poorly designed interfaces increase the mental work users must do, which is often called cognitive load: the effort of finding, holding and combining information on the screen. When the load is high, nurses spend attention on the record that they could spend on the patient. My argument is that poor usability is a workload and safety problem, not a training problem, and that informatics nurses have a duty to design around how nurses think.

Recent research suggests the payoff of doing so can be large. Taylor-Vaughan et al. (2026) conducted a randomized crossover simulation with 36 intensive care nurses, comparing a record prototype that groups information spatially, the way a nurse pictures a patient, with a traditional linear flowsheet. With the spatial prototype, nurses completed a standardized documentation task 177 seconds faster per task, or 27%, and their workload scores on the NASA Task Load Index were 51.3% lower. Accuracy rose from 92.86% to 98.70%. Usability scores favored the prototype but did not differ significantly, while nurses' intention to use it was substantially higher. The study was a simulation with a small sample in one specialty, so it cannot show how the design would perform during a real shift. Still, the size of the effects suggests that where information sits on the screen can count for nearly as much as having it recorded at all.

For informatics nurses, this means usability testing with real nurses should come before go-live, not after complaints arrive, and redesign should start from the questions nurses ask at handoff and at the bedside. Two biblical principles guide me here. Paul told the Philippians to look not only to their own interests but to the interests of others (English Standard Version Bible, 2001/2016, Philippians 2:4), and design is a place where the builder's convenience and the user's need often conflict. He also described the church as a body whose parts care for one another (English Standard Version Bible, 2001/2016, 1 Corinthians 12:25), which reminds me that informatics and bedside nursing serve the same patient. A record that makes a nurse search for her own patient has served the database instead of the people it was built for.

Reply to Monica

Monica, you suggested that most of the frustration nurses feel with the record would fade with better training, since super-users on your unit find information quickly. I think training helps, but nurses' own accounts of changing records suggest it is only one part. Brunner et al. (2026) interviewed 15 frontline nurses and nurse informaticists from three US health systems that had moved from one electronic record to another and identified ten recommendations in three areas: training and support, workflow and usability, and governance. Organizations found that vendor training was not enough and that nurses had to build institution-specific guidance, but they also recommended redesigning workflows with nurse input before go-live and creating shared governance for ongoing decisions. In other words, training sat beside design and governance rather than replacing them. Super-users may be fast because they have memorized the record's workarounds, which is valuable, but a design that needs workarounds still costs every other nurse time, and it costs most on nights and weekends when super-users are not on shift. New graduates and travel nurses, who have had the least time to learn the workarounds, are left carrying the heaviest cognitive load. Proverbs says that a person who is slack in work is a brother to one who destroys (English Standard Version Bible, 2001/2016, Proverbs 18:9), and I think a careless design can do quiet damage at the scale of a whole hospital. Does your unit have a way for nurses to report design problems, separate from requests for more training, and does anyone review those reports with the build team?

Reply to Kevin

Kevin, I appreciated your point that the most useful screen in your hospital is the handover summary, because it pulls the key information into one place. A recent Australian study adds an interesting twist. Jedwab et al. (2025) evaluated an updated electronic handover page across a large tertiary health service using record data and nurse surveys before and after the update. Adoption of the page did not change significantly, but nurses needed to leave the page less often to find information during handover, and satisfaction rose on two items, precise information and sufficient information. Free-text comments suggested the update was acceptable to nurses. The finding I take from this is that a better page did not automatically bring more nurses to use it, even though those who used it found it better. Habits at handoff are strong, and nurses who had built their own paper report sheets over years may not abandon them for a screen, however well designed, unless someone shows them on a real shift that it saves time. That suggests a design improvement still needs an implementation plan, including showing nurses what changed and why, and measuring adoption by unit so that informatics staff can visit the units where use stays low and learn what is getting in the way. James warns that hearing the word without acting on it is self-deception (English Standard Version Bible, 2001/2016, James 1:22), and perhaps informatics teams need a similar reminder that a good design delivered without follow-through may never be used. How did your hospital introduce its handover summary, and do you know how many nurses actually use it at shift change?

References

Brunner, J. A., Amano, A., Gauntlett, L., Sullivan, S. C., Krein, S. L., & Davila, J. A. (2026). Recommendations for improving EHR transitions: Nursing perspectives from three healthcare systems. Medical Care, 64(1 Suppl. 1), S91-S99. https://doi.org/10.1097/MLR.0000000000002233

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Jedwab, R. M., Pham, A. T., Qu, Y., Brook, R., Foster, J., Garduce, J. N., Li, S., Smith, J. M., & Dobroff, N. (2025). Nurses' adoption, perceived usability, and satisfaction with an updated electronic handover page within the electronic medical record: A mixed-methods study. Nursing Reports, 15(10), Article 369. https://doi.org/10.3390/nursrep15100369

McGonigle, D., & Mastrian, K. G. (2018). Nursing informatics and the foundation of knowledge (4th ed.). Jones & Bartlett Learning.

Taylor-Vaughan, L., Helena, M. W., Silva Torres, G. E., Shea, K. D., Reed, P. G., & Gephart, S. M. (2026). Spatially integrated electronic health record prototype improves usability and reduces cognitive load for intensive care nurses: A randomized crossover trial. Applied Clinical Informatics, 17(3), 604-614. https://doi.org/10.1055/a-2903-5822