The call for electronic health records (EHRs) began in the mid-2000s, with a goal for every American to have an EHR by 2010 (Bush, 2006). Medicare and Medicaid mandated the use of EHRs as of January 1, 2014 (Centers for Medicare and Medicaid Services [CMS], 2023). Despite these initiatives and the use of healthcare technology in clinical practice, advanced practice registered nurse (APRN) students have inconsistent access and educational immersion with EHR documentation in the provider role. Students need the opportunity to document directly in the EHR or train with other healthcare technology to master essential EHR skills. Barriers to EHR access exist for APRN students. Deficits in EHR access prevent students from becoming fully prepared for the responsibilities of a practicing clinician, as technology is a crucial component of the clinical workflow (Ortiz Pate et al., 2023).

Nursing educational organizations, such as the American Association of Colleges of Nursing (AACN), National Organization of Nurse Practitioner Faculty (NONPF), and Quality and Safety Education for Nurses (QSEN) recognize effective use of technology and EHRs as essential competencies for graduate nursing education that are integrated in their guidance for nursing curriculum. The Essentials: Core Competencies for Professional Nursing Education, published by AACN (2021), discusses the importance of informatics competency to improve quality of care, patient safety, and communication among patients and the healthcare team. The NONPF National Task Force Standards (NTFS, 2022) state that APRN programs must provide adequate resources for didactic, clinical, and simulation experiences, to enable students to attain informatics competence. Health information technology and informatics is also included in graduate level nursing competencies developed by QSEN (2012). Particularly, competency with health information technology is important to improve patient-centered care, teamwork, collaboration, evidence-based practice, and quality improvement (QSEN, 2012). Synthesizing relevant data, developing a patient-centered, evidence-based plan of care, prescribing, ordering, and evaluating interventions, are essential competencies that can be accomplished with fluency in using EHRs.

In the past ten years the APRN workforce has doubled and by 2023 APRNs will comprise 27 % of all primary care providers (Poghosyan & Whelan, 2023). APRNs are among the largest group of providers at the forefront of care in a rapidly changing technological landscape (Hah & Goldin, 2019), emphasizing the need for a strong EHR education program embedded in their curricula. The current curriculum in many APRN programs provides limited opportunities for hands-on use, access, and opportunities to work with EHRs. Nevertheless, healthcare organizations and policymakers expect health professionals to be competent in using EHRs and technology (Borycki & Kushniruk, 2019). The requirement for competence in informatics for APRNs is not new, as the AACN (2006) Essentials for Doctoral Education for Advanced Nursing Practice included an essential requirement that DNP graduates be able to use, “Information systems/technology and patient care technology for improvement and transformation of health care.” However, this essential requirement did not necessarily refer to preparation in EHR use. In April 2021, the AACN rolled out a new model and framework for nursing education, The Essentials: Core Competencies for Professional Nursing Education, which includes an essential requirement for competency in informatics for nurses prepared at the advanced-level. Master's level APRN programs and DNP programs are considered advanced-level preparation (AACN, 2021). It should be noted that DNP preparation is mandated for Certified Registered Nurse Anesthetists (Council on Accreditation of Nurse Anesthesia Educational Programs, 2021). Specifically, Domain 8 in The Essentials (AACN, 2021), calls for preparation of advanced-level nurses with competency in “Informatics and Healthcare Technologies.” The AACN Essentials (2021) competency-based approach may be an opportunity to incorporate EHR preparation into APRN academic programs. Students need help applying informatics concepts to practice. Virtual, web-based simulations maximize learning efficiency in online nursing curriculum. Hands-on experience with EHRs through simulation may facilitate the advancement of skills and knowledge to improve clinical decision-making (Choi, Bove, Tarte, & Choi, 2021).

EHRs are linked with increased quality of care and patient safety when they are used appropriately (Upadhyay & Opoku-Agyeman, 2023). Utilizing information and communication technology to gather and share data improves communication among patients and their healthcare teams. EHRs provide an avenue for improving the quality and integrity of data shared among clinicians (Choi, Bove, Tarte, & Choi, 2021). APRNs need to become fluent in the use of technology. A workforce adept at using technology will provide better patient care. However, for clinicians to gain competency requires educational curricula and learning opportunities that simulate real-world practice (Choi, Bove, Tarte, & Choi, 2021). The importance placed on competency in EHR skills by educational and professional organizations, demonstrates that this is an area in which academic EHRs could fill the gap. The term academic EHR refers to clinical software systems used to document patient information within an educational school setting and may include simulated EHRs, EHR systems developed or purchased by faculty within an academic institution, or publically accessible open-source EHR systems used in an academic setting (Forman et al., 2020). Academic EHRs could provide students with realistic practice to develop fluency and competency upon graduation. Nursing education must provide the ability to meet these competencies by providing opportunities for students to learn how to use EHRs effectively (Eardley et al., 2021). There is a need to appraise the published literature to identify effective educational strategies to facilitate APRN students' competency with EHRs.