Organizational analyses of computer user acceptance among nurses.

Abstract

Users of information technology in organizations invariably encounter problems with computer usage. Explanations for computer non-use have identified individual, cognitive and attitudinal differences, and inadequate human-systems interface as affects on user acceptance. This study explored user acceptance among nurses in three research hospitals through the influences of social and organizational structures. The conceptual framework used argues that nurses' computer acceptance is effected by (1) the integration of information systems with nurses' information and clinical work demands, (2) organizational and professional role expectations and (3) social context. Both qualitative and quantitative (i.e., focus groups, participant observations, survey) data were collected. The survey response rate was 30 percent (n = 547). Survey data were used to triangulate with the qualitative findings. Institutional histories on information systems implementation showed that where there was greater user participation in hospital information systems (HIS) selection, there was greater computer use and acceptance. HIS use increased nurses' interdepartmental dependence with other groups of users, which in turn required greater coordination so that information is entered and that nursing tasks are carried out in a timely manner. Coordination was marred by users working under different routines and guidelines, systems going down, and problems with physical and cognitive location of information. Better integration of computing and nursing practice was possible when management had the desire to do so. Problems with physical and cognitive location of information can be partly solved by HIS designers. Hospital membership, position occupied, and unit norms were found to be significant predictors of computer use. Nurse managers experienced lesser role conflict, used computers more, and had considerable influence over their staff nurses' computer access and use. Work groups that regarded computer non-use acceptable had lower user acceptance. Computer skill and ethnicity were also found to be significant predictors. Exploratory regression analyses suggested that organizational variables were better predictors of actual computer use, and individual variables were better predictors of attitudinal user acceptance. These findings underscore the importance of social context and organizational structures in understanding computer use.