HealthMay 30, 2024

How to improve the nurse experience with a simplified EHR

Nurses need a simplified EHR to do their best work. Including them in design and optimization is the key to positive results

Electronic health records (EHRs) contribute to nurse work pressures and distract from patient care—a pressing challenge in a time of labor shortages and increased nurse burnout. Because of this, the value of EHR simplification is increasing.

Because of this dynamic, the potential to free up frontline nurses is significant. A recent study out of Applied Clinical Informatics Journal found that nurses in inpatient settings spend an average of 22% of their time interacting with the EHR.

Accomplishing this goal of liberating nurses to do what they do best and leverage technology as a support will require a focus on reducing bedside workload for frontline clinicians and using technologies like tele-nursing functions to support this class of our most vulnerable healthcare workers.

Nurse are spending too much time on electronic health records

Nurses spend a significant amount of time in the EHR, directly affecting patient care. A recent study in the journal, Critical Care Nurse found that part-time nurses spend at least 17% of their time working on the EHR and neurosurgical and medical intensive care unit nurses spend 25 and 19.9 hours per month respectively.

For all its benefits, EHRs can also contribute to burnout, take away from time spent on providing high-quality patient care, and increase worker frustration.

EHRs impact nursing care for patients

Beyond the clinician experience, time spent on the EHR can also impact time spent on nursing care for patients. A 2023 integrative review of electronic health records in nursing care asked nurses about their experiences with EHR documentation and impact on patient care. It found that EHRs:

  • Impede face-to-face communication
  • Promote a tendency toward task-oriented communication
  • Promote a formulaic communication style
  • Impacted communication patterns

These findings highlight the fact that, while EHRs are critical to promoting clinical safety standards, the use of the technology must be reflective and considerate of the importance of two-way nurse-patient interactions.

Nurse workflows depend on an efficient EHR

Time spent on EHRs can also interfere with nurse workflows, causing shifts in focus and other distractions. Interruptions can occur frequently, increasing mental workload and the potential for negative outcomes. A 2023 study in BMC Nursing found that, across 145 shift observations, 2,871 interruptions occurred with a mean task duration of about 85 minutes per shift.

Supporting nurses in EHR use

But some organizations are taking steps to reduce the burden of electronic documentation on frontline workers. The Cleveland Clinic recently found that their inpatient nurses were spending an average of about 144 minutes on the EHR during each 12-hour shift.

Elizabeth Tomaszewski,  DNP, RN, CRNP, CNE, CCRN, ACNP-BC, ACNPC, reflects on the nurse EHR experience. “Nurses are at patient bed sides, on the mobile computer clicking through the system. This is one of the major dissatisfiers that patients bring up—nurses are constantly on the computer instead of face to face and rendering care like we used to be. But there’s opportunity here. If a nurse has information when a question comes up from the patient, they can step in immediately.”

Involving frontline clinicians is the key to simplifying the EHR

Without the input of clinicians, EHRs can lean toward excessive complexity. M. Michael Shabot, MD, FACS, FCCM, FACMI, explains. “At this point, hospitals are essentially universally on EHRs. But there’s a persistent problem of their being entirely too many different ways to chart something or look up information. I’ve been glad to see hospitals genuinely collaborating with frontline clinicians to design these systems, simplify them and make them easier to work with.”

Nurses should be involved closely in EHR optimization and development. At the development phase, this can include methods like participatory design and co-design, which should be extended to nurses as members of a diverse group of contributing clinicians.

How to leverage telemedicine and tele-nursing to improve the nurse EHR experience

Healthcare leaders should explore a range of options in reducing bedside workload for nurses. One area of growing potential is remote documentation that could give patient time back to frontline nurses.

AdventHealth recruits and trains “virtual nurses” to reduce care team workloads in three of its hospitals. These nurses serve as a “second set of eyes”, helping with admissions and discharges to free care teams to work more closely with higher acuity patients. Patients have expressed appreciation for having a “second nurse” involved in their care. Similar tele-nursing functions could be applied in other ways to address challenges that nurses experience with EHRs.

Tomaszewski sees this type of program as simply keeping up with the current challenges of healthcare. “There is a chance to take nurses who might want to move away from the bedside and utilize them in a telemedicine or a tele-nursing capacity, looking at quality measures, and supporting other functions.”

The EHR of the future starts with nurses

As the challenges and complexities of nursing continue to evolve, new possibilities to apply technologies in fresh ways will emerge. Healthcare leaders can take advantage of these by listening to their frontline clinicians and involving them as key stakeholders in clinical and organizational success.

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