Time Spent by Intensive Care Unit Nurses on the Electronic Health Record

Abstract

Background The amount of time spent on the electronic health record is often cited as a contributing factor to burnout and work-related stress in nurses. Increased electronic health record use also reduces the time nurses have for direct contact with patients and families. There has been minimal investigation into the amount of time intensive care unit nurses spend on the electronic health record. Objective To quantify the amount of time spent by intensive care unit nurses on the electronic health record. Methods In this observational study, active electronic health record use time was analyzed for 317 intensive care unit nurses in a single institution from January 2019 through July 2020. Monthly data on electronic health record use by nurses in the medical, neurosurgical, and surgical-trauma intensive care units were evaluated. Results Full-time intensive care unit nurses spent 28.9 hours per month on the electronic health record, about 17.5% of their clinical shift, for a total of 346.3 hours per year. Part-time nurses and those working as needed spent 20.5 hours per month (17.6%) and 7.4 hours per month (14.2%) on the electronic health record, respectively. Neurosurgical and medical intensive care unit nurses spent 25.0 hours and 19.9 hours per month, respectively. Nurses averaged 23 clicks per minute during use. Most time was spent on the task of documentation at 12.3 hours per month, which was followed by medical record review at 2.6 hours per month. Conclusion Intensive care unit nurses spend at least 17% of their shift on the electronic health record, primarily on documentation. Future interventions are necessary to reduce time spent on the electronic health record and to improve nurse and patient satisfaction.

A Systematic Review of Nurses' Perceptions of Electronic Health Record Usability Based on the Human Factor Goals of Satisfaction, Performance, and Safety

“…1,2 The large amount of time spent on EHRs is often considered a contributing factor to nurses' burnout and work-related stress. 3 Despite the widespread use of EHRs, nurses' documentation needs within the EHR are not well supported. 4 The poor usability of EHRs has emerged as a major barrier to their effective use by nurses, particularly when considering the substantial amount of work they undertake.…”

“…4 The poor usability of EHRs has emerged as a major barrier to their effective use by nurses, particularly when considering the substantial amount of work they undertake. 3,4 The impact of poor EHR usability on nurses' workload burden and burnout is well known. [5][6][7] The time required to perform EHR tasks, the difficulty of these tasks, and the overall usability of the system directly impact the mental workload experienced by nurses.…”

“…Nurses rely on electronic health records (EHRs) for clinical decision-making, documentation, and care coordination 1 . Clinical nurses spend 17% to 27% of their work time on EHR-related work, 1–3 which surpasses the time dedicated to communication or direct/indirect patient care activity 1,2 . The large amount of time spent on EHRs is often considered a contributing factor to nurses' burnout and work-related stress 3 .…”

“…Clinical nurses spend 17% to 27% of their work time on EHR-related work, 1–3 which surpasses the time dedicated to communication or direct/indirect patient care activity 1,2 . The large amount of time spent on EHRs is often considered a contributing factor to nurses' burnout and work-related stress 3 . Despite the widespread use of EHRs, nurses' documentation needs within the EHR are not well supported 4 …”

“…The poor usability of EHRs has emerged as a major barrier to their effective use by nurses, particularly when considering the substantial amount of work they undertake 3,4 . The impact of poor EHR usability on nurses' workload burden and burnout is well known 5–7 .…”