EHR Training With Escape Rooms For New Nurses Shows Results

By Andrea Fox

Nurses with less than two years of experience increase their confidence in performing during electronic health record outages after escape room-style training, Michael Allen of Indiana University Health said at HIMSS25.

Because simulated escape rooms have shown success when used for clinical training, Michael Allen, senior clinical informatics nurse at Indiana University Health, thought they might also help new nurse graduates game out how they would perform during electronic health record outages.

His hunch was correct. New nurses who participated in his escape room study felt more confident in performing certain critical tasks during EHR downtime, said Allen during his session at HIMSS25 this past week.

Improving nurse confidence

After hospitals and health systems nationwide began to roll out electronic health records, many aspects of patient safety improved.

"When it goes down, however, there's a harm risk," Allen said.

Technologies such as smart rooms, which have been shown to improve care coordination among patients, families and providers, are also designed to make shrinking clinical workforces more efficient.

"As many nurses leave the workforce, it has become pivotal for hospitals to embrace technology that modernizes the care environment and offers a more enriching workplace for clinicians and staff," Jeff Fallon, chairman and CEO of Vibe Health by eVideon, said in December.

When greener nurses are faced with downtime procedures caused by outages, cyberattacks and other events, they are vulnerable to missteps – for example, checking patient armbands, said Allen.

"Schools aren't teaching how to document on paper anymore, neither are hospitals nor healthcare systems," he said. "As a result, these new graduates aren't prepared for when the [EHR] goes down. We've all seen it."

Experience that new graduates have in their first few years of nursing "is not the same that we have," he said to a room full of nurse leaders attending the global conference.

"They don't have old nurses anymore. Those old nurses quit during the COVID [pandemic]," Allen said.

During system outages of less than 12 hours, patient documentation will be left to the end of their shift, he said.

"They're just going to backcharge the whole thing."

Applying what new nurses know

Where studies have shown that traditional training methodologies have been less effective in downtime training, Allen said he gathered 28 participants with less than two years of experience at Ball Memorial Hospital for escape room-style training.

Allen applied Kolb's experiential learning theory to design the challenges for the engaging, interactive and hands-on escape room method, which has already proven effective for mixed groups of nurses.

"This is an adult learning theory, and basically, it takes career and position, and it uses this to merge concrete experience and abstract conceptualization with reflective observation and active experimentation," Allen said.

"The escape from training worked."

By applying what they know to an experience in the escape room, new nursing graduates find out what doesn't work and get support from the proctor.

"We can coach them on it, and then they can re-reason what we've taught them and go back through, come up with a new formula, and find out what works," Allen said.

The briefing at the beginning of the training simulation gave the nurse participants the basics of the escape room and charting documentation, and at the end, each was debriefed.

"The reason is this is not about creating an obstacle to overcome, but rather, it's an educational purpose," he said.

Tasks in the escape room, which accommodated five nurses at a time, included finding policies and policy tech, "because our policy tech still works with a network outage," Allen said.

The nurses had to find the forms, take a phone order, fax an order and write in medication – five tasks in total.

After completing the study, Allen said he now suggests that escape room training for new nurses focus on three things that can be covered in-depth in a short amount of time.

"You want this to be a little bit challenging, so it's fun. Because if you achieve something, then you get that little dopamine reward," he said.

Allen suggests conducting the training twice per year and keeping follow-up participant surveys to five or fewer questions.