NUR 633 Module 2 Short Paper Example

The Hours Nurses Give to the Record: Measuring and Reducing Documentation Burden on a Medical-Surgical Unit

[Student Name]

Southern New Hampshire University

NUR 633: Informatics and Communication Technology

Module Two Short Paper

[Instructor Name]

[Date]

The Hours Nurses Give to the Record: Measuring and Reducing Documentation Burden on a Medical-Surgical Unit

Electronic health records promised legible, shareable and complete information, and they have delivered much of that. They have also asked nurses to document more than ever, often in ways that duplicate information already recorded elsewhere. The resulting documentation burden takes time from patients and contributes to nurses' frustration with their work. This paper reviews evidence on how much time documentation takes, how the burden can be measured and how it relates to burnout, then applies that evidence to a medical-surgical unit. It argues that documentation burden should be measured with data the record already produces and reduced by removing work, not by asking nurses to chart faster.

How Much Time Documentation Takes

Hendrich and colleagues followed 767 nurses with tracking devices and self-reports across 36 hospitals. Charting consumed a little over a third of the time nurses spent on practice, close to two and a half hours of a 10-hour shift, and it outweighed both giving medications and coordinating care; hands-on patient care took roughly a fifth, and assessment with vital signs under a tenth (Hendrich et al., 2008). The study was conducted as electronic records were spreading, and its figures are now dated, but it gives a sense of scale: over a third of a nurse's working time was spent on the record rather than with the patient.

Measuring the Burden

Burden is harder to measure than it seems. Asking nurses how long they spend documenting produces estimates shaped by frustration, and direct observation is expensive. Moy and colleagues mapped how researchers have tried to measure the problem in physicians and nurses and found three families of methods: observers with stopwatches, questionnaires and, more and more, EHR audit logs, which record every click, field and screen with a timestamp. The review noted that nurses were studied far less often than physicians and that definitions of burden varied, making comparisons difficult (Moy et al., 2021). Audit logs offer a practical way forward for a single unit: they can show time spent in flowsheets per shift, the number of fields completed and the proportion of fields that duplicate data captured elsewhere, such as vital signs from monitors.

Why Burden Matters: Burnout and Usability

Lost minutes are only part of the cost. In a survey of nurses using validated measures of documentation burden, EHR usability and burnout, higher documentation burden was associated with higher burnout, and poor usability of the record was associated with both (Gesner et al., 2022). The correlations were weak to moderate and the design was cross-sectional, so the study cannot show that documentation causes burnout. It does suggest that poorly designed documentation is part of the environment nurses find exhausting. National attention has grown accordingly. A symposium of informatics and clinical leaders set a goal, known as 25 by 5, of reducing documentation burden to 25% of its current level within five years, and it called for removing low-value documentation, improving usability and changing regulatory requirements that drive excess charting (Hobensack et al., 2022).

Applying the Evidence to 6 West

On 6 West, the composite 32-bed unit this course follows, nurses name three sources of burden, and each can be measured before anything is changed. The admission assessment contains about 190 fields, many of which repeat information from the emergency department record or the admitting provider's history. Vital signs measured on networked monitors are written on paper and then typed into the flowsheet, a double entry that takes time and introduces errors. And hourly rounding is documented as a separate checkbox every hour, even though the rounding itself is also visible in other notes. An audit log review for one month would quantify each of these: flowsheet minutes per nurse per shift, fields completed at admission and the proportion of vital signs entered manually.

The nurses' own accounts matter as much as the logs, because they reveal why fields exist and which ones anyone reads. In informal conversations, 6 West nurses said they complete a fall risk reassessment every shift even when nothing has changed, because a past audit flagged missing entries; that the skin assessment asks for the same information in two places; and that they often chart late in the shift from memory because interruptions make real-time charting impossible. Late charting is itself a safety concern, since the record may not reflect the patient's condition when another clinician reads it. These accounts suggest that some burden comes from rules rather than software, such as audit-driven requirements to document every shift regardless of change. Pairing nurses' explanations with audit log data would show which fields consume the most time and which ones are required by regulation, by hospital policy or merely by habit, which is the distinction a redesign needs.

Three Changes

Three changes remove work rather than speeding it up. First, integrate the networked vital signs monitors with the EHR so that readings flow into the flowsheet after nurse validation, ending double entry. Second, convene a small group of 6 West nurses with an informatics nurse to review the admission assessment field by field, removing items already captured elsewhere and items not used by anyone downstream; many organizations find a substantial share of fields can be retired. Third, move routine normal findings to charting by exception, in which nurses document changes from an established normal baseline rather than rewriting normal findings every shift, with safeguards defined by policy. Each change would be measured with the same audit log metrics used for the baseline, with the unit's own target set as a step toward the national goal.

Conclusion

A third of a nurse's shift can disappear into the record, and badly designed records travel with burnout. The data needed to measure the burden already sit in audit logs, and the most effective responses remove duplicate and low-value documentation rather than asking nurses to work faster. For 6 West, device integration, a leaner admission assessment and charting by exception offer a measurable start.

References

Gesner, E., Dykes, P. C., Zhang, L., & Gazarian, P. (2022). Documentation burden in nursing and its role in clinician burnout syndrome. Applied Clinical Informatics, 13(5), 983-990. https://doi.org/10.1055/s-0042-1757157

Hendrich, A., Chow, M. P., Skierczynski, B. A., & Lu, Z. (2008). A 36-hospital time and motion study: How do medical-surgical nurses spend their time? The Permanente Journal, 12(3), 25-34. https://doi.org/10.7812/TPP/08-021

Hobensack, M., Levy, D. R., Cato, K., Detmer, D. E., Johnson, K. B., Williamson, J., Murphy, J., Moy, A., Withall, J., Lee, R., Rossetti, S. C., & Rosenbloom, S. T. (2022). 25 x 5 Symposium to Reduce Documentation Burden: Report-out and call for action. Applied Clinical Informatics, 13(2), 439-446. https://doi.org/10.1055/s-0042-1746169

Moy, A. J., Schwartz, J. M., Chen, R., Sadri, S., Lucas, E., Cato, K. D., & Rossetti, S. C. (2021). Measurement of clinical documentation burden among physicians and nurses using electronic health records: A scoping review. Journal of the American Medical Informatics Association, 28(5), 998-1008. https://doi.org/10.1093/jamia/ocaa325