More Than Charting: Teaching Clinical Judgment Through the EHR
A short overview of a longitudinal EHR curriculum thread that teaches nursing students to use the chart for clinical judgment, not just navigation. References and contact information included.
If you found this page through my poster, welcome. Here you’ll find a short summary of the work, the references, and a way to reach me.
The Problem
Most EHR instruction teaches students to navigate the chart and document in it. That matters, but it isn’t enough. Graduates must pull information together across the whole record to give safe, evidence-based care. Students don’t develop that skill by accident. It needs purposeful scaffolding across the entire program.
What I Built
In my teaching at the Boise State University School of Nursing, I built a longitudinal, competency-based EHR thread. It runs from the first chart review to final-semester clinical judgment.
I started with what a graduate should be able to do with EHR information. Then I used backward design to set expectations for each earlier semester, aligned with course outcomes, AACN competencies, and QSEN concepts.
Every activity uses the same cycle: locate, interpret, integrate, act, document, and communicate. Students run the whole cycle from their first semester. Only the conditions change.
- Start of program: self-paced EHR lab missions. One patient, one cycle.
- Mid program: unfolding cases. New results and orders arrive, and students repeat the cycle as the patient’s situation changes.
- End of program: a full patient load with evolving conditions across every patient.
The most important lesson: if a student can complete an activity just by locating information, the activity isn’t teaching clinical judgment. Checkpoints and deliverables must capture the student’s thinking, not just the answer.
Where HealthCareSim Fits
This approach needs a training EHR where the instructor can change conditions during the scenario: release new results, add orders, and advance time. I needed that for my own teaching, so I built HealthCareSim. Students use it in every semester of the thread.
Want to Learn More?
I’ve also developed student and instructor guides, clinical thinking tools, and competency checkpoints to support this work. If you’d like more information, or want to talk about the approach, email me at christinelarsen583@boisestate.edu.
References
American Association of Colleges of Nursing. (2026). The Essentials: Core competencies for professional nursing education.
Nuamah, J. K., Adapa, K., & Mazur, L. M. (2022). State of the evidence on simulation-based electronic health records training: A scoping review. Health Informatics Journal, 28(3). https://doi.org/10.1177/14604582221113439