Original ArticlesNurses' Use of Positive Deviance When Encountering Electronic Health Records-Related Unintended ConsequencesBristol, Alycia A. PhD, RN, AGCNS-BC; Nibbelink, Christine W. PhD, RN; Gephart, Sheila M. PhD, RN; Carrington, Jane M. PhD, RNAuthor Information School of Nursing, Loma Linda University, Loma Linda, California (Dr Bristol); and College of Nursing, The University of Arizona, Tucson (Drs Nibbelink, Gephart, and Carrington). Correspondence: Alycia A. Bristol, PhD, RN, AGCNS-BC, School of Nursing, Loma Linda, CA 92350 (email@example.com). This project was funded by the Lawrence B. Emmons Foundation from The University of Arizona. Dr Gephart acknowledges research support from the Robert Wood Johnson Foundation Nurse Faculty Scholars Program and the Agency for Healthcare Research and Quality (K08HS022908).The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality or the Robert Wood Johnson Foundation.The authors declare no conflict of interest. Nursing Administration Quarterly: January/March 2018 - Volume 42 - Issue 1 - p E1-E11 doi: 10.1097/NAQ.0000000000000264 Buy Metrics Abstract As organizations adopt electronic health records (EHRs), nurses frequently encounter system barriers and difficulty performing role expectations. This article describes nurses' experiences with unintended consequences emerging from the use of an EHR. In some situations, nurses were positively deviant when encountering unintended consequences relating to EHRs to accomplish patient care or protect patient safety. Nurses engaged in work-arounds to provide patient care when the EHR did not meet their needs, sometimes in positively deviant ways. Qualitative data were collected from 5 open-ended questions at the end of a quantitative survey. Analysis included coding of responses and organization of processes in line with the triangle model, a human factors framework, to identify overarching themes. Five themes emerged: (1) User support after implementation of EHR; (2) User satisfaction with EHR; (3) Communication for patient care, quality, and safety; (4) Effort to complete tasks; and (5) Areas for improvement. Nurses' ability to adopt positive deviance as they experience unintended consequences offers opportunities for organizations to engage nursing perspectives in improving the EHR and engineer it to be more resilient to nursing work. © 2018 Wolters Kluwer Health, Inc. All rights reserved.