Change in nurses' psychosocial characteristics pre- and post-electronic medical record system implementation coinciding with the SARS-CoV-2 pandemic: pre- and post-cross-sectional surveys.

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.