Hospital Digital Transformation, Nursing Data Burden, and Leadership and Governance Capacity: A Critical Narrative...

To critically synthesize how hospital digital transformation reconfigures nursing work and data burden, and to examine the distinct contributions of nurse-leader capability and organizational governance capacity.

Digital systems can support documentation, surveillance, coordination, and clinical decision-making. The same systems can add redundant entry, fragmented attention, excessive notifications, cognitive workload, and data-quality responsibilities. Technology effects, nursing burden, and implementation leadership are often discussed separately, limiting their usefulness for nursing management.

Critical narrative review.

A structured search of PubMed/MEDLINE and OpenAlex covered January 1, 2015, to August 21, 2026, supplemented by citation chasing and authoritative policy sources. Seventeen searches produced 8094 records before deduplication and 5735 unique records. A computer-assisted relevance gate identified 2231 potentially relevant records, from which a rule-based, domain-balanced ranking generated 220 candidates. Two authors independently reviewed the candidates; 140 records underwent structured annotation, and 58 cited evidence records received detailed author-led appraisal and claim verification. Evidence was organized across technology and work, data burden, leadership and governance, and context and equity. Interpretation was weighted by design, directness, access depth, methodological limitations, consistency, and setting. The Scale for the Assessment of Narrative Review Articles (SANRA) informed reporting quality but was not treated as a conduct standard.

Digital systems did not produce a uniform workload effect. Benefits were most credible when systems reduced duplicate entry, automated data transfer, improved information access, or fitted local workflow. Burden arose through documentation complexity, task switching, nonactionable alerts or alarms, verification work, and fragmented infrastructures. Individual digital competence supported adaptation but could not compensate for poor usability, inadequate staffing, weak training, or unclear accountability. Leadership capability and governance capacity operated at different levels and should not be modeled as a single mediator. Evidence from China illustrated rapid implementation and local innovation, but remained too context-specific for national or cross-system generalization.

Hospital digital transformation is best evaluated as a sociotechnical reconfiguration of nursing work. Nurse managers need measures that distinguish time burden, cognitive burden, alert burden, alarm burden, and data-quality work. Organizations need nursing representation, workflow-centered design, continuing training, technical support, data standards, and explicit accountability. The proposed framework is an evidence-informed organizing heuristic, not a validated causal model.