Nurses Need a More Significant Say In Regards to EHR Burnout

Nurses have valuable insight into ways to reduce EHR burnout, but there is a need for further research into ways to better organize, manage, and display this information to mitigate nurse burnout, according to a study published in the Journal of the American Medical Informatics Association.

Nurses outnumber physicians by four to one, however, the number of studies published in MEDLINE on “physician burnout” compared to those on “nurse burnout” is four to one. In other words, the research community pays attention to physician burnout significantly more than nurse burnout.

According to a systematic review referenced by the research team, nurse burnout ranges from 15 to 45 percent and because of the US nursing shortage, failure to address this burnout will have a trickle-down effect throughout healthcare.

As a result, further attention and research on nurse burnout is required to mitigate this overlooked area of healthcare, the researchers said.

Researchers analyzed MEDLINE, Embase, CINAHL, PsycINFO, ProQuest, and Web of Science for literature reporting on EHR use, nurses, and well-being.

After scouring through roughly 4,500 articles, 12 articles met the three areas of criteria.

The 12 studies focused mostly on nurse and health IT level connections, while one assessed organizational level characteristics.

The studies found nurses recommend EHR, health IT, health organization, and policy-level enhancements to boost well-being and reduce nurse burden.

“Although current evidence suggests that time spent in the EHR is associated with physician wellbeing, time spent using the EHR was not associated with nurse well-being, suggesting that the quantity of effort may be less important than the quality,” wrote the study authors.

For example, registered nurses, licensed practical nurses, and nursing assistants reported EHR downtime led to paper documentation. As a consequence, nurse reported total EHR time may underrate the connection between nurse burnout and documentation burden.

While the researchers expected nurse practitioners would have increased EHR time compared to other nurses, the research team only found one study that assessed their time in the EHR. Therefore, more research is needed in that area.

Furthermore, the study authors found nurse burnout is impacted by the various nurse units or settings, along with the various work environments and patient population, such as age, mortality rates, and acuity of patients. These different settings impact the amount of time a nurse works in her respective EHR and the degree of burnout.

Nurses also reported enhanced or optimized EHR interface displays can reduce cognitive load, thus leading to decreased burnout and increased patient safety. Just like physicians, nurses recommend significant EHR interface improvement to decrease cognitive load.

But while there are ways to reduce burden, policy changes and health IT advances will likely increase the amount of information in the EHR, which could lead to further time in the EHR, wrote the authors.

“It is reasonable to assume that the typical nurse may see increases in the amount of data, patient contributed or otherwise, in the EHR,” wrote the study authors. “Skills to turn those data into actionable information to make clinical decisions could be augmented with increased digital literacy and simulations in nursing programs.”

Researchers pointed at a study based on HIE usage reports that said nurses were more likely to access that system to access information. However, other studies reported EHR users said EHRs are a direct result of information overload. Thus, additional information in the EHR may worsen clinician burden even with advanced EHR training.  

“Future research is needed to test multicomponent interventions that address these complex factors and use participatory approaches to engage nurses in intervention development,” concluded the study authors.