Frustration with electronic health records has never been higher among RNs, with vast majorities complaining of poor workflows, bad communication and scant input on implementation decisions, a new survey shows.

[See also: RNs key to EHR improvement, says CIO]

Although they're on the front lines of care delivery, and the most frequent users of EHRs, an overwhelming 98 percent of the 13,650 licensed RNs polled by Black Book for its latest EHR Loyalty Poll say they've never been included in their hospitals' IT decisions or design.

Their dissatisfaction has reached "an all time high," according to Black Book, with 85 percent of nurses saying they grapple daily with flawed EHR systems.

[See also: CNIO position on the rise]

These nurses are pointing fingers: 88 percent of poll respondents say they blame financial administrators and CIOs for selecting low-performing EHR systems based on price, and of cutting corners at the expense of quality of care.

Indeed, 84 percent of nursing administrators in not-for-profit hospitals (and 97 percent of those at for-profit facilities) say EHRs' impact on nurses' workloads were not considered highly enough in their administration's final EHR selection decision.

"Although the inpatient EHR replacement frenzy has calmed temporarily, the frustration from nursing EHR users has increased exponentially," said Doug Brown, managing partner of Black Book Market Research, in a press statement announcing the findings.

Meaningful use has "many IT departments scurrying to implement these EHR's without consulting direct care nurses," he added.

Among other complaints from the Black Book report:

• 94 percent of nurses don't believe their current EHR has improved the communication between the nurse and the care team
• 90 percent say their EHR has adversely affected communications between nurses and their patients.
• 67 percent of nurses say they've been taught workarounds in flawed EHRs to allow other health team members to view pertinent patient information
• 69 percent of nurses in for-profit hospitals say their IT department is "incompetent"
• Just 30 percent say their IT departments respond quickly to fix aspects of the EHR that nurses point out as vulnerabilities in documentation.
• Just 26 percent say they agree with the statement: "As a nurse, I believe the current EHR at my organization improves the quality of patient information."

Nurses were most satisfied with the usability of Cerner, McKesson, NextGen and Epic Systems, according to Black Book. Meditech, Allscripts, eClinicalWorks and HCare got the lowest satisfaction scores.

The efficacy of a hospital's EHR is starting to have big effects on recruitment and retention of RNs: 79 percent of job-seeking nurses polled say the reputation of the hospital's EHR system is a "top three" consideration in their choice of where they will work.

"Many compounding nurse productivity problems can be sourced to the failure of those selecting and implementing an EHR to involve direct care nurses in the process," said Brown.

"Add to that the unique software interfaces from medical equipment and the multiple EMRs of each individual physician's office, it's no surprise that hospital nurses are getting discouraged and seeking employment in less complex organizations.

"EHRs have become an advantage for some hospitals in attracting top nursing talent, but in many cases a poorly implemented EHR with chaotic processes and bungling IT support is becoming a detriment to hospital nurse retention and recruitment," he said.

It doesn't have to be this way. Earlier this year Healthcare IT News spoke with Dave Holland, vice president and CIO at Southern Illinois Healthcare, a three-hospital system based in Carbondale, Ill.

He makes nurses a focal point of his IT decision-making, recognizing them as critical players in helping develop better EHR usability and effectiveness.

"When you're in the hospital, I know physicians make a lot of decisions about your care, but it's really nurses who deliver your care," Holland said.

"The EHR can be a very efficient tool, but you have to buy into it, you have to know about it. The people that are using the systems – unless you get them excited about it, and get them enough training so they see the value of it – it just becomes a hammer."

He and his team took a close look at the workload of SIH's nurses, and realized they were having to do too much "from the seat of their pants," said Holland.

"We realized that nursing has so many interruptions, so many different things they have to do and so many processes, that anything we could do to make it easier on them – to help them not only do a good job, but feel confident and know that they did a good job – was very beneficial."

Too many nurses are "burned out and frazzled at the end of the day," he said. "We need to give them tools to help them deliver quality care and help them to know they're doing a good job."