FEATURE ARTICLE

The Effect of Implementation of a Nursing

Information System
Experiences in a Regional Teaching Hospital in Taiwan
Min-Chi Liao, MBA, Jing-Er Chiu, PhD, Ching-Mei Tsai, MS
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example, nurses have to wait for a computer response when

The implementation of a nursing information system is a rev-
olutionary change in that with its help nurses can quickly they query a patient test report, making it impossible to im-
complete various assessments and treatment records and mediately inform the patient of the results. Another example
simplify manual work. Consequently, physicians and inter- is that, after the physician makes a medical decision, nurses
disciplinary teams can query information and deliver the must wait for the computer to print the medication adminis-
most accurate treatment. Since the implementation of a nurs- tration and treatment records. In addition, traditionally, a
ing information system to the case hospital, the record- prescription is first recorded in handwriting before being
ing time difference between new and senior nurses was transferred to the paper-based medication administration
reduced; for new nurses, the recording time per shift de- and treatment record, further increasing the working hours
creased from 66.2 ± 15.0 minutes to 37.16 ± 15.7 minutes, of the nurses. Further, during recording, if the nurse is dis-
while for senior nurses with more than 10 years of experi-
tracted by the patient's family members, doctors, or other
ence, it decreased from 45.4 ± 6.65 minutes to 29.1 ±
members of the caring team, the record can often be wrong
4.23 minutes. With the application of the innovation diffusion
theory, the Nursing Department achieved cross-team coop- or incomplete. Another problem is that the same item must
eration with the Information Department and successfully be recorded repeatedly in multiple forms. For example, the
developed the nursing information system, which laid a sizes of various catheters must be recorded repeatedly in forms
solid foundation for the case hospital to further develop such as catheter records, nursing records, discharge records,
other information systems. and so on, where data may be inconsistent. Physicians' hand-
writing is often illegible, so the contents and semantics of their
KEY WORDS: Effectiveness, Improvement, Nursing
information system writing are often difficult to identify. Because nurses often
need to write multiple medical records, they tend to complete
the treatment first, leaving documentation for later or even af-
ter the shift.
ith advancements in information and wireless net-

W works, smart products have become preferred

among various walks of life, and many industries
have used information to simplify cumbersome manual
During the orientation of the new nurses employed in the
Nursing Department, they stated that handwriting the nurs-
ing records was time consuming, and the same thing needed
to be written repeatedly, causing a 2- to 3-hour delay in their
work. In clinical practice, nurses' work is often varied; in ad-
off-duty time.
dition to caring for patients, they also have to complete many
A mobile nursing station integrates wireless networks, in-
assessment and care records. Nurses often must run back and
formation system, and equipment, enabling nurses to com-
forth between the nursing station and the patient units, and
plete documentation quickly, reduce repeated writing time,
many situations can increase their working hours. For
increase direct nursing care of patients, and process the com-
Author Affiliations: Graduate School of Health Industry Management, National Yunlin University of puterization of nursing records to increase efficiency and re-
Science and Technology; Department of Nursing, Yunlin Branch, National Taiwan University Hospital; duce the work load of nurses.
and Institute of Industrial Engineering and Management, National Yunlin University of Science and
Technology (Ms Liao); Department of Statistics, University of Missouri, Columbia, and Department of Therefore, computerization of medical records and reduc-
Industrial Engineering and Management, National Yunlin University of Science and Technology tion of the time taken for nurses to document physician orders
(Dr Chiu); and National Chung Cheng University Medical Institute of Information Management
and Department of Nursing, Yunlin Branch, National Taiwan University Hospital (Ms Tsai). promote patient safety.1,2
This study was approved by the Research Ethics Committee (case no. 01401035RINC). Hou and Yu3 found that after implementation of a nurs-
The authors have disclosed that they have no significant relationships with, or financial interest ing admission assessment information system the average ob-
in, any commercial companies pertaining to this article.
servation time decreased from 10.5 minutes to 8.4 minutes.
Corresponding author: Min-Chi Liao, N0:640, No. 579, Sec. 2, Yunlin Rd, Douliou City, Yunlin
County 640, Taiwan, Republic of China (Y00179@ms1.ylh.gov.tw). After implementation of the daily nursing physical assessment
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. information system, the average observation time was de-
DOI: 10.1097/CIN.0000000000000593 creased from 1.5 minutes to 1.4 minutes. Gao and Chen4

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FEATURE ARTICLE

reported that reducing the recording time will be influenced for repetitive documentation. In addition to improvements
by perceived usefulness and supervisor support. Recording in efficiency of conventional records, it also facilitates imme-
times were significantly improved after the application of diate communication of the patient's clinical information
nursing information system (NIS). The completeness of elec- to various healthcare teams and reduces human errors dur-
tric recording was better than handwriting and improved ing communication so that the patient receives complete and
documentation quality.4 continuous care.1,8
The implementation of an NIS is therefore a revolution- An NIS is primarily adopted for tasks including a physi-
ary change as it can eliminate computer congestion at the cian signing a prescription, emergency examination clas-
nursing station, simplify the tedious and repetitive writing sification, intake and output quantity recording, nursing
of nursing records so that more time can be spent at the problem and process recording, medication administration
patient's bedside to accurately complete various nursing as- recording, and care treatment.9 The first priority of man-
sessments and record the results in the NIS, and avoid the re- agers and system designers should be a system capable of
dundant process in which results must be recorded on paper automatically integrating nursing workflows and treatment
first before being formally transferred to the medical record activities while considering patient safety. The system should
at the nursing station. Additionally, physicians and members be developed from the nurse's point of view; satisfaction and
of other interdisciplinary teams, such as therapists and dieti- work efficiency depend on whether the system has a useful
tians, also benefit from the system as they can check the and convenient operating interface and is easy to use.10,11
patient's relevant assessments or treatments online and pro-
vide the patient with the timeliest and most accurate rehabil- CLINICAL PROFESSIONAL COMPETENCY
itation or nutrition prescriptions. ADVANCEMENT SYSTEM FOR CLINICAL NURSES
Whether the NIS can be successfully implemented de- Nursing competence requires appropriate professional train-
pends on not only the software design and the nursing trolley ing.12 A study revealed large differences in clinical compe-
hardware equipment, but also the nurses' degree of accep- tency among nursing school graduates. Therefore, a clinical
tance of the system.5 The degree of acceptance increases if nursing competency grading system was introduced in the
the system can substantially save time in handwriting and re- 1970s.13 In Taiwan, a nursing staff competency advancement
duce nursing workload. This study investigated the effect of system was set up in the 1982s.14 The authors pointed out that
implementation of an NIS. The reduced writing time of nurs- using nursing competency to establish the job hierarchy re-
ing records and delay in off-duty time are discussed. We hope sults in the following: promotion of nursing competency ad-
the results can provide helpful references to other hospitals vancement system, encouragement of nursing staff to learn
who would like to develop NISs and promote nursing systems. systematically and progressively, increase in self-affirmation,
By saving the cumbersome recording time and reducing improvement of work attitude, stimulation at work, and im-
workload, hospitals can increase retention rates and reduce provement of teaching and management competencies.15,16
turnover among nurses so that more professional nurses can The Taiwan Nurses Association has formulated guide-
be trained. lines for frontline nurse competency advancement, to be
used by hospitals as the basis for a clinical professional com-
LITERATURE REVIEW petency advancement system through which a specialist
Nursing Information System Development and Nursing competency system for nurses is systematically established,
Clinical Practice to increase professional competency and ensure a stable
The clinical work of nurses is cumbersome because, in addi- workforce and patient safety. The clinical competency grade
tion to taking care of patients, they must also complete many is divided into N (less than 1 year of experience) and N1, N2,
assessments and records. Information technology research and N3, and N4 (work experience of at least 4 years), whereas
development, as well as its introduction, have become an im- competencies range from the ability to execute basic nursing
portant part of healthcare and nursing practice in various tasks to caring for critically ill patients and teaching and
medical institutions. The NIS should be planned and devel- research capabilities.17
oped such that efforts toward informatization are made in
all aspects, including clinical, teaching, administration, and Nursing Information System Benefits and Promotion
community care. With the aid of informatization, work effi- Nursing information is a new industry that combines nursing
ciency, patient safety, nursing service quality, management per- and information technology. The introduction of informa-
formance, teaching quality, and research effectiveness are tion technology and the development of medical information
all improved.6,7 systems is a strategic goal deployed by major hospitals to en-
A complete information system can provide consistent hance their advantages in competition. It can be applied
standards of care and reduce manual errors and time taken to human resource management, shift management, and

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network learning system construction, which enables nurses resistance when promoting online documentation or com-
to study anytime and anywhere so that professional ability puter-related functions, the main concern was the addition
and the effectiveness of nursing education are improved.6 of a new task on top of the busy workload rather than the
The study performed by Liou et al18 in 2016 showed that computer technology itself. A study performed by Moody
a computerized model of performance-based measurement and Snyder25 in 1995 showed that clinical nurses spent ap-
could objectively measure nursing pregraduates' and clinical proximately 15% to 20% of their daily time writing up case
nurses' performance-based competence. Nursing training records. A medical center in Taiwan conducted a survey
courses could be tailored to improve clinical competence. targeting the workload of nursing staff and found that, while
The study performed by Heal et al19 in 2017 demonstrated indirect nursing time occupied the highest portion of nursing
a rapid response system that includes a rapid response team staff's workload, nursing records were the most time-consuming
and early warning signs system. A set of early warning signs task of indirect nursing.26 These findings suggest that nursing
system criteria was fully integrated into the patient's elec- records are a heavy load for clinical nursing staff.
tronic medical record. Any total score exceeding an assigned According to Rogers'27 diffusion of innovation theory,
threshold prompted a follow-up by the leader of the rapid re- there are four governing factors: innovation, communication
sponse team to promote safe and effective care. channel, social system, and time. The informatization pro-
Using an NIS, electronic medical records, and early warn- cess is actually a dynamic adaptation process in which
ing signs systems improves collaboration among healthcare changes in the innovation program will be affected by user
professionals and improves patient outcomes.19,20 characteristics and information cognition. Huang et al28
Implementing an NIS can effectively enhance nursing care pointed out in a study performed in 2017 that the most crit-
quality and nursing management, reduce repetitive tasks and ical variables affecting use of the NIS are user satisfaction
avoid omissions, reduce the occurrence of transcribing and and perceived usefulness. Nursing staff are key to the success-
recognition errors due to physicians' handwriting, and im- ful implementation of the system. As a result, managers
mediately obtain medical advice and use treatment timing should facilitate the innovation by first obtaining support
to improve patient safety. from early adopters and then expanding use through in-
structional courses, operational learning, and opinion ex-
Key Factors Affecting the Promotion of a Nursing change, followed by adaptive learning to increase the
Information System acceptance of the NIS. The promotion of the NIS should be
Information has become the most influential external change combined with practical work so that nurses understand that
force during the past two decades. Since “change” refers to the system helps improve work efficiency, allowing them to
the destruction of an existing rule and stability, it is often spend more time focusing on patient care or professional
resisted, which is the major challenge faced by managers. learning. Through this method, the introduction of the in-
Implementing an NIS has a substantial impact on clinical formation system can be successful.29
practice and drastically changes normal ways of working.
Thus, besides planning changes according to the trend, nurs- RESEARCH METHODS
ing managers should also focus on staff reactions, carefully Several NISs were introduced, including an “admission nurs-
evaluate causes of resistance, facilitate the trend of infor- ing assessment system,” “body assessment system,” “pressure
matization, and understand standard nursing language. sore and fall assessment system,” “nursing problem resolu-
Managers' combined consideration of the internal needs tion planning system,” “restrain care system,” and “catheter
and the external trends substantially benefits the promotion record system.”
of the information system within the organization.21,22 The nursing information interface is presented as a 3  3
However, when an NIS does not meet the needs of nurs- grid. A personal account number and password are required
ing practice, its implementation and application will be more to enter the operation page. As regards the information
difficult. Therefore, the goal of utilizing nursing information equipment, a wireless network and a mobile E-nursing trol-
is to develop a standard, easy-to-operate, and manageable ley were established so that nurses could complete various
NIS that satisfies clinical needs and combines cross-domain nursing evaluation and documentation items by the bedside.
knowledge applications. Consequently, the information in- All NIS data are integrated into an electronic medical record.
troduction process should involve needs assessment and con- The information supervisor created the online schedule for
firmation, system design and correction, system testing and the NIS. Weekly supervisory meetings were scheduled for
introduction, and, finally, system evaluation.23 discussions and follow-up. The theory of diffusion of innova-
Kirkley and Stein24 investigated the reason for nurse resis- tions forms the basis for the NIS introduction as a two-stage
tance to computerization. Through in-depth interviews, online plan. First, a nurse who was interested was assigned
they found that, although many organizations experienced to one internal medicine and one surgery ward as a

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FEATURE ARTICLE

demonstration unit. The case hospital sent the information su- 4. The difference in recording times depending on years
pervisor and interested nurses to the system's general hospital of nursing experience was analyzed.
benchmark to learn NIS operations and then discuss 5. The difference in recording times depending on ability
information needs. Second, the information technologist levels was analyzed.
set and started the test information system. 6. The difference in recording times depending on the
levels of education was analyzed.
Arrangement of the Information System Operation Training
The information nurse from the system's general hospital Data Analysis
was invited as a lecturer to provide education, training, Descriptive statistics, paired t test, and analysis of variance
and practical tests regarding nursing information systems. (ANOVA) were performed using the statistical software
In the second stage, after the demonstration unit successfully IBM SPSS Statistics v 18 (IBM, Armonk, NY) to verify and
introduced the system, it was expanded to various units in analyze the effectiveness of NIS implementation.
parallel. Interested nurses help introduce the NIS into the
case hospital.
Nursing informatization requires systematic planning for RESULTS
its successful introduction. The Department of Nursing of Descriptive Statistics of Biographical Information
the case hospital established a post of information supervisor Among the 69 participants enrolled, 32 (46.4%) were from
who is responsible for planning the introduction of nursing the internal medicine department, followed by 13 (18.8%)
information systems. As this information supervisor carries each from the surgical and orthopedic departments.
out cross-disciplinary collaboration with the information Twenty-five participants (36.2%) had less than 1 year of expe-
technology center and Department of Nursing of the rience, followed by 21 (30.4%) with 5 to 10 years of experi-
system's general hospital, the needs of patients and nurses ence, 10 (14.5%) with more than 10 years of experience,
are used to formulate and revise relevant NIS content. eight (11.6%) with 1 to 3 years of experience, and five
Training of interested nurses and establishment of the (7.2%) with 3 to 5 years of experience. Thirty-four partici-
demonstration unit model were carried out by applying the pants (49.3%) had an ability level of N2, followed by 21
theory of diffusion. The interested nurses facilitated the suc- (30.4%) with N and 10 (14.5%) with N1. Twenty-five partic-
cessful introduction of nursing information systems across 12 ipants (36.2%) had an educational level of 5-year college,
wards, thereby successfully promoting NIS. followed by 18 (26.1%) with 4-year technical school, 16
(23.2%) with 2-year technical school, and 10 (14.5%) with
Study Participants 2-year college.
This study was approved by the Research Ethics Committee
(case no. 201401035RINC). There was no conflict of interest. Difference Before and After Implementation in Total Time
This study employed purposive sampling; the morning meeting Spent on New Patient Nursing Process
of every ward implementing NIS was used to explain the Table 1 shows the total times the 69 participants spent on
content of this study and recruit participants with more than new patient procedure records before and after NIS imple-
3 months of experience. mentation. Recording time measurements before were per-
The study process protected participant rights and en- formed from December 16 to December 30, 2013. The
sured that recording time and questionnaire data were col- average total time before was 56.9 minutes with an SD of
lected only after the purpose of the study was explained 14.06 minutes. Recording time measurements after were
and personal consent was obtained. A total of 69 participants performed from May 26 to June 6, 2014. The average total
were enrolled in the study. time after was 36.4 minutes with an SD of 12.08 minutes.
The difference between before and after in the average time
Study Procedures participants spent on new patient nursing procedure records
1. Handwriting time was measured using a timer and was 20.5 minutes with an SD of 12.92 minutes. The results
was recorded for each nursing procedure. showed that the introduction of the NIS effectively reduced
2. The recording time of the postintroduction nursing the time spent on various assessments and nursing records.
process was collected: 4 months after the introduction Paired t test was conducted to compare the difference be-
of the NIS, and the time each participant spent on tween before and after for the 69 participants. The results
completing each record using the information system were statistically significant, which means the time spent on
was measured using a timer. records was indeed reduced. The NIS automatically imported
3. The effect of introducing the NIS was verified by com- the patient's previous record, so that data or assessment only
paring before and after recording times. needed to be filled in once, and were then automatically

518 CIN: Computers, Informatics, Nursing October 2020

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Table 1. Difference Before and After on Total Time Spent on New Patient Nursing Process
(N = 69)
Before After Difference Pairwise t P
Average 56.9 36.4 20.51 13.19a .00
SD 14.06 12.08 12.92

imported into the relevant forms, saving the time spent on statistically significant for different years of experience. Partic-
repetitively recording the same data or assessment. ipants with less than 1 year of experience had a time of
37.16 ± 15.7 minutes, while senior participants with more
Difference Between Recording Time Depending on Years than 10 years of experience had a time of 29.1 ± 4.23 minutes.
of Experience The average time spent after implementation was signifi-
Whether there was a difference in the recording time de- cantly reduced. Before implementation, the averages were
pending on years of nursing experience after adopting the 45.4 and 66.2 minutes, respectively, while after implementa-
NIS was verified by one-way ANOVA. The comparisons tion, they were 29.10 and 37.16 minutes, respectively. The
of recording times before and after and the difference of be- results suggested that the introduction of the NIS was able
fore and after were conducted using three ANOVA tables, as to reduce not only the total time spent but also the difference
shown in Table 2. between senior and junior staff. The NIS allows the auto-
The ANOVA of the total time spent before improvement matic import of patient-related information. A good design
showed that the differences in recording times were statisti- of the information functions, such as various nursing plans
cally significant (P < .05) for different years of experience. and instructions, reduces the time spent on repetitive hand-
While senior participants spent less time, 45.4 ± 6.65 minutes, writing of nursing records and improves accuracy and
junior participants spent more time, 66.2 ± 15 minutes, sug- effectiveness.
gesting that, with more working experience and proficiency, The differences in improved time due to the introduction
senior participants spent less time on manual recording than of the NIS for participants with different years of experience
junior participants before implementation. were statistically significant (P < .05). The improvement for
The ANOVA of the total time spent after implementation participants with less than 1 year of experience (29.4 ±
showed that the differences in recording times were not 13.36 minutes) was more significant than for participants

Table 2. Difference Between Years of Participant Experience on Recording Time

(N = 69)
Level Years of Experience n Average SD F P
Total time spent before improvement <1 y 25 66.20 15.00 8.082a <1 y >5 to 10 y = >10 y
1–3 y 8 60.13 13.03
3–5 y 5 56.80 7.56
5–10 y 21 50.19 9.27
>10 y 10 45.40 6.65
Total time spent after improvement <1 y 25 37.16 15.70 1.123 —
1–3 y 8 37.25 12.59
3–5 y 5 37.20 10.11
5–10 y 21 38.52 9.17
>10 y 10 29.10 4.23
Time difference before and after improvement <1 y 25 29.04 13.36 7.706a <1 y >5 to 10 y
1–3 y 8 22.88 6.24
3–5 y 5 19.60 6.35
5–10 y 21 11.67 11.29
>10 y 10 16.30 6.58
a
P < .05.

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FEATURE ARTICLE

with 5 to 10 years of experience (11.67 ± 11.29 minutes), ability levels spent less time, 38.0 ± 1.41 minutes, participants
suggesting that the introduction of the NIS to the case hospi- with lower ability levels spent more time, 69.24 ± 14.57 minutes,
tal was more helpful for new staff in learning how to perform suggesting that, with higher professional ability to care for
assessments and nursing records, which reflects the current patients and better logical thinking and organizational struc-
social trend of young people familiar with information tech- ture ability, participants with higher ability levels spent less
nology. During the initial period of NIS implementation, se- time on manual recording before implementation
nior participants complained that they were unfamiliar with The total time spent after implementation showed that
using computers to input patient-related information. How- the differences in times spent by different ability levels were
ever, after multiple operation practices, once they realized not statistically significant, suggesting that the introduction
that the NIS could simplify workflow, they made the effort of the NIS was effective. There is no statistically significant
to adapt and execute. For participants with 5 to 10 years difference in the total time spent by participants with differ-
of experience, the time spent was reduced from 50.19 mi- ent ability levels, which suggests that all nurses can use the
nutes before implementation to 38.52 minutes after imple- NIS structured as a 9-square screen to complete various as-
mentation, while for senior participants with more than sessments, treatments, care, and nursing records.
10 years of experience, it was reduced from 45.4 minutes The differences in improved time for participants with
to 29.10 minutes. different ability levels were statistically significant (P < .05).
The NIS brought in multiple new functions (ability to im- The improvement was more obvious in participants with
port the patient's previous assessment and care record and lower ability levels. The greatest time saving was among par-
need to make corrections only according to the current situ- ticipants with N ability level, who demonstrated time saving
ation) and had the advantage that nurses could stand at the of 29.86 ± 13.23 minutes; for participants with higher abili-
patient's bedside and instantly complete the records for var- ties, time saving was 11.50 ± 2.12 minutes. This was be-
ious vital signs and assessment, which then reduced the time cause, before implementation, participants with N ability
required for records that were based on memory or written level spent the longest time on recording, while participants
on a paper. As a result, it was beneficial to both senior and with N4 ability level spent the least. Less time was saved after
junior participants. implementation for participants with N4 ability level; before
improvement, both spent more time recording—69.24 and
Difference Between Recording Time Based on the Ability 38.0 minutes, respectively—while after improvement, both
Levels of Participants spent less time—39.38 and 26.50 minutes, respectively.
For different participant ability levels, the results in Table 3 The results revealed that, although participants with higher
show that the total time spent before implementation was ability levels were initially superior in multiple care and nurs-
statistically significant (P < .05). While participants with higher ing abilities, participants with lower ability levels (new nurses)

Table 3. Difference Between Participant Ability Levels on Recording Time

(N = 69)
Level Ability Level Average SD F Postcomparison
Total time spent before improvement N 69.24 14.57 9.88a N > N1
N1 55.30 11.66 N > N2
N2 51.53 9.28 N > N4
N3 46.50 2.12
N4 38.00 1.41
Total time spent after improvement N 39.38 17.11 1.02 Not applicable
N1 38.80 9.07
N2 34.82 9.08
N3 30.50 2.12
N4 26.50 3.54
Time difference before and after improvement N 29.86 13.23 4.98a N > N2
N1 16.50 12.35
N2 16.71 10.67
N3 16.00 4.24
N4 11.50 2.12
a
P < .05.

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were more familiar with the computer products and demon- The results in the time before and after implementation
strated a greater acceptance of the NIS. As a result, after they for different education levels were not statistically significant
were trained to perform nursing assessments and treatment (P > .05). Among all the participants, time changes before
handling, these participants were able to instantly complete and after implementation were the most significant for par-
the patient assessment and online records, so the time spent ticipants with an education of 5-year college, which reduced
was greatly reduced, eventually leading to improved work ef- from 58.64 ± 12.30 minutes to 35.80 ± 8.86 minutes; for
ficiency. Therefore, the introduction of the NIS was beneficial each new patient admission, the recording time was reduced
for participants with lower ability levels; they were able to sys- by 22.84 ± 15.56 minutes. This indicated that the clear
tematically complete multiple tasks, including patient-related system interface and the convenience of automatic import
assessments and treatment and care recording. The system made the system easy to learn, so training and individual
helped save recording time and successfully increased partic- work efficiency were not affected by academic qualifications.
ipant work confidence.
DISCUSSION AND CONCLUSION
Difference Between Recording Time Depending on This study found that, in training the interested early
Education Levels adopters and establishing a demonstration unit model, the
Table 4 shows the ANOVA results of recording time for early adopter is an important messenger who can promote
different education levels. The total time spent before imple- the successful implementation of NIS. This model can be
mentation was not statistically significant for different ed- used as a reference for other hospitals in promoting NIS.
ucation levels. Before implementation, participants with an With the introduction of the NIS, paper-based records were
education of 4-year technical school spent less time, 53.33 ± converted to information-based, so the time nurses spent on
13.0 minutes, while those with an education of 5-year college nursing records was effectively reduced.
spent more time, 58.64 ± 12.30 minutes. The introduction of the NIS reduced recording time dif-
The total time spent after implementation was not statis- ferences between junior and senior participants; for new
tically significant depending on different education levels. Af- hires, the recording time per shift was reduced from 66.2 ±
ter implementation, participants with an education of 2-year 15.0 minutes to 37.16 ± 15.7 minutes, while for senior par-
college spent less time, 33.80 ± 11.07 minutes, while those ticipants with more than 10 years of experience, it was re-
with an education of 2-year technical school spent more, duced from 45.4 ± 6.65 minutes to 29.1 ± 4.23 minutes.
39.50 ± 13.82 minutes. After implementation, time spent The system also reduced the recording time difference of
was significantly reduced; before implementation, the aver- participants with different ability levels; for participants of
age times were 56.6 and 58.5 minutes, respectively, whereas N ability level, the recording time per shift was reduced from
afterward, they were 33.8 and 39.50 minutes, respectively. 69.24 ± 14.57 minutes to 39.38 ± 17.11 minutes, while for
The results suggested that the introduction of an NIS re- participants of N4 ability level, it was reduced from 38.0 ±
duced the total time spent as well as the differences among 1.41 minutes to 26.50 ± 3.54 minutes. Additionally, the sys-
participants with different education levels. tem also reduced the recording time difference of participants

Table 4. Difference Between the Education Degrees on Recording Time

(N = 69)
Level Education Degree Average SD F Postcomparison
Total time spent before improvement 5-year college 58.64 12.30 0.57 Not applicable
2-y college 56.60 14.26
2-y technical school 58.50 17.83
4-y technical school 53.33 13.00
Total time spent after improvement 5-y college 35.80 8.86 0.52 Not applicable
2-y college 33.80 11.07
2-y technical school 39.50 13.82
4-y technical school 36.00 15.03
Time difference before and after improvement 5-y college 22.84 15.56 0.81 Not applicable
2-y college 22.80 9.48
2-y technical school 19.00 12.91
4-y technical school 17.33 10.34

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FEATURE ARTICLE

with different education levels; for participants with an edu- diversified. It is the nursing managers' important responsibil-
cation of 5-year college, the recording time per shift was re- ity and obligation to determine how to use information to
duced from 58.64 ± 12.3 minutes to 35.8 ± 8.86 minutes, effectively simplify nurses' work. Using information can im-
while for participants with an education of 4-year technical prove nurses' work efficiency and enable them to stay longer
school, it was reduced from 53.33 ± 13.0 minutes to at the patient's bedside and reduce their off-duty delay while
36.0 ± 15.03 minutes. These results indicate that, due to also improving care quality and patient satisfaction.
the clear operating interface and the convenience of opera-
tion, the system was equally beneficial to participants with dif-
ferent years of experience, ability levels, and education levels. Acknowledgments
In particular, it could help new staff to learn and improve The authors thank the hospital chiefs as, without their support and the
work confidence. hospital research grants, the successful introduction of the NIS and the
From clinical practice observation and research analysis, completion of this study would not have been possible. The authors also
it was found that new participants demonstrated a higher acknowledge the nursing managers and nurses of all units for their sup-
proficiency and acceptance of computers than senior partic- port and express their special thanks to the information team for their
ipants. This is likely because young people are now more ex- guidance and assistance.
posed to information technology and, consequently, have a
faster typing speed than senior staff. During implementation, References
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