University of Oulu

Heponiemi T, Kaihlanen A, Gluschkoff K, Saranto K, Nissinen S, Laukka E, Vehko T. The Association Between Using a Mobile Version of an Electronic Health Record and the Well-Being of Nurses: Cross-sectional Survey Study. JMIR Med Inform 2021;9(7):e28729,

The association between using a mobile version of an electronic health record and the well-being of nurses : cross-sectional survey study

Saved in:
Author: Heponiemi, Tarja1; Kaihlanen, Anu-Marja1; Gluschkoff, Kia1;
Organizations: 1Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
2Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
3Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.2 MB)
Persistent link:
Language: English
Published: JMIR Publications, 2021
Publish Date: 2021-11-02


Background: Mobile devices such as tablets and smartphones are increasingly being used in health care in many developed countries. Nurses form the largest group in health care that uses electronic health records (EHRs) and their mobile versions. Mobile devices are suggested to promote nurses’ workflow, constant updating of patient information, and improve the communication within the health care team. However, little is known about their effect on nurses’ well-being.

Objective: This study aimed to examine the association between using a mobile version of the EHR and nurses’ perceived time pressure, stress related to information systems, and self-rated stress. Moreover, we examined whether mobile device use modifies the associations of EHR usability (ease of use and technical quality), experience in using EHRs, and number of systems in daily use with these well-being indicators.

Methods: This was a cross-sectional population-based survey study among 3610 Finnish registered nurses gathered in 2020. The aforesaid associations were examined using analyses of covariance and logistic regression adjusted for age, gender, and employment sector (hospital, primary care, social service, and other).

Results: Nurses who used the mobile version of their EHR had higher levels of time pressure (F1,3537=14.96, P<.001) and stress related to information systems (F1,3537=6.11, P=.01), compared with those who did not use mobile versions. Moreover, the interactions of mobile device use with experience in using EHRs (F1,3581=14.93, P<.001), ease of use (F1,3577=10.16, P=.001), and technical quality (F1,3577=6.45, P=.01) were significant for stress related to information systems. Inexperience in using EHRs, low levels of ease of use, and technical quality were associated with higher stress related to information systems and this association was more pronounced among those who used mobile devices. That is, the highest levels of stress related to information systems were perceived among those who used mobile devices as well as among inexperienced EHR users or those who perceived usability problems in their EHRs.

Conclusions: According to our results, it seems that at present mobile device use is not beneficial for the nurses’ well-being. In addition, mobile device use seems to intensify the negative effects of usability issues related to EHRs. In particular, inexperienced users of EHRs seem to be at a disadvantage when using mobile devices. Thus, we suggest that EHRs and their mobile versions should be improved such that they would be easier to use and would better support the nurses’ workflow (eg, improvements to problems related to small display, user interface, and data entry). Moreover, additional training on EHRs, their mobile versions, and workflow related to these should be provided to nurses.

see all

Series: JMIR medical informatics
ISSN: 2291-9694
ISSN-E: 2291-9694
ISSN-L: 2291-9694
Volume: 9
Issue: 7
Article number: e28729
DOI: 10.2196/28729
Type of Publication: A1 Journal article – refereed
Field of Science: 316 Nursing
Funding: This study was supported by the Ministry of Social Affairs and Health (project 414919001) and the Strategic Research Council at the Academy of Finland (project 327145). None of them had any role in the design of the study and collection, analysis, and interpretation of the data or in the writing.
Copyright information: © Tarja Heponiemi, Anu-Marja Kaihlanen, Kia Gluschkoff, Kaija Saranto, Sari Nissinen, Elina Laukka, Tuulikki Vehko. Originally published in JMIR Medical Informatics (, 06.07.2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Medical Informatics, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.