When it hits the mark, satire is sometimes mistaken for truth. For example, when this “article” Nurses Now Required to Chart What and When They are Charting was making the rounds on Facebook I saw more than a few comments from nurses who mistook it as real news. “As if we don’t have enough to do,” and “Like computerized charting isn’t bad enough,” were some of their opinions on it.
The piece jokes that nurses will have to chart that they are charting: “Nurses are required to additionally document, ‘I am currently charting that I documented the prior statement: rang call light for PRN pain medication, dispersed 1000mg acetaminophen.'”
How could something that sounds so silly be mistaken as a legitimate news article? Because good satire contains a bit of truth. In this case, the reality it’s alluding to is nurses’ frustration with EHRs.
According to survey results released in October by Black Book Market Research, 92% of nurses were dissatisfied with inpatient EHR systems. They reported the technology has disrupted workflow and productivity and negatively affected their jobs. Lest you think this is just another case of front line staff being resistant to change, hospital administrators validated these statements. Some 84% of administrators at not-for-profit hospitals and 97% of administrators at for-profit hospitals confirmed that EHRs’ impact on nurses’ workloads were not considered highly enough when selecting an EHR system.
Here’s more specifics on the nurses’ responses regarding EHRs:
- 98% of nurses at for-profit, chain facilities are dissatisfied with the time allowed to be spent with patients versus the time allowed to document on the EHR.
- 94% of nurses do not believe the use of their current EHR system has improved the communication between nurses and the care team.
- 90% of nurses said their facilities’ current EHR systems negatively impacted communication between nurses and patients.
- 30% of nurses believe their hospitals’ IT departments and administrations respond quickly to make changes in the EHR when nurses recognize vulnerabilities in documentation.
- 26% of nurses agree with the statement, “As a nurse, I believe the current EHR at my organization improves the quality of patient information.”
Achieving Meaningful Use has been a motivating factor spurring facilities to adopt EHRs, and according to the ONC it improves quality, safety, patient engagement, and care coordination. But are these goals really being met? The nurses’ responses aren’t exactly a resounding endorsement from the professionals giving the bulk of hands-on patient care.
So what can be done to improve nurses’ experiences with EHRs?
First off, bedside nurses need to be included in the decision making process when selecting an EHR system. It’s not enough for nursing administrators or managers to be the only nursing representatives evaluating the options. They may understand financial and business reasons surrounding EHRs, but they don’t have a handle on nurses’ day-to-day workflow and how EHRs may affect patient care. Those using the technology to provide patient care 24/7 need to have a say.
Speaking of finances, 88% of nurses blame financial administrators and CIOs for selecting low-performing systems based on pricing and incentives and for cutting corners at the expense of care quality. Yes, being fiscally responsible is important but sometimes you get what you pay for. I’ve seen the results of this firsthand and it’s not pretty.
One employer had an unbearable EHR system. Part of the problem was nurses’ workflow had not been considered when implementing the system. But another issue was the organization had not paid extra to have the system customized for its specific needs. Because of this, nurses faced excess amounts of charting just to get through screens and fields that were irrelevant.
There must also be continued evaluation of the system. You can’t just launch an EHR and be done with it. There needs to be follow-up to see how it is performing and how it is or is not interrupting nurses’ workflows. There needs to be hard data collected regarding time spent charting versus time spent providing patient care so an honest evaluation can be made. Patient outcomes and experiences also need to be assessed to see how the technology is affecting those situations.
Finally, issues brought to light by nurses need to be fixed in a timely manner. Sadly, respondents to the survey did not have kind words for their IT colleagues. In addition to being slow to resolve problems, 69% of nurses in for-profit inpatient settings reported their IT department as “incompetent” when describing the level of expertise their organization’s in-house staff has working with the selected EHR software.
The results of the survey may sound harsh and critical of EHR and IT, but it’s essential that the nurses’ message be heard. All the patient satisfaction measures, quality improvements, safety initiatives that are now being championed will be worthless if workflow and patient care are impeded to the point that patient outcomes are being negatively affected. It’s time to start listening to what nurses using EHR systems are saying before there is a crisis involving patient outcomes.
Jennifer Thew, RN, MSJ
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