Table 3.

Unadjusted and Adjusted Odds Ratios Indicating the Effects of Electronic Health Record (EHR) Usability on Nurse Job Outcomes

	Unadjusted		Adjusted for EHR Adoption Level		Fully Adjusted
Outcome	OR (95% CI)	P	OR (95% CI)	P	OR (95% CI)	P
Burnout (High Emotional Exhaustion)
EHR Usability (reference: Better)
Poorer	1.42(1.23-1.63)	<0.001	1.46 (1.25-1.70)	<0.001	1.41 (1.21-1.64)	<0.001
Moderate	1.14 (1.00-1.30)	0.05	1.16 (1.02-1.32)	0.02	1.14 (1.00-1.30)	0.06
Comprehensive EHR (reference: basic EHR or less)	--		1.09 (0.97-1.23)	0.17	1.14 (1.01-1.28)	0.03
Job Dissatisfaction
EHR Usability (reference: Better)
Poorer	1.71 (1.45-2.02)	<0.001	1.77 (1.48-2.12)	<0.001	1.61 (1.37-1.90)	<0.001
Moderate	1.32(1.12-1.55)	0.001	1.35 (1.15-1.59)	<0.001	1.24 (1.07-1.44)	0.004
Comprehensive EHR (reference: basic EHR or less)	--		1.10 (0.96-1.26)	0.16	1.09 (0.96-1.23)	0.18
Intent to Leave
EHR Usability (reference: Better)
Poorer	1.30 (1.10-1.55)	0.003	1.24 (1.04-1.48)	0.02	1.31 (1.09-1.58)	0.004
Moderate	1.02 (0.86-1.21)	0.80	0.98 (0.83-1.17)	0.85	1.04 (0.87-1.24)	0.66
Comprehensive EHR (reference: basic EHR or less)	--		0.86 (0.74-0.99)	0.04	0.88 (0.76-1.01)	0.08

Notes: OR=odds ratio. CI=confidence interval. EHR usability categories were defined using tertiles of the hospital-level EHR usability score: poorer (lowest tertile), moderate (middle tertile), and better (highest tertile). Odds ratios in job outcome models are from robust logistic regression models adjusted for hospital characteristics (size, teaching status, high-technology procedure capability, state, nurse staffing level, % of nurses with bachelor’s degree or higher), nurse characteristics (age, sex, years of RN experience, unit type(medical/surgical, intensive care, other) and the clustering of nurses within hospitals. Sample size for nurse outcomes range from 9,546 (emotional exhaustion) to 12,004 (intention to leave).