Faculty Perceptions of Student

Documentation Skills During the Transition

from Paper-Based to Electronic Health
Records Systems
Pamela Young Mahon, PhD, RN, NEA-BC; Donna M. Nickitas, PhD, RN, NEA-BC;
and Kathleen M. Nokes, PhD, RN, FAAN

Abstract

Nursing faculty perceptions of teaching undergraduate

nursing students documentation skills using either paperbased or electronic health record systems were explored in
this study. Twenty-five nursing faculty in a large urban public school of nursing were interviewed using a 13-item survey
questionnaire. Responses were analyzed using the constant
comparative method, and four major themes arose: teaching
strategies; learning from experts; road from novice to expert;
and legal, ethical, and institutional issues. Results demonstrate how faculty overcome myriad obstacles encountered
while teaching clinical documentation processes. Self-efficacy
theory, with its emphasis on knowledge, skills, and social
context, describes how faculty are modeling behaviors necessary to succeed during this transition from paper to electronic documentation. The school of nursing is integrating the
findings from this research to further informatics integration
across the curricula, and ongoing research is planned to investigate issues of self-efficacy and student and clinical staff
perceptions of teaching-learning clinical documentation.
Received: March 18, 2009
Accepted: December 21, 2009
Posted: May 28, 2010
Dr. Mahon is Associate Professor, Dr. Nickitas is Professor, and
Dr. Nokes is Professor, Hunter Bellevue School of Nursing, Hunter
College of the City University of New York, New York, New York.
This research was supported in part by the Jonas Center for
Nursing Excellence, Enhance Student Nursing Literacy in Electronic
Health Record Technologies Grant.
The authors have no financial or proprietary interest in the materials presented herein.
Address correspondence to Pamela Young Mahon, PhD, RN,
NEA-BC, Associate Professor, Hunter Bellevue School of Nursing, Hunter College of the City University of New York, 425 East 25th Street, Box
861, New York, NY 10010-2590; e-mail: pmahon@hunter.cuny.edu.
doi:10.3928/01484834-20100524-06

Journal of Nursing Education Vol. 49, No. 11, 2010

he world is in the midst of an informatics revolution. Informatics is reconfiguring our world view
from linear, hierarchical, and separate structured
realities to overlapping, interacting concepts and disciplines (Nelson & Staggers, 2008). Recognizing this revolution, the federal government first called for an Electronic
Health Care Record for the majority of Americans by 2014
(Raymond, 2004). President Obamas stimulus package,
the American Recovery and Reinvestment Act of 2009, addresses the improvement of health care services by specifically targeting health information technology (Title XIII)
and the development and implementation of electronic
health record systems (EHRS). All three major professional nursing associations, as well as a national nursing
informatics coalition, have published policy statements
that support competency in nursing informatics for all
practicing nurses, as well as nursing students (American
Association of Colleges of Nursing [AACN], 2008; American Nurses Association [ANA], 2008; National League for
Nursing [NLN], 2008; Technology Informatics Guiding
Education Reform [TIGER], 2009). The NLN identified
the importance of preparing the next generation of nurses
to practice in a technology-rich environment and called on
faculty, deans, administrators, and the NLN itself to advocate that all students graduate with up-to-date knowledge
and skills in each of three critical areas: computer literacy,
information literacy, and informatics (NLN, 2008).
The Institute of Medicines (IOM) Quality Chasm series
identified that the quality of patient care would improve
when safety is assured. To that end, the faculty members
of the Quality and Safety Education for Nurses (QSEN)
panel adapted the IOMs competencies for nursing by proposing definitions that described essential features of respected and competent nursing (Cronenwett et al., 2007).
Knowledge, skills, and attitudes (KSAs) for each defined
competency were developed for prelicensure nursing education programs. Of the six competencies identified by
615

nursing faculty perceptions

the IOM and defined by QSEN, informatics was listed last

because informatics KSAs were deemed essential for developing the other five QSEN competencies. By achieving
KSAs in informatics, nursing graduates will have the ability to apply information and technology to communicate,
manage knowledge, mitigate error, and support decision
making (Cronenwett et al., 2007, p. 129).
Nurses must have immediate access to current patient
data to deliver safe and effective care. The goal of all EHRS
is to allow that immediacy of access and facilitate communication among multiple caregivers. Nursing students and
new graduates who are competent in the use of EHRS will
be competitive in the professional marketplace. As a key to
safe patient care outcomes, informatics has been incorporated by the AACN as an essential curricular component
necessary for accreditation of baccalaureate nursing programs (AACN, 2008). With informatics competencies, nursing students will learn about the strengths and limitations
of EHRS to access essential information at the point of care,
communicate across disciplines and settings, coordinate
care, and guide patients more effectively through the many
transitions that comprise the health care experience. The
new nurses KSAs will develop as the professional nurse develops and participates fully in design, selection, and evaluation of information technologies that support safe patient
care (Cronenwett et al., 2007, p. 130).
Most health care organizations are slowly adopting
EHRS, and nursing students are being introduced to this
technology. However, to have informatics successfully integrated throughout nursing curricula, there is another challenge that must be addressed first: nursing faculty must
become knowledgeable about EHRS. In a survey of undergraduate deans and directors of 266 U.S. nursing programs,
faculty members were rated at the novice or advanced
beginner level in teaching informatics content (McNeill et
al., 2003). In research evaluating computer competencies in
a BSN program, Ornes and Gasserts (2007) findings supported earlier reports that nursing faculty were the greatest block to incorporating technology into curricula. Fetter
(2008) surveyed nursing faculty at one mid-size sectarian
university and reported that participants admitted the need
to embrace information technology. In the Fetter study,
faculty recommended that they themselves acquire more
consistent and advanced knowledge and skills and that,
like students, expectations for faculty performance in informatics should be standardized and documented. The NLN
(2008) reported considerable confusion among the 2,097
deans, directors, and nursing faculty respondents to a 2006
e-mail survey regarding what nursing informatics entails
and what constitutes the necessary knowledge to practice
in an informatics-rich environment. Regarding acquisition
of informatics knowledge and skills, 80% of faculty in the
NLN survey stated that they were self-taught.
Background
Recognizing the challenges of threading informatics
throughout nursing curricula, nursing faculty from a large
616

urban public university with a diverse student population

received a grant to increase skills in the use of healthrelated technology-based information systems. The nursing schools mission is to address the health care issues of
urban, underserved populations in New York City. About
70% of the undergraduate prelicensure nursing students
(N = 200) are members of racial and ethnic minorities, and
most of the graduates remain in nursing positions within New York City (Ebenstein, Weinberg, Dale, & Croke,
2009). The nursing school is part of the nations largest
public urban university system and is bordered on both
sides by large public hospitals: the flagship of the largest municipal hospital system in the United States and a
federal medical center. Clinical rotations occur in these, as
well as in many academic medical centers and voluntary
hospitals.
Purpose and Conceptual Framework
The aim of this research was to explore nursing faculty
perceptions of teaching undergraduate nursing students
documentation skills using either paper-based or EHRS.
The researchers were interested in conducting this exploration within the context of the self-efficacy model. Educational systems have undergone fundamental changes during historical periods of cultural and technological change
(Bandura, 2006). In her concept analysis of self-efficacy,
Zulkosky (2009) underscored the roles of beliefs, perceptions, and experiences of mastery and defined self-efficacy
as a persons perceived capability to perform a behavior.
Perhaps Bandura (1982) best explained the phenomenon of
faculty persistence to overcome obstacles and develop new
skills within the construct of perceived self-efficacythe
causal predictor (motivation) of behavior is ones belief in
the capability to perform an act. Furthermore, self-efficacy
explains a situation-specific confidence that indicates the
level at which one believes one can successfully perform
a task (Bandura, 1997). Faculty are motivated to acquire
a new skill if they have confidence that they will succeed
and if they believe in the outcome. Key to the successful
learning of new skills is the cyclical nature of self-belief,
self-confidence, and self-efficacy: Greater efficacy leads to
greater effort and persistence, which leads to better performance (a new mastery experience), which in turn leads
to greater efficacy (Woolfolk Hoy, 2004, p. 2). Nursing
faculty are aware that persistence and practice are foundational for the self-efficacy that leads to successfully acquiring new knowledge and skills. Positive attitudes lead
to knowledge and skills that, when successfully acquired,
result in ongoing positives attitudes that continue the process of successful learning.
Research studies document the role of self-efficacy in
successful learning outcomes for nursing students who gain
confidence, comfort, and competence as they begin working with real patients (Jenkins, Shaivone, Budd, Waltz, &
Griffith, 2005), as they engage in health promotion principles in their daily practice (Laschinger, McWilliam, &
Weston, 1999), and as they become more aware and pracCopyright SLACK Incorporated

Mahon, Nickitas, & Nokes

ticed in providing cultural care (Lim, Downie, & Nathan,

2004). The same concepts of self-efficacy apply to nursing
faculty as they continue to navigate new technology territory and are renewed and motivated by new successes.
Ethical Considerations
The study protocol was approved by the colleges institutional review board. Participation was voluntary and
participants had the right to withdraw from the study at
any time. Faculty members were interviewed by the one
researcher (P.Y.M.) who was not a member of the colleges
Personnel and Budget Committee and who therefore was
not involved with decisions regarding hiring, reappointment, tenure, and promotion considerations. The projects
administrative assistant transcribed the interviews, and
confidential identifier codes were assigned. No identifying
information was used at any time. The interviews were
stored and secured on the computer in password protected
files.
Procedure
Letters of invitation to participate and informed consent
were mailed to all faculty teaching prelicensure nursing
students in hospital settings. Each potential participant
received a letter describing the study and a written consent form. Interested faculty made an appointment with
the faculty interviewer at a mutually convenient time.
Each confidential, in-person interview took approximately
25 to 50 minutes to complete and consisted of the faculty interviewer, the faculty participant, and the research
assistant who assisted in transcribing events occurring
during the interview. The guide questions consisted of 13
items7 closed-ended questions and 6 open-ended questions. After each interview was transcribed, the faculty
participants were offered the opportunity to review their
transcript for accuracy.
Sample
The school of nursing is focusing initial efforts to integrate technology in the prelicensure undergraduate
programs because these students are younger, probably
digital natives, and have had no prior exposure to EHRS
in clinical settings. To gain insight into the perceptions of
nursing faculty teaching these prelicensure students, the
researchers surveyed full-time and part-time faculty who
taught undergraduate nursing students in clinical settings. Sixteen full-time faculty were eligible and invited to
participate in the survey, and 15 full-time faculty accepted
and completed the survey (94% response rate). Fourteen
part-time adjunct faculty were eligible, and 10 accepted
and completed the survey (71% response rate). In total, 25
of 30 eligible faculty were surveyed (83% response rate).
Participants were experienced faculty; they had taught in
this school of nursing a median of 3 years (range, 1 to 19
years); taught clinical courses a median of 5 years (range,
1 semester to 25 years); and had practiced nursing with a
minimum of a masters degree in nursing for a median of
11 years (range, 1 to 31 years).
Journal of Nursing Education Vol. 49, No. 11, 2010

Method
Because this was an exploratory study, the qualitative
constant comparative method (CCM) was used to analyze
the data and identify significant patterns across individuals and among groups. This process was repeated until the
researchers assessed the saturation point of data clustering and recurring patterns of theme identification. The
research team chose the CCM because it is an analytic
procedure for generating theory in a systematic way. The
constant comparison of incidents on the basis of as many
of their similarities and differences as possible brings
out underlying uniformities and diversities and accounts
for differences with single, higher level concepts (Glaser,
1965, p. 444). The goals of the CCM are to discern conceptual similarities, to refine the discriminative power of categories, and to discover patterns. In this way, researchers
can develop a theory inductively by categorizing, coding,
delineating categories, and connecting those categories
(Boeije, 2002).
The process of CCM is both descriptive and explanatory. CCM internal validity occurs when data categories
are understood within context (Dye, Schatz, Rosenberg, &
Coleman, 2000), and internal validity of findings increases when comparisons are highly regarded (Boeije, 2002).
External validity is achieved when data are understood
through comparison (Dye et al., 2000). Sampling that has
been conducted in a reasonably homogeneous sample provides the basis for generalizing the concepts and relationships between them to units that may be absent from the
sample but which represent the same phenomenon (Boeije, 2002, p. 393).
As a team, all three researchers reviewed the transcripts, noted responses across each open-ended survey
item within each interview, and coded categories of responses to determine the core message or the storyline.
The team then compared each response to open-ended
items on the interview guide across interviews and coded
categories of responses to determine patterns and themes.
Categories were compared until saturated and delimited
to achieve parsimony of variables and a more applicable
scope of the theory.
Results
Four major themes emerged based on direct quotes,
codes, categories, and clusters (Table).
Theme 1: Teaching Strategies
Without exception, every faculty participant identified
teaching documentation skills through a demonstrationreturn demonstration method. Through both group and
one-on-one instruction, faculty reviewed some examples of
nursing notes using textbooks or samples from the medical
record such as I first review the hospitals documentation
system then I orient students to the hospitals documentation requirements. Students write a draft note for their
assigned patient that faculty correct and edit, and then co617

nursing faculty perceptions

Table
Summary of Major Themes
Major Theme
Teaching strategies

Learning from
experts

Road from novice to

expert

Cluster
Teaching/learning

Discovering ways of
knowing

Role identity/
perception

Categories

Codes

Enhancing skills; group

learning exercises; one-onone instruction; providing
documentation, illustrations;
stimulating critical thinking;
teachinglearningteaching

Enhancing skills; moving

from knowledge to
application domain;
unlearning/learning;
visibility/invisibility

Providing illustrations,
examples
Group learning exercises
One-on-one instruction
Enhancing skills
Learning from role models
Stimulating critical thinking
Unlearning/learning
Role-modeling through
critique
Teaching, learning,
teaching

Learn from role models;

role-modeling through
critique

Knowledge to application
domain
Critical thinking

Legal/ethical/
institutional issues

Protection
assurance

Institutional and policy

issues; legal and liability
(ethical); patient specific;
encountering barriers

Visibility/invisibility
Encountering barriers
Protection/nondisclosure
Patient specific
Institutional and policy
issues
Legal and liability
Ethical

sign after the student entered the information into the clinical documentation system. Continuing group discussion
of documentation principles along with individual editing
of students notes were identified as leading to successful
note writing by students. Rationale for this group as well as
one-on-one teaching-learning strategy was to enhance documentation skills and stimulate critical thinking. Faculty
felt strongly about the value of this method, even though
the recurring sentiment was: Its very time consuming to
check through ten student notes twicetheir initial note
and then corrected copy and then countersign. But I feel
this is the best way. From participants general comments
about documentation, almost all faculty wondered if and
how much documentation was taught in lecture, as well
as in the college laboratory, and believed they taught the
bulk of clinical documentation in the clinical areas. For example, Sometimes documentation material is not covered
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Illustrative
Respondent Quotes
Faculty reviews note,
student documents and
faculty counter signs note
in chart.
Review paper and
electronic documentation;
provides sample.
Emulated staff RN notes.
Discussed concepts
and reviewed individual
documentation.

Students wrote too much

info according to staff, not
instructor.
Seniors received repeated
feedback. Staff describe
notes as clear and concise.
I had a code for medication
administrationonly
instructor had a code.
Students used professors
code. Paper backup.
Training process for
facilitys computerized
system takes away too
much time from clinical.
Limited availability of
computers on unit for
student use.

in lab. This puts both the student and me at a disadvantage

because it takes time in pre-conference and post-conference and on the floor to teach the students. Faculty were
most vocal regarding the perceived amount of time spent
on teaching documentation in the clinical area both to the
group and with each individual student. Respondents reported spending a median of 2 hours (range, 30 minutes to
4 hours) of an 8-hour clinical day on refining documentation
skills for a clinical group of 8 nursing students.
Theme 2: Learning from Experts
This theme arose from discovering ways of knowing
that came from two primary expert sources: the nursing
faculty and the staff nurses in the clinical setting. Faculty
highlighted well-written staff RN notes to emulate, helping students write organized, succinct, and meaningful
notes: I look for good examples written by the staff nursCopyright SLACK Incorporated

Mahon, Nickitas, & Nokes

es and have students follow that example. Not only did

students learn from the role-modeling provided by faculty
and staff, but the students themselves also role-modeled
as a result of facultys structured critique in each clinical
course:
I try to pair a student who is good at documenting with one who needs a lot of help. It usually works out
well.
In post-conference, I have the students read their
progress notes out loud. The other students correct it
[and] it gets better as the semester goes along.

In clinical settings using EHRS, faculty noted that both

they and their students were highly reliant on staff nurses who were proficient in the hospitals EHRS. Faculty in
these settings reported EHRS challenges centered on inordinate amounts of time necessary for orientation to the
system, establishing passwords, and acquiring access to
the system. Obstacles to the flow of faculty work included
staff nurses who were unable to sufficiently assist faculty
and students, insufficient numbers of computers for faculty and student use, time taken to log on with each student and multiple time-outs (automatically logged off) per
session, and repeating this sequence of time-consuming
activities for each clinical setting because different hospitals had different EHRS. Faculty who felt they and their
students had met with success documenting using the
hospitals EHRS credited finding reliable staff nurses who
could assist them and the students to problem-shoot and
find shortcuts.
Most faculty recognized the potential increased convenience of computer-based documentation, but a few
expressed doubt that documenting in electronic records
contributes to nursing expertise:
Students are more motivated to learn but I do not
know if electronic documentation is helping them to document.
Endless drop-down menus are annoying, take too
much time, and dont promote critical thinking.

Theme 3: Road from Novice to Expert

This theme emerged as students experience grew,
skills were honed, and perceptions of professional roles
broadened as they progressed through the program. Initially, faculty identified that students must unlearn inadequate writing habits, although all of the undergraduate students had completed at least 60 credits of liberal
arts requirements before entering the nursing program.
In the first clinical course, Fundamentals of Nursing,
faculty identified challenges in paper-based documentation that focused on students varying language abilities,
including limited English proficiency, grammar, syntax,
legibility, and spelling. A frequent observation by faculty
was students unfamiliarity with medical terminology and
incorrect use of abbreviations. Frustration was expressed
at students inability to develop a written entry that was
organized and succinct:
Students over documented.
Students had too many anecdotals and did not focus.

Journal of Nursing Education Vol. 49, No. 11, 2010

Students need to write more specifics on goals that

were set. They forgot to write how they would revise plans,
goals, and treatments.

Faculty noted that the challenge in each semester is how

to translate clinical assessment into clear and precise
documentation. They also said, Students must overcome
emotional block to fear and hard time assessing patient.
To help students overcome these challenges, faculty
reported success over time with paper-based documentation through the process of repeated student note writing,
faculty edit, and student rewrite of corrected note. Faculty
cited that practice is key for successful documentation
in a paper-based system and that frequent reinforcement
of the nursing process framework, body systems entries,
SOAP (Subjective, Objective, Assessment, Plan) notes,
SBAR (Situation, Background, Assessment, Recommendation) notes, or other agency-specific documentation policy
formats was time consuming but productive. Faculty noted
that in junior year many students are told by staff RNs that
they were writing too much. By senior year, faculty noted
that this rarely happens and staff usually described senior
student notes as clear and concise: Juniors wrote too much
info according to staff, not me. Seniors received repeated
feedbackstaff describe their notes as clear and concise.
Theme 4: Legal-Ethical-Institutional Issues
The last theme concerns legal-ethical-institutional issues. Institutional policies on documentation, all designed
to assure patient protection, served as an enormous constraint on faculty and students alike. Fifty-eight percent
reported experience teaching EHRS. One faculty participant stated, The training process for the hospitals
computerized system takes away too much time from
clinical. There is limited availability of computers on
the unit for student use. Every faculty respondent identified similar circumstances along with their concern for
fulfilling legal and ethical responsibilities to the patient
in terms of adequately documenting the care provided by
the students they supervise. Faculty expressed concern
about potential liability issues because I have a code for
medication administrationonly I (the instructor) have a
code. Students use my code. Each clinical setting only
issued an EHRS access code to the faculty instructor and
then each of the 10 students in the instructors group used
the faculty members code.
Discussion
This study explored how nursing faculty perceived
teaching documentation skills to prelicensed nursing students in clinical settings that have either paper-based systems, electronic systems, or both. Findings demonstrated
how faculty attempt to overcome the myriad obstacles
encountered during the process: time expenditures and
constraints, language challenges for a diverse student
population, lack of access to secure patient documentation
systems (software), and insufficient numbers of computer
terminals (hardware).
619

nursing faculty perceptions

Strengths include reporting faculty perceptions of their

experiences teaching documentation across the undergraduate clinical courses and comparing their solutions to
continuing obstacles in both paper-based as well as EHRS.
With a national average of faculty age well in the 50s
(AACN, 2005), most nursing faculty have long practiced
paper-based documentation. The uniformity of responses
underlying the first major theme of teaching strategies
for documentation using paper that is filed in a paperbased medical record reveals that faculty have attained
a plateau of comfort in this area. Regardless of setting,
faculty members express confidence teaching paper-based
documentation skills because of long-standing experience
and success in this medium. Faculty cited obstacles to success in teaching paper-based systems as attributable to
student factors such as students lack of familiarity with
terminology or students inexperience in general. System
or faculty (self) related problems were not cited.
In a paper-based system, faculty efforts have been rewarded and reinforced many times over the years, and faculty respondents in this study expressed the level of confidence expected in the context of self-efficacy theorythat
is, success is reinforced by prior successes. Faculty viewed
themselves as proficient in hand-written documentation
and as one of the experts identified in the theme of learning from experts. It is learning from expert faculty that
makes possible the theme of from novice to expert for
students in clinical rotations. Faculty presence, guidance,
and modeled expertise help transform the student learners to recognizable clinicians. In this way, students moved
from just citing the elements of a good note to actually
writing one and thus becoming visible in the patient record as a provider of care.
When new challenges present themselves in each new
clinical setting using different EHRS, the learning curve
is steeper and the energy required to persist, problem
solve, and skillfully use the system is greater than that
required for success using the familiar paper system. Faculty expressions of frustration and inability to teach using an EHRS reflected the many obstacles identified by
the respondents. EHRS are designed to thwartthat is,
designed to force the user to follow correct procedure in
order not to bypass the systems default safety protocols.
Facultys motive to work around programmed safety features is understandable, as is the emergence of the major
theme of legal and ethical issues. How can any patient
receive medications on time when there are 10 students
assigned to 10 or more patients, and the one faculty is the
only person with a password to the EHRS? Students use
the faculty members password because faculty are seeking to provide a thorough, timely learning experience that,
ironically, helps ensure that all rights of patient medication administration are enacted, including documentation.
The ethical and legal conundrum for facultyprovide a
quality learning patient care experience for students or
follow strict EHRS documentation protocolleads faculty
to question their ability to teach in the face of such persistent obstacles. Facultys perceived self-efficacy, their
620

belief in their own capacity to optimally perform, is diminished.

Continuing Concerns
A serious limitation was failing to capture faculty views
of their own ability to transition from paper to electronic
record systems. In addition, it became apparent to the
researchers that there were other critical questions that
emerged. For example, how do faculty view themselves assuming the role of both student and teacher while developing proficiency in EHRS after spending years, or even
decades, in a paper-based system? Do faculty embrace the
new electronic health record, or do they practice avoiding
it? During this time of paper-to-EHRS transition, how do
faculty succeed? And how do faculty acquire the necessary
knowledge, skills, and attitudes to successfully transition
and impart these skills to students?
Face-to-face interview of faculty respondents by a faculty colleague may not be the best procedure for obtaining results. Perhaps a more optimal procedure should be
enacted in the future, such as having a non-faculty, nonstaff interviewer to produce more candid and reflective
responses.
Implications
An important implication identified by this research
study was the notion of role-modeling. Faculty best integrate new technology throughout the curricula when they
consciously use role-modeling as a teaching strategy. Faculty model their attitudes about both gaining knowledge of
the new technology and acquiring skills in mastering the
new technology. Students are extremely perceptive about
the attitudes and beliefs faculty telegraph them. Each of
our nursing students can likely answer that question in
regard to their lecturer, laboratory instructor, or clinical
instructor. As self-efficacy theory posits, our attitudes affect our behaviors and the attitudes and behaviors of those
we teachfaculty teach attitude as much as content. Faculty must communicate to students that we truly are lifelong learners, and that includes continuous updating of
our skills related to the latest technological advances.
Regarding informatics, 80% of faculty respondents to an
NLN (2008) survey reported they are self-taught. Educators
should be the first to recognize that such reliance on this
method of learning is inefficient. Due to the recent technological revolution, most faculty are learners, so called digital
immigrants, within an EHRS setting. And like our nursing
students, faculty competencies in the area of informatics
must be identified and standardized, as is done for students
by NLN and AACN standards. We can share our frustrations
over the many glitches we encounter, but we must also balance that with lessons in how we work through the problems
inherent to new learning and new technologies. Faculty can
model self-efficacy: the patience, support, and persistence
that characterize individual development within a professional discipline are how professions grow leaders.
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Mahon, Nickitas, & Nokes

The school of nursing is integrating the results of this

research for faculty development related to teaching
EHRS as part of a comprehensive plan to integrate informatics throughout the curricula and increase health care
information competencies of the nursing students. The
college is supporting faculty participation in national efforts, such as the NLN HITS program and the Harvard
Institute for Medical Simulation. Novice faculty receive
support to attend faculty development programs on informatics and teaching. Faculty share the latest findings
and techniques regarding informatics, begin to create and
implement plans begun at these national venues, engage a
critical mass of other faculty, and systematically integrate
informatics throughout the curricula.
Given that the constant comparative method requires
gathering data from other core constituencies, further research will explore students and clinical staff RNs perceptions of teaching-learning documentation to further
understanding of the role of self-efficacy as health systems
transition to EHRS.
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