Electronic health records (EHR) and other Health Information Technology (Health IT) have certain benefits but have also been cited as burdensome and are often a stress point for nursing practice. The health record documentation experience for nurses may be time-consuming, require redundant entries, or be confusing to navigate, adding to frustrations (1, 2). Some things organizations can do to improve EHR experiences are:

• Reduce redundant entries, keystrokes, clicks, pop-ups, log-in requirements, and unnecessary documentation (1, 3).
• Include direct-care staff in decisions regarding redesigning and implementing technologies impacting their practice and patient care areas (1, 2, 3).
• Clean up user interfaces to remove ‘visual clutter’ (1).
• Improve interoperability between platforms for consistent and timely information exchange and eliminate repetitive tasks (1, 4).
• Assess opportunities to utilize clinical assistants or non-clinical staff to perform documentation work (1, 2, 5).
• Account for documentation time when scheduling to reduce note-taking pressure (1, 2, 5).
• Invite all stakeholders to inventory the needs of current documentation and risk mitigation requirements and eliminate non-value-added tasks and policies that add unnecessary documentation burden (1, 2, 3, 6).
• Establish a patient-centered/user-centered design principle to guide decisions for accessibility, workflow, and use of current and emerging Health IT (1, 2, 3, 6).
• Evaluate unit-time cost of documentation requirements to identify where documentation time can be shaved by altering a collection mechanism (typing, dropdown selections, VR, etc.) (1).
• Increase efficiencies by adopting technical solutions such as badge scans or biometrics for usernames and passwords, voice recognition software for patient documentation, and auto-population of screening/test results (1).

References:

1. National Academies of Sciences, Engineering, and Medicine, National Academy of Medicine, & Well-Being, C. O. S. A. T. I. P. C. B. S. C. (2020). Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being (1st ed.). National Academies Press.
2. Michel, L., Waelli, M., Allen, D., & Minvielle, E. (2017). The content and meaning of administrative work: a qualitative study of nursing practices. Journal of Advanced Nursing, 73(9), 2179–2190. https://doi.org/10.1111/jan.13294
3. Sinsky, C., A., Basch, P., Brown, M., T., & et al. (2018, August 30). Electronic Health Record Optimization: Strategies to help organizations maximize benefits and minimize burdens. AMA STEPS Forward. https://edhub.ama-assn.org/steps-forward/module/2702761
4. Erickson, S. M., Rockwern, B., Koltov, M., & McLean, R. M. (2017). Putting Patients First by Reducing Administrative Tasks in Health Care: A Position Paper of the American College of Physicians. Annals of Internal Medicine, 166(9), 659. https://doi.org/10.7326/m16-2697
5. Bergey, M. R., Goldsack, J. C., & Robinson, E. J. (2019). Invisible work and changing roles: Health information technology implementation and reorganization of work practices for the inpatient nursing team. Social Science &Amp; Medicine, 235, 112387. https://doi.org/10.1016/j.socscimed.2019.112387
6. Kohl, R., Calderon, K., Daly, S., & Hanson, C. (n.d.). Reducing Administrative Burden: Refocusing on Patient-Centric Care. TMF Health Quality Institute. https://www.tafp.org/Media/Default/Downloads/practice-resources/TMF-admin-burden.pdf

Technology, tools, and data strategies can optimize resources and workflows to reduce burdens and stressors in the workplace. Some considerations that organizations can make are:

• Assess the current capacity to use technology and data to optimize efficiency. (1)
• Include direct-care staff in decisions that impact their practice environments and workflows when acting on data-informed plans (1)
• Intentionally collaborate with direct-care staff to develop, test, and implement innovative measures to streamline processes and reduce burden. (2)
• Identify redundant data collected across platforms and find ways to integrate technology to streamline a single collection point. (3)
• Use technology to better estimate scheduling needs and allow flexibility for shifts by converting scheduling away from manual inputs for day-to-day staffing. (1)
• Digitize competency to inform staffing decisions electronically, which can help predict staffing that will minimize assignment frustration. (1)
• Perform analytics to identify staff engagement trends and potential burnout indicators to enhance efforts in creating a healthy workplace environment. (1)
• Align all stakeholders to support nurses with timely resources using technology and data to guide decisions. (1)
• Support a meaningful recognition culture by integrating data to facilitate triggers that lead to recognition moments. (1, 4)

References:

1. UKG and Wolters Kluwer. (2022). Nursing’s Wake Up Call: Change is Now Non-Negotiable. UKG and Wolters Kluwer. https://assets.contenthub.wolterskluwer.com/api/public/content/4cf675a695da4cfe97105ec756777486?v=65d29918
2. Erickson, S. M., Rockwern, B., Koltov, M., & McLean, R. M. (2017). Putting Patients First by Reducing Administrative Tasks in Health Care: A Position Paper of the American College of Physicians. Annals of Internal Medicine, 166(9), 659. https://doi.org/10.7326/m16-2697
3. National Academies of Sciences, Engineering, and Medicine, National Academy of Medicine, & Well-Being, C. O. S. A. T. I. P. C. B. S. C. (2020). Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being (1st ed.). National Academies Press.
4. AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence (2nd ed.). (2016). American Association of Critical-Care Nurses. https://www.aacn.org/WD/HWE/Docs/HWEStandards.pdf

Organization-specific policies and procedures may create unnecessary burdens on staff and potentially harm patient care. Regulatory requirements and payment rules can be misinterpreted and lead to more stringent than necessary protocols (1). Organizations can align their rules more effectively and relieve worker stress by considering the following:

• Collaborate with direct care staff and patients to identify senseless obstacles and rules that contribute to work stress, impede workflow, or negatively impact care delivery (1, 2, 3, 4).
• Contact regulatory bodies to clarify rule scope/intent and align the policies to match without added burdens. (1, 3)
• Work in partnership with nurses to identify solutions to common issues such as accessibility or wait times 1, 2).
• When writing new rules, include direct-care staff in policy decisions (1, 2).
• Remove any restrictions/requirements that are not mandatory and contribute little or no value to patient care. (1, 3, 4)
• Write policies and job descriptions for all roles to work to top of license, education, and training. (1, 5)

References:

1. Berwick, D. M., Loehrer, S., & Gunther-Murphy, C. (2017). Breaking the Rules for Better Care. JAMA, 317(21), 2161. https://doi.org/10.1001/jama.2017.4703
2. Perlo J, Balik B, Swensen S, Kabcenell A, Landsman J, Feeley D (2017). IHI Framework for Improving Joy in Work. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement. (Available at ihi.org)
3. National Academies of Sciences, Engineering, and Medicine, National Academy of Medicine, & Well-Being, C. O. S. A. T. I. P. C. B. S. C. (2020). Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being (1st ed.). National Academies Press.
4. Kohl, R., Calderon, K., Daly, S., & Hanson, C. (n.d.). Reducing Administrative Burden: Refocusing on Patient-Centric Care. TMF Health Quality Institute. https://www.tafp.org/Media/Default/Downloads/practice-resources/TMF-admin-burden.pdf
5. Bergey, M. R., Goldsack, J. C., & Robinson, E. J. (2019). Invisible work and changing roles: Health information technology implementation and reorganization of work practices for the inpatient nursing team. Social Science &Amp; Medicine, 235, 112387. https://doi.org/10.1016/j.socscimed.2019.112387