Electronic Health Record Training for Nurse Practitioner Students: What UTA Research Found

Electronic Health Record Training for Nurse Practitioner Students: What UTA Research Found

A study published this month in The Nurse Practitioner adds new weight to a question NP programs have largely deferred: when should electronic health record training for nurse practitioner students begin? Research from the University of Texas at Arlington found that students who received EHR training earlier in their graduate program reported stronger confidence and lower frustration than peers encountering the technology for the first time, according to UTA. The findings add to a growing debate over whether programs can continue relying on clinical placement sites to close that gap.

The study tracked 121 graduate students enrolled in two UTA courses, Family I and Family II. Students in Family II, who had already worked with EHR systems in an earlier course, consistently reported higher confidence and stronger perceived clinical readiness. Family I students, using EHRs for the first time, reported lower preparedness and more frustration, per UTA researchers. Overall satisfaction with integrated EHR training rated 3.7 out of 5. The more significant signal was the gap between the two groups. That gap, UTA researchers suggest, reflects a curriculum timing problem that programs can address before students ever reach a clinical site.

Only 10% of U.S. nursing schools currently integrate EHR training into their curricula, according to a 2024 implementation study, which noted that the gap is seen to decrease students' effectiveness as new nurses.

What the UTA findings show about EHR timing and nurse practitioner student readiness

The core finding is sequential: students with prior EHR exposure arrive at the same course content better prepared than those without it. That difference showed up in self-reported confidence, perceived benefit from the training, and frustration levels.

Rhonda Winegar, a practicing nurse practitioner and assistant professor in UTA's family NP graduate program, said that students who arrive at clinical rotations already familiar with EHR workflows enter with a clearer sense of what to expect. "By introducing students to electronic health records earlier, they feel more confident going into their clinical rotations and know what to expect," Winegar said, per the UTA release. "That helps reduce burnout for both students and the preceptors who supervise their clinical training."

Students familiar with EHR systems before clinical placements also required less on-the-job instruction from their preceptors, which UTA researchers said could help reduce technology-related stress on the experienced clinicians who train them, per the UTA release. That secondary effect matters: the U.S. Surgeon General's 2022 advisory on health worker burnout identified EHRs as a key factor contributing to clinician burnout, and Tietze noted that one in three nurses leave their first position within the first year, according to UTA.

One limitation worth stating plainly: the UTA findings rest on self-reported confidence and satisfaction, not objective clinical performance measures. The study did not directly measure burnout outcomes for students or preceptors, and UTA researchers acknowledged that larger-scale studies are needed before the field can draw conclusions about downstream effects on clinical competency, patient outcomes, or workforce retention, per the UTA release. Higher perceived readiness is meaningful, but it is not the same as confirmed competency.

Why clinical placements cannot reliably fill the EHR gap

NP programs have historically assumed students would develop EHR fluency during clinical rotations. UTA's interim chief nurse officer and chair of graduate nursing, Tietze, said that assumption does not hold consistently. "We assumed that when students got to their clinical site, that's where they were going to gain their knowledge of how to use an electronic health record. Well, guess what? That doesn't happen all the time," Tietze said, per the UTA release. "It depends on the clinic. It depends on the preceptor. It was not a consistent process."

The variability is structural. Winegar described one common scenario: a preceptor sees patients throughout the day and then batches all order entry and documentation afterward. A student shadowing that encounter observes the patient interaction but never sees real-time documentation happen, per the UTA release. The clinical learning is real, but the documentation workflow stays invisible.

Employers are paying attention to the resulting gap. Tietze said hospitals are directly telling nursing programs they need graduates prepared for transition to practice, per UTA. "We're either burning them out, or we haven't prepared them," she said.

A parallel problem appears at the prelicensure level. A pilot study published in late 2024 observed students in a direct-entry, prelicensure program using EHRs during simulation-based experiences and found minimal actual engagement with the system, concluding that programs need more deliberate EHR integration in simulation to better reflect real clinical documentation practice, according to research in Nurse Educator. That study involved undergraduate students rather than NP students, so it does not directly test graduate-level training, but the pattern of underuse during simulation is relevant context for programs at both levels.

The readiness gap is not a student failure. It reflects a predictable mismatch between what clinical sites can reliably teach and what programs have assumed they would cover.

Curriculum timing, sequence, and the questions the UTA research raises

The clearest implication of the UTA findings concerns sequence. Students who encounter EHR systems earlier in their program arrive at the same curriculum content better prepared and less frustrated than those who do not, per UTA researchers. The practical question that raises: does a given program's first structured EHR exposure happen before or after students' first clinical placement?

A 2024 implementation study at a BSN prelicensure program offers adjacent evidence on what structured, early integration can look like in practice. Approximately 430 students completed six lab experiences using an academic EHR added to simulation labs. Documentation accuracy scores ranged from 91% to 96%. Competency scores on a standardized rubric showed modest, non-significant gains, which researchers attributed partly to grading leniency early in the sequence. Instructors reported being hesitant to discourage students with early grades and admitted to grading more leniently at first. The program's stated next step: introduce the assessment rubric earlier, with lower-stakes completion grades, to normalize documentation practice before formal evaluation begins, per the implementation study. This is BSN-level evidence rather than NP-level, but the structural lesson carries across program types.

A 2026 curriculum review published in Nurse Educator found that while professional nursing guidelines broadly define informatics and technology competencies, specific guidance on embedding those competencies in nurse educator programs remains limited, according to the review. The review focused on nurse educator students rather than NP students specifically, but it identified five competency themes used to revise master's-level course objectives: facilitating learner proficiency with EHRs and standardized terminologies; using existing and emerging health care technologies in practice; using data and technology to inform nursing practice; incorporating informatics and health care technology standards in curriculum; and promoting digital literacy. Programs working through their own curriculum alignment may find those themes useful as a reference point.

The UTA research raises several concrete questions for NP programs:

• When do students first encounter structured EHR training, and does that happen before or after their first clinical placement?
• Is EHR training graded, or treated as an unassessed orientation activity?
• Do students practice workflow logic, including how orders are entered and how documentation fits into a patient encounter, or primarily system navigation?
• Is there a competency checkpoint before clinical rotations begin?
• Does EHR training in simulation reflect how documentation actually works in the clinical environments students will enter?

None of these are recommendations from the current research, which does not prescribe a specific curriculum design. They are questions the UTA findings surface as worth examining.

What the evidence supports and what still needs stronger proof

Earlier, structured EHR training appears to improve NP students' perceived readiness and reduce frustration at the point of clinical placement, per research in The Nurse Practitioner. Students with prior EHR exposure also appear to require less real-time instruction from preceptors. Those findings are direction-setting.

What the current research has not confirmed: objective clinical competency gains, measurable burnout reduction for students or preceptors, and long-term workforce outcomes including first-year retention. UTA researchers said future studies will examine larger student groups to assess whether early EHR training produces definitive improvements in clinical effectiveness, per the UTA release.

For NP program faculty and curriculum leaders, the practical starting point is an audit of current course sequencing. The central question the UTA research surfaces is whether students are building EHR fluency early enough to enter clinical rotations with confidence, or building it on the job at their preceptors' expense. Programs can use the five competency themes from the 2026 nurse educator curriculum review as one reference point for identifying gaps, keeping in mind that review addressed nurse educator programs rather than NP programs directly.

For students comparing NP programs, the research suggests asking when EHR training is introduced in the sequence and whether academic EHR practice tools are available before the first clinical rotation. If a program's first EHR exposure happens at the clinical site, it is worth asking whether that is consistent across placements or depends on the individual preceptor and clinic.