This article presents qualitative results collected 6 months after implementation of a clinical information system in four nursing homes in the Midwestern USA. Researchers explored initial implementation strategies, discussed employee experiences and analyzed employee satisfaction. Transcript-based analysis and axial coding were completed to illustrate recurring phenomena. Common attributes were identified by two gerontological nurse experts and a researcher with human factors expertise. Common themes emerging from 22 focus groups and direct observation of more than 120 nursing home staff were perception and cognition, change, workable systems, competence, and connectedness. Implementation strategies associated with lower satisfaction were availability of equipment, training resources, and the presence of information technology professionals. Initial clinical information system implementation strategies and employee satisfaction could be enhanced by the inclusion of a system life cycle charter plan, emphasizing change management procedures, improving start-up projections, hiring adequately trained information technology staff, and providing a system support plan. Findings will be useful to administrators and policy makers who are contemplating implementation of a clinical information system.