Nursing handover is a complex cognitive activity that requires consolidation and sharing of distributed patient information. During handover cognitive artefacts are usually used to reduce nurses’ cognitive load and ease the process of information sharing between nurses. The objective of this study is to investigate the effects of using the Electronic Patient Record (EPR) as a cognitive artefact for nursing handover. A multiple case study methodology was followed to collect data from four units in two Saudi Arabian hospitals. The units differed in their EPR usage mode: 1) units with extensive EPR use, 2) units with medium EPR use and 3) units with minimal EPR use. Findings highlight the role EPR can play at the different levels and demonstrate the role of EPR during the two different phases of handover:(handover preparation and the handover meeting. Advantages and disadvantages derived from using EPR as a cognitive artefact for nursing handover are discussed from the perspective of Distributed Cognition theory.