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Related Experiment Videos

Association Between Electronic Health Record-Based Nursing Workload and Turnover: Retrospective Cohort Study.

Linlin Xia¹, Daphne Lew², Lindsay Tessmer³

¹Division of Computational and Data Sciences, Washington University in St. Louis, St. Louis, MO, United States.

|June 12, 2026

Summary

Electronic health record (EHR) audit logs reveal that increased medication administration tasks and decreased alert engagement predict higher nurse turnover. These findings can inform retention strategies for nursing staff.

Keywords:

clinical informatics electronic health records nurse turnover nursing workload workforce retention

Related Experiment Videos

Area of Science:

Nursing Informatics
Healthcare Management
Health Services Research

Background:

Nurse turnover presents a significant challenge for healthcare systems.
Objective and scalable workload measures predicting turnover are limited.
Electronic health record (EHR) audit logs offer a potential data source for quantifying nursing work patterns.

Purpose of the Study:

To evaluate the association between EHR-derived nursing workload measures and inpatient nurse turnover.
To identify specific EHR-based workload indicators linked to nurse attrition.

Main Methods:

Analysis of EHR audit log data for inpatient nurses from medical and surgical units over one year.
Development of workload measures including nurse activities, patient load, and cognitive load from EHR data.
Mixed-effects logistic regression used to assess associations between workload measures and turnover, adjusting for covariates.

Main Results:

A higher proportion of medication administration actions was linked to increased odds of nurse turnover (OR 2.20).
Greater alert engagement (OR 0.48) and more years of licensure (OR 0.57) were associated with lower turnover odds.
Among 432 nurses, 19% left the institution in 2022.

Conclusions:

EHR-derived workload metrics, specifically medication administration burden and alert engagement, are independently associated with nurse turnover risk.
Patterns in EHR usage can help identify nurses at higher risk of leaving.
These insights can inform targeted strategies to improve nursing workforce retention.