Nurses report increased stress levels, and they have said a major contributor to burnout is unproductive charting – a burden that the KLAS Arch Collaborative says hospitals and health systems are able to help reduce. 

A new KLAS report describes how – outlining a three-step process that provider organizations can follow to reduce charting and empower nurses to focus more on patient care. 

WHY IT MATTERS

In the most recent American Nurses Foundation’s Mental Health and Wellness survey, which 7,400 nurses responded to between April 24 and May 26, 2023, nearly two-thirds of nurses indicated that their jobs caused them high stress while 45% agreed or strongly agreed that electronic health records add frustration to their day.

After a look at the data, KLAS researchers said that by knowing and acting on nurse feedback, redesigning problematic workflows and addressing employee knowledge gaps, healthcare organizations could turn nurse productivity and well-being around, reduce turnover and save on hiring costs.

"Arch Collaborative data shows that unproductive charting is a significant time waste," KLAS researchers said. "Specifically, 35% of nurses report spending three or more hours per week on unproductive charting." 

The data identified a connection between poor nursing efficiency and higher rates of burnout.

"Things requiring charting are verging on ridiculous and make it difficult to provide patient care due to the immense amount of charting required," one nurse responded in an Arch Collaborative EHR experience survey.

In their new report, the researchers outlined how the three-step process reduces unproductive tasks, freeing up time and reducing documentation stress.

"Efforts to reduce unnecessary charting should focus on helping nurses feel that the EHR enhances, rather than hinders, their delivery of patient care," KLAS researchers said in Empowering Nurses to Focus on Patient Care 2024.

"Arch Collaborative data indicates that nurses who report less time on unproductive charting have higher general satisfaction with the EHR than nurses who report more unproductive charting."

The first step in reversing these experiences is knowing where to start, researchers said. To assess nurse charting frustrations within an organization, KLAS recommends providers conduct internal perception surveys and gather EHR usage data and other sources to inform efficiency needs and prioritize workflow improvements.

"End-user feedback is critical," they said. "After changes have been implemented, remeasure to gauge success."

Once problem workflows with the highest need for intervention are identified, health systems and hospitals can redesign them and establish documentation change processes, they said. 

That redesign team, they noted, should be multidisciplinary, composed of frontline nurses, nursing leadership, informaticists and compliance specialists.

The third step is addressing workflows where knowledge gaps – "rather than cumbersome flow sheets" – are causing nurse charting frustrations. 

"Educate nurses on any changes made to flow sheets based on the opportunities identified in step 2," the researchers said. They also advised on the use of charting by exception as an organizational standard to reduce duplicative charting.

THE LARGER TREND

Fixing pesky daily documentation irritants can keep healthcare's post-pandemic burnout from worsening, if healthcare organizations intervene early on and don't dismiss their employees' concerns.

Nurses' enthusiasm for EHR tasks, in particular, has been a hot-button issue since the onset of the pandemic with improved onboarding, ongoing training, inclusion in governance and heightened communication efforts frequently cited as remedies for the nurse burnout crisis.

A 2022 study for a KLAS nursing guidebook showed a significant drop, with just 59% of nurses surveyed finding ongoing training helpful compared with 71% of those surveyed in 2020. 

Including nurses in EHR governance and decision-making is a key practice to implement because organizations with multi-disciplinary teams see higher EHR satisfaction, the researchers said. 

"Organizations should focus on helping nurses get to the root problem, and then work together with analysts to find a solution," according to KLAS. 

ON THE RECORD

"Nurses who report more than three hours of unproductive charting in a week report higher levels of burnout than those who do not," the KLAS researchers said in the new report. "Given this added stress, it is unsurprising that these nurses also report a higher likelihood of leaving their organization."

Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.