Beyond alarm fatigue: nurses' experiences of behavioral nudge fatigue in digital clinical environments.

BACKGROUND

Digital health technologies such as electronic health records, clinical decision support systems, and reminder mechanisms are increasingly integrated into nursing practice to enhance patient safety and support clinical decision-making. While these systems function as behavioral nudges intended to guide clinical actions, sustained exposure to frequent alerts and reminders may generate unintended cognitive and emotional consequences for nurses. Although alarm fatigue has been widely studied, broader experiences related to continuous digital nudging in nursing practice remain underexplored.

METHODS

This study employed a qualitative descriptive design to explore the experiences of nurses providing direct patient care in surgical and internal medicine units with digital clinical alerts and reminder systems. Semi-structured interviews were conducted with nurses working in medical, surgical, and intensive care units of a university hospital. Data were analyzed using thematic analysis following Braun and Clarke’s framework.

RESULTS

Five main themes were identified: (1) perceived clinical value of digital alert systems, (2) alert fatigue and cognitive burden, (3) alarm fatigue and perceived clinical risk, (4) professional experience, autonomy, and job satisfaction, and (5) expectations for system improvement. While participants acknowledged the role of alerts in supporting patient safety and workflow organization, they also reported cognitive overload, emotional exhaustion, desensitization, and concerns about reduced professional autonomy associated with persistent digital prompting.

CONCLUSION

The findings highlight behavioral nudge fatigue as a broader extension of alarm fatigue, capturing the cumulative cognitive, emotional, and professional impact of sustained digital nudging in nursing practice. Addressing behavioral nudge fatigue through human-centered system design and greater involvement of nurses in alert governance may support both nurse well-being and patient safety in increasingly digitalized healthcare environments.