Nurses' Use of Positive Deviance When Encountering Electronic Health Records-Related Unintended Consequences

Alycia A. Bristol, Christine W. Nibbelink, Sheila M. Gephart, Jane M. Carrington

Research output: Contribution to journalArticlepeer-review

31 Scopus citations


As organizations adopt electronic health records (EHRs), nurses frequently encounter system barriers and difficulty performing role expectations. This article describes nurses' experiences with unintended consequences emerging from the use of an EHR. In some situations, nurses were positively deviant when encountering unintended consequences relating to EHRs to accomplish patient care or protect patient safety. Nurses engaged in work-arounds to provide patient care when the EHR did not meet their needs, sometimes in positively deviant ways. Qualitative data were collected from 5 open-ended questions at the end of a quantitative survey. Analysis included coding of responses and organization of processes in line with the triangle model, a human factors framework, to identify overarching themes. Five themes emerged: (1) User support after implementation of EHR; (2) User satisfaction with EHR; (3) Communication for patient care, quality, and safety; (4) Effort to complete tasks; and (5) Areas for improvement. Nurses' ability to adopt positive deviance as they experience unintended consequences offers opportunities for organizations to engage nursing perspectives in improving the EHR and engineer it to be more resilient to nursing work.

Original languageEnglish (US)
Pages (from-to)E1-E11
JournalNursing administration quarterly
Issue number1
StatePublished - 2018


  • electronic health record
  • informatics
  • nursing
  • positive deviance
  • resilience engineering
  • unintended consequences

ASJC Scopus subject areas

  • Leadership and Management


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