Electronic health records usability and its influence on nurse decision-making, burnout, and turnover: A literature review

Electronic health records (EHRs) are now the dominant infrastructure through which nurses assess patients, make clinical judgments, document care, and communicate with the interdisciplinary team. Despite widespread adoption following the Health Information Technology for Economic and Clinical Health (HITECH) Act, national surveys consistently show that nurses rate the usability of their EHR systems poorly. This review synthesizes empirical and theoretical literature examining how EHR usability affects nurse clinical decision-making, contributes to professional burnout, and predicts turnover intention, while also considering the sociotechnical and organizational factors that moderate these relationships. Across the reviewed literature, poor usability is repeatedly linked to increased cognitive workload, documentation burden, alert fatigue, burnout, intention to leave, and adverse patient outcomes. At the same time, nurse-centered design and supportive work environments are identified as protective factors.