Purpose: The usability, user satisfaction, and impact of electronic nursing record (ENR) systems were investigated. Methods: Thismixed-method research was performed as a time–motion (TM) study and a survey which were carried out at six hospitals betweenAugust and November 2013. The TM study involved 108 nurses from medical, surgical, and intensive care units at each hospital, plusan additional 48 nurses who served as nonparticipating observers. In the survey, 1879 volunteer nurses completed the Impact ofENR Systems Scale, the System Usability Scale, and a global satisfaction scale. Qualitative and quantitative analyses were performed. Results: The mean scores for the ENR impact, system usability, and satisfaction were 4.28 (out of 6), 58.62 (out of 100), and 74.31(out of 100), respectively, and they differed significantly between hospitals (F=43.43, p qqqlt;.001, F=53.08 and p qqqlt;.001, and F=29.13and p qqqlt;.001, respectively). A workflow fragmentation assessment revealed different patterns of ENR system use among the includedhospitals. Three user characteristics—educational background, practice period, and experience of using paper records—significantlyaffected the system usability and satisfaction scores. Conclusion: The system quality varied widely among the ENR systems. Thegenerally low-to-moderate levels of system usability and user satisfaction suggest many opportunities for improvement.