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The implementation of an electronic health record is a dramatic change in a healthcare organization; however, little is known about how nurse attitudes toward the electronic health record change over time. The purpose of this research project was to compare nurses' attitudes before and at 6 and 18 months after implementation of a comprehensive electronic health record. A presurvey-postsurvey design using a modified Nurses' Attitudes Toward Computerization Questionnaire was implemented with a population of nurses employed at an academic medical center. On average, the nurses' attitude about the electronic health record became less positive between preimplementation (n = 312) and 6 months after implementation (n = 410) (74.2 vs 65.9, P < .0001) and preimplementation and 18 months after implementation (n = 262) groups (74.2 vs 67.7, P < .0001). No significant improvement between 6 and 18 months after implementation groups (P = .16) was noted. Prior to electronic health record implementation, the nurses were uncertain yet hopeful about the benefits. However, 18 months after implementing a comprehensive electronic health record, challenges remain regarding cumbersome documentation processes and promoting interdisciplinary communication. Thus, the results demonstrate a gap between preimplementation expectations and the postimplementation reality of the actual experience. Nonetheless, some subjects have experienced positive benefits after implementation of the comprehensive electronic health record and remain hopeful for the future.

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Florence Nightingale and subsequent nurse scholars have written about the impact of the environment on human health. Nightingale described, and staked out, the nurse’s role in optimizing environments for healing. Since Nightingale’s time numerous scholars have documented that environmental conditions play a major role in the health of individuals and populations. As nurses become more informed about the environment as a determinant of human health, they will be able to advocate more effectively for environmental conditions that promote health. This article provides both theoretical and practical perspectives to integrate environmental concerns into nursing practice. It recommends specific actions nurses can undertake to improve the environment within the health care setting. In particular the article provides a historical review of an environmental focus in nursing, discusses ways to manage both upstream waste and downstream waste (solid, biohazard, and hazardous chemical wastes) so as to decrease environmental pollution, and recommends specific nursing actions to promote a healthy environment within our health care agencies.