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BackgroundNursing homes (NHs) are increasingly implementing electronic health records (EHRs); however, little information is available on EHR use in NH settings. It remains unclear how care workers perceive its safety, quality, and efficiency, and whether EHR use might ease the burden of documentation, thereby reducing its implicit rationing. ObjectiveThis study aims to describe nurses’ perceptions regarding the usefulness of the EHR system and whether sufficient numbers of computers are available in Swiss NHs, and to explore the system’s association with implicit rationing of nursing care documentation. MethodsThis was a multicenter cross-sectional study using survey data from the Swiss Nursing Homes Human Resources Project 2018. It includes a convenience sample of 107 NHs, 302 care units, and 1975 care workers (ie, registered nurses and licensed practical nurses) from Switzerland’s German- and French-speaking regions. Care workers completed questionnaires assessing the level of implicit rationing of nursing care documentation, their perceptions of the EHR system’s usefulness and of how sufficient the number of available computers was, staffing and resource adequacy, leadership ability, and teamwork and safety climate. For analysis, we applied generalized linear mixed models, including individual-level nurse survey data and data on unit and facility characteristics. ResultsOverall, the care workers perceived the EHR systems as useful; ratings ranged from 69.42% (1362/1962; guarantees safe care and treatment) to 78.32% (1535/1960; allows quick access to relevant information on the residents). However, less than half (914/1961, 46.61%) of the care workers reported sufficient computers on their unit to allow timely documentation. Half of the care workers responded that they sometimes or often had to ration the documentation of care. After adjusting for work environment factors and safety and teamwork climate, both higher care worker ratings of the EHR system’s usefulness (β=−.12; 95% CI −0.17 to −0.06) and sufficient numbers of computers (β=−.09; 95% CI −0.12 to −0.06) were consistently associated with lower implicit rationing of nursing care documentation. ConclusionsBoth the usefulness of the EHR system and the number of computers available were important explanatory factors for care workers leaving care activities (eg, developing or updating nursing care plans) unfinished. NH managers should carefully select and implement their information technology infrastructure with greater involvement and attention to the needs of their care workers and residents. Further research is needed to develop and implement user-friendly information technology infrastructure in NHs and to evaluate their impact on care processes as well as resident and care worker outcomes.

Background: As the number of nursing home residents with multiple healthcare needs grows, the demand for nursing expertise increases. The implementation of new care models involving nurses with expanded roles is crucial for ensuring quality care in nursing homes. Objectives: To investigate the characteristics and activities of nurses employed in nursing homes in expanded roles and the factors associated with variation in the activities performed. Methods: This multicentre cross‐sectional survey in Switzerland collected data from a convenience sample of 118 nursing homes between September 2018 and October 2019. From a subsample of 62 nursing homes, we analysed the characteristics and activities of 104 nurses in expanded roles. Associations between the activities performed and the educational background of the nurses in expanded roles, their direct supervisors' positions and the presence of physicians in the nursing homes were examined. Results: Most Registered Nurses in expanded roles were diploma educated (48%), with fewer having a bachelor's (35%) or master's degree (17%). Overall, direct clinical practice and guidance and coaching activities were conducted monthly to weekly; consultation, evidence‐based practice, collaboration and ethical decision‐making activities were conducted monthly. We saw variations where a higher educational background was associated with more frequent evidence‐based practice activities (z = 3.47, p < 0.001), and if direct supervisors were ward managers, nurses in expanded roles worked more frequently below their scope of practice (z = 4.10, p < 0.001). Conclusion: This is the first study to use Hamric's integrative Advanced Practice Nursing model to examine the activities of nurses in expanded roles in nursing homes. We found considerable variation in their activities, where nursing homes seem to adapt their roles to their educational background and the local context. Implications for Practice: Our findings show the importance of clarifying role expectations for Registered Nurses in expanded roles, allowing them to practice at the top of the licence to meet residents' complex healthcare needs. [ABSTRACT FROM AUTHOR]

Introduction: Nursing care left undone occurs when nurses omit activities because of resource shortfalls. Higher levels of nursing care left undone are associated with worse nurse staffing and organizational factors. Plentiful evidence from acute, long‐term and community care supports such associations; however, mental healthcare settings are under‐studied. Aim: The aim of the study was to describe nursing care left undone's frequency in mental health inpatient settings and explore its association with nurse staffing levels. Method: As part of the multi‐centre cross‐sectional MatchRN Psychiatry study, data were collected by questionnaire from 114 units in 13 Swiss psychiatric hospitals. Nursing care left undone was analysed describing frequencies descriptively and used linear mixed models to assess its association with staffing. Results: Data from 994 nurses were analysed. The most commonly omitted activities were evaluating nursing processes (30.5%), formulating nursing diagnoses (27.4%) and defining care objectives (22.7%). Nursing care left undone was higher in units with low staffing levels. Discussion: As in somatic care settings, in psychiatric hospitals, 'indirect' care activities are most commonly omitted. Implications for Practice: This study highlights factors affecting the frequency of nursing care left undone, including staffing levels and perceived leadership. The findings emphasize the importance of nurse managers taking action to improve work environment factors. [ABSTRACT FROM AUTHOR]