The Impact of Digital Transformation on Nursing Professional Experience: Critical Interpretive Synthesis Review Developing the Fragmented Professional Transition in Nursing (FPT-N) Model
Abstract Background Digital transformation through electronic health records (EHRs), telehealth, mobile health, and emerging AI has reshaped nursing work. Beyond questions of adoption and usability, nurses report disruptions to workflow continuity, professional identity, moral agency, and the meaning of care. Objective This study aimed to synthesize interdisciplinary evidence on how digital transformation reshapes nursing professional experience and to develop the fragmented professional transition in nursing (FPT-N) model as a critical sociotechnical explanatory framework. Methods A critical interpretive synthesis was conducted across nursing, health informatics, and organizational literature. A structured search of PubMed or MEDLINE, CINAHL, PsycInfo, and Scopus was followed by purposive theoretical sampling for conceptual richness. We included primary qualitative and mixed methods studies, 1 quantitative observational workflow study, and secondary syntheses used for triangulation. Qualitative evidence was appraised with the Critical Appraisal Skills Programme qualitative checklist to inform interpretive weighting. We used line-by-line coding, constant comparison, memoing, and synthesizing arguments. Results The search identified 2847 records. After removing 865 duplicates, 1982 records were screened, 124 full-text reports were assessed, and 13 evidence sources were included. The synthesis generated 3 interacting mechanisms: workflow fragmentation, epistemic injustice in data-centric care, and expansion of invisible digital articulation work. Quantitative triangulation showed that 2871 interruption events were recorded across 145 observed shifts in 1 EHR workflow study, supporting the interpretation that digital work can intensify cognitive load. Contextual moderators, including governance, staffing, interoperability, and digital capital, shaped whether nurses experienced adaptive reintegration or alienation. Conclusions Digital transformation may reconfigure important parts of nursing work around data production, potentially reducing the visibility of narrative clinical judgment and amplifying hidden coordination labor in some contexts. The FPT-N model offers a critical explanatory framework for examining when digital health implementation supports adaptive reintegration vs fragmented professional transition. The model identifies actionable targets for design and governance: aligning EHR workflows with nursing cognition, reducing interruptive documentation burden, recognizing invisible digital articulation work, preserving narrative clinical judgment, and involving nurses in sociotechnical decision-making.