Objective Online health and social care services are getting widespread which increases the risk that less advantaged groups may not be able to access these services resulting in digital exclusion. We examined the combined effects of age and digital competence on the use of online health and social care services. Methods We used a large representative population-based sample of 4495 respondents from Finland. Paper-based self-assessment questionnaire with an online response option was mailed to participants. The associations were analyzed using survey weighted logistic regression, exploring potential non-linear effects of age and controlling for potential sex differences. Results Higher age, starting from around the age of 60 was associated with a lower likelihood of using online services for receiving test results, renewing prescriptions and scheduling appointments. Good digital competence was able to hinder the age-related decline in online services use, but only up to around the age of 80. Conclusions Our results suggest that older adults are at risk of digital exclusion, and not even good digital competence alleviates this risk among the oldest. We suggest that health and social care providers should consider older users’ needs and abilities more thoroughly and offer easy to use online services. More digital support and training possibilities should be provided for older people. It is equally important that face-to-face and telephone services will be continued to be provided for those older people who are not able to use online services even when supported.

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Background Digital services have become an essential part of nurse's work and nursing informatics competence a prerequisite for nurses to carry out their professional roles. Urgent investments are needed in informatics competence development and integrating informatics into nursing curricula. However, this has shown to be a challenge in many countries. In 2015, Finnish eHealth strategies emphasised the importance of investing more in informatics education for health professionals. This study evaluated whether these strategies have succeeded in increasing the informatics competences of registered nurses. Methods The data were collected in Finland with an electronic survey (end of 2018). The sample comprised 1639 nurses who were categorised in eight groups based on their graduation year. Analysis of covariance was used to examine whether the graduation year was associated with nurses' overall informatics competence and four specific competences (terminology based documentation; patient-related digital work; general IT competency; e-documentation according to structured national headings). Models were adjusted for age, gender, work setting and geographical area. Results Graduation year was associated with the nurses' overall informatics competence (F = 4.91 p < 0.001) and specific competences related to terminology based documentation (F = 5.27 p < 0.001), patient-related digital work (F = 4.00 p < 0.001) and general IT competency (F = 3.63 p = 0.001). Nurses graduated after the 2015 strategies (between 2016 and 2018) had the highest competence. The earlier the nurses' graduation year was the lower the nursing informatics competences. Conclusions Existing eHealth strategies may have urged Finnish nursing programs to add more informatics training in their curricula. Nurses' informatics competence affects the quality of health care, thus, more training should be provided especially for nurses with earlier graduation years who have not had formal nursing informatics education. Key messages Results highlight the importance of having eHealth strategies with educational initiatives stating the directions and objectives of education programs. Healthcare organisations should invest in providing more in-service education in nursing informatics especially for those nurses who have not had informatics included in their undergraduate studies.

Background Ability to use information systems is a crucial part of nurses' competence, but evidence on whether this competence is associated with stress among nurses is lacking. As part of the 'Towards socially inclusive digital society: Transforming service culture' (DigiIN, funded by the Strategic Research Council, project 327145), we examined the associations of registered nurses' informatics competence with distress and information systems related stress. Methods The data was collected in Finland with an electronic survey at the end of 2018. The sample comprised 1639 nurses. Analyses of covariance were used to examine whether the nurses' informatics competence was associated with distress and information system-related stress. In addition to overall informatics competence, we also examined the associations of four dimensions of informatics competence (terminology based documentation; e-documentation according to structured national headings; general IT competency; patient-related digital work) with dependent variables. Models were adjusted for age, gender and employment sector. Results Nurses' overall informatics competence was associated with lower distress (F = 9.90 p = 0.002), but not with information system-related stress. The analyses with four competence dimensions showed that patient-related digital work competence was associated both with lower distress (F = 3.95 p = 0.047) and information system-related stress (F = 4.63 p = 0.032). In addition, general IT competency was associated with information system-related stress (F = 12.6 p < 0.001). Conclusions Especially lack of patient-related digital work competence seems to stress nurses. Supporting nurses in patient-related digital work and improving nurses' general IT competency by training could decrease their stress related to information systems and improve their wellbeing. Key messages Nurses should be supported more in patient-related digital work. Nurses’ high IT competency is associated with lower stress, and thus, healthcare organizations may benefit from providing more IT training for nurses to decrease their stress levels.

Background Challenges in transitioning from a student to a registered nurse may contribute to new nurses high turnover rates. Final clinical practicum (FCP) before graduation is known for its importance in preparing students for the transition but little is known about the specific elements of FCPs essential for successful transition. We examined the associations between multiple FCP elements and transition experiences in new nurses and whether work characteristics modified these associations. Methods The data were collected in 2018 with electronic survey. The sample comprised 712 Finnish nurses graduated within the last two years. Linear regression analyses was used to examine the association of five FCP elements (Preparing for demands; Being part of team; Systematicness of FCP; Teacher involvement; Quality of supervision) with the transition experience that was measured with four scales demonstrating its emotional, physical, socio-developmental and intellectual domains. Work characteristics were defined based on demand-control -model and multiple potential confounders were considered. Results Several associations were found between the FCP elements and the four transition indicators (psychological distress, sleep problems, role conflict/ambiguity and perception of transition/educational preparation). Systematicness of FCP was, however, the only element associated with all the transition indicators, whereas quality of supervision was not associated with any. Multiple interactions were also detected between the FCP elements and job demands. Conclusions Our results suggest that FCP experiences reflect to new nurses’ first years of employment. Especially systematic planning and implementation of FCP, collegial work atmosphere and an opportunity for students to become an active member of the work community should be ensured for promoting a smoother transition from student to nurse. This could increase the chances to retain new nurses in the health care workforce. Key messages Well planned and implemented final clinical practicums with an opportunity to become an active member of professional team could help nursing students to obtain a smoother transition into nurses. The benefits of having a good final clinical practicum experience may be squandered if considerably high level of job demands (e.g. timepressure) is experienced in the first years of employment.