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Appl Clin Inform 2022; 13(05): 983-990
DOI: 10.1055/s-0042-1757157
Research Article

Documentation Burden in Nursing and Its Role in Clinician Burnout Syndrome

Emily Gesner
1   University of Massachusetts-Dartmouth, North Darmouth, Massachusetts, United States
,
Patricia C. Dykes
2   Brigham and Women's Hospital, Massachusetts, United States
3   Harvard Medical School, Massachusetts, United States
,
Lingling Zhang
4   University of Massachusetts-Boston, Bostan, Massachusetts, United States
,
Priscilla Gazarian
4   University of Massachusetts-Boston, Bostan, Massachusetts, United States
› Author Affiliations Funding None.
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Abstract

Objectives The purpose of this study is to understand the relationship between documentation burden and clinician burnout syndrome in nurses working in direct patient care. The Office of the National Coordinator considers documentation burden a high priority problem. However, the presence of documentation burden in nurses working in direct patient care is not well known. Furthermore, the presence of documentation burden has not been linked to the development of clinician burnout syndrome.

Methods This paper reports that the results of a cross-sectional survey study comprised of three tools: (1) The burden of documentation for nurses and mid-wives survey, (2) the system usability scale, and (3) Maslach's burnout inventory for medical professionals.

Results Documentation burden has a weak to moderate correlation to clinician burnout syndrome. Furthermore, poor usability of the electronic health record (EHR) is also associated with documentation burden and clinician burnout syndrome.

Conclusion This study suggests that there is a relationship between documentation burden and clinician burnout syndrome. The correlation of poor usability and domains of clinician burnout syndrome implies the need for more work on improving the usability of EHR for nursing documentation. Further study regarding the presence of documentation burden and its correlation to clinician burnout syndrome should focus on specific areas of nursing to understand the drivers of documentation burden variation within and across specialty domains.

Keywords

documentation - burnout - electronic health record - health care providers - documentation burden - nurse burnout

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects, and was reviewed by University of Massachusetts-Boston Institutional Review Board.




Publication History

Received: 31 January 2022

Accepted: 01 August 2022

Article published online:
19 October 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Willard-Grace R, Knox M, Huang B, Hammer H, Kivlahan C, Grumbach K. Burnout and health care workforce turnover. Ann Fam Med 2019; 17 (01) 36-41
    CrossrefPubMedSearch in Google Scholar
  • 2 Friganović A, Selič P, Ilić B, Sedić B. Stress and burnout syndrome and their associations with coping and job satisfaction in critical care nurses: a literature review. Psychiatr Danub 2019; 31 (2, suppl 1): 21-31
    PubMedSearch in Google Scholar
  • 3 Padilla Fortunatti C, Palmeiro-Silva YK. Effort-reward imbalance and burnout among ICU nursing staff: a cross-sectional study. Nurs Res 2017; 66 (05) 410-416
    CrossrefPubMedSearch in Google Scholar
  • 4 McHugh MD, Kutney-Lee A, Cimiotti JP, Sloane DM, Aiken LH. Nurses' widespread job dissatisfaction, burnout, and frustration with health benefits signal problems for patient care. Health Aff (Millwood) 2011; 30 (02) 202-210
    CrossrefPubMedSearch in Google Scholar
  • 5 NSI. 2021 National Health Care Retention & RN staffing report. NSI Nursing Solutions . Recruitment Retention Results 2021; ;(717): 560-3863
    PubMedSearch in Google Scholar
  • 6 Colosi B, Nursing S. 2019. National Health Care Retention & RN Staffing Report. Nursing Solutions Inc.; Published 2019
  • 7 Schutte L. Building a business case for recruitment and retention best practice - association of staff physician recruiters. In: Journal of Association of Staff Physician Recruiters (ASPR). St. Louis: : Association of Staff Physician Recruiters; 2012
  • 8 Alharbi J, Wilson R, Woods C, Usher K. The factors influencing burnout and job satisfaction among critical care nurses: a study of Saudi critical care nurses. J Nurs Manag 2016; 24 (06) 708-717
    CrossrefPubMedSearch in Google Scholar
  • 9 Neumann JL, Mau LW, Virani S. et al. Burnout, moral distress, work-life balance, and career satisfaction among hematopoietic cell transplantation professionals. Biol Blood Marrow Transplant 2018; 24 (04) 849-860
    CrossrefPubMedSearch in Google Scholar
  • 10 Rozo JA, Olson DM, Thu HS, Stutzman SE. Situational factors associated with burnout among emergency department nurses. Workplace Health Saf 2017; 65 (06) 262-265
    CrossrefPubMedSearch in Google Scholar
  • 11 Gesner E, Gazarian P, Dykes P. The burden and burnout in documenting patient care: an integrative literature review. Stud Health Technol Inform 2019; 264: 1194-1198
    PubMedSearch in Google Scholar
  • 12 Moy AJ, Schwartz JM, Chen R. et al. Measurement of clinical documentation burden among physicians and nurses using electronic health records: a scoping review. J Am Med Inform Assoc 2021; 28 (05) 998-1008
    CrossrefPubMedSearch in Google Scholar
  • 13 Padden J. Documentation burden and cognitive burden. CIN: Computers, Informatics . Nursing 2019; 37 (02) 60-61
    PubMedSearch in Google Scholar
  • 14 Colicchio TK, Cimino JJ, Del Fiol G. Unintended consequences of nationwide electronic health record adoption: challenges and opportunities in the post-meaningful use era. J Med Internet Res 2019; 21 (06) e13313-e13313
    CrossrefPubMedSearch in Google Scholar
  • 15 Kaye SP. Nurses' attitudes toward meaningful use technologies: an integrative review. CIN: computers, informatics. Nursing 2017; 35 (05) 237-247
    PubMedSearch in Google Scholar
  • 16 Matthews JH, Bruflat CM, Chard R. American Nurses Association. ANA's Principles for Nursing Documentation : Guidance for Registered Nurses
    PubMed
  • 17 Oregon Secretary of State. Oregon Secretary of State Administrative Rules- Nurse Practice Act. Published 2017. Accessed July 5, 2022 at: https://secure.sos.state.or.us/oard/viewSingleRule.action?ruleVrsnRsn=216342
    PubMed
  • 18 Board of Registration in Nursing. Massachusetts Nurse Practice Act; 1994. Accessed July 5, 2022 at: https://www.massnurses.org/files/file/Legislation-and-Politics/np_act.pdf
    PubMed
  • 19 Campos NK. The legalities of nursing documentation. Nursing Manage (Brux) 2009; 40: 16-19
    CrossrefPubMedSearch in Google Scholar
  • 20 Darmawan VI, Suharsono T, Kristianingrum ND, Chalidyanto D. The relationship between nurses' motivation and electronic nursing care documentation in a hospital inpatient unit. Eur J Mol Clin Med 2020; 07 (05) 803-807
    PubMedSearch in Google Scholar
  • 21 Howe JL, Adams KT, Hettinger AZ, Ratwani RM. The use of health information technology to improve care and outcomes for older adults. Res Gerontol Nurs 2015; 8 (01) 5-10
    CrossrefPubMedSearch in Google Scholar
  • 22 Keene DJ, Lamb SE, Mistry D. et al. “Electronic health record usability issues and potential contribution to patient harm.”. Journal of the American Medical Association 2018; 319 (12) 1276-1278
    CrossrefPubMedSearch in Google Scholar
  • 23 Middleton B, Bloomrosen M, Dente MA. et al; American Medical Informatics Association. Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA. J Am Med Inform Assoc 2013; 20 (e1): e2-e8
    CrossrefPubMedSearch in Google Scholar
  • 24 Melnick ER, Dyrbye LN, Sinsky CA. et al. The association between perceived electronic health record usability and professional burnout among US physicians. Mayo Clin Proc 2020; 95 (03) 476-487
    CrossrefPubMedSearch in Google Scholar
  • 25 Sengstack P. Think Globally, Act Locally: Reducing the Burden of Documentation in the EHR. Paper presented at: NENIC Annual Symposium; 2019
    PubMedSearch in Google Scholar
  • 26 Sutton DE, Fogel JR, Giard AS, Gulker LA, Ivory CH, Rosa AM. Defining an essential clinical dataset for admission patient history to reduce nursing documentation burden. Appl Clin Inform 2020; 11 (03) 464-473
    Thieme ConnectPubMedSearch in Google Scholar
  • 27 Collins S, Couture B, Kang MJMJ. et al. Quantifying and visualizing nursing flowsheet documentation burden in acute and critical care. AMIA Annu Symp Proc 2018; 2018: 348-357
    PubMedSearch in Google Scholar
  • 28 Collins S, Couture B, Kang MJ. et al. Quantifying and visualizing nursing flowsheet documentation burden in acute and critical care. Paper presented at: AMIA Annu Symp Proc. Published online 2018: under review
    PubMed
  • 29 Baumann LA, Baker J, Elshaug AG. The impact of electronic health record systems on clinical documentation times: a systematic review. Health Policy 2018; 122 (08) 827-836
    CrossrefPubMedSearch in Google Scholar
  • 30 Shanafelt TD, Dyrbye LN, Sinsky C. et al. Relationship between clerical burden and characteristics of the electronic environment with physician burnout and professional satisfaction. Mayo Clin Proc 2016; 91 (07) 836-848
    Search in Google Scholar
  • 31 Schierberl Scherr AE, Ayotte BJ, Kellogg MB. Moderating roles of resilience and social support on psychiatric and practice outcomes in nurses working during the COVID-19 pandemic. SAGE Open Nurs 2021;7:23779608211024213
    PubMed
  • 32 Qualitrics Survey Software. Published online 2020
    PubMed
  • 33 Shaufell W, Leiter MP, Masalach C, Jackson SE. Maslach Burnout Inventory-HSS Scoring and Interpretation Key;2016. Accessed July 5, 2022 at: www.mindgarden.com
    PubMed
  • 34 Maslach C, Jackson S, Leiter MP. Maslach Burnout Inventory Manual. 4th ed. 2014
    Search in Google Scholar
  • 35 Gold Y. The factorial validity of the Maslach Burnout Inventory in a sample of California elementary and junior high school classroom teachers. Educ Psychol Meas 1984; 44 (04) 1009-1016
    CrossrefPubMedSearch in Google Scholar
  • 36 Iwanicki EF, Schwab RL. A cross validation study of the Maslach Burnout Inventory. Educ Psychol Meas 1981; 41 (04) 1167-1174
    CrossrefPubMedSearch in Google Scholar
  • 37 Brown JA, Cooper AL, Albrecht MA. Development and content validation of the Burden of Documentation for Nurses and Midwives (BurDoNsaM) survey. J Adv Nurs 2020; 76 (05) 1273-1281
    CrossrefPubMedSearch in Google Scholar
  • 38 Bangor A, Kortum PT, Miller JT. An empirical evaluation of the system usability scale. Int J Hum Comput Interact 2008; 24 (06) 574-594
    CrossrefPubMedSearch in Google Scholar
  • 39 Lewis JR, Utesch BS, Maher DE. Measuring perceived usability: the SUS, UMUX-LITE, and AltUsability. Int J Hum Comput Interact 2015; 31 (08) 496-505
    CrossrefPubMedSearch in Google Scholar
  • 40 Peres SC, Pham T, Phillips R. Validation of the system usability scale (SUS): SUS in the wild. Proc Hum Factors Ergon Soc Annu Meet 2013; 57 (01) 192-196
    CrossrefPubMedSearch in Google Scholar
  • 41 Martins AI, Rosa AF, Queirós A, Silva A, Rocha NP. European Portuguese validation of the system usability scale (SUS). Procedia Comput Sci 2015; 67: 293-300
    CrossrefPubMedSearch in Google Scholar
  • 42 Will T. Measuring and interpreting system usability scale. Published 2022. Accessed July 5, 2022 at: https://uiuxtrend.com/measuring-system-usability-scale-sus/
    PubMed
  • 43 Gesner E, Gazarian P, Dykes P. The burden and burnout in documenting patient care: an integrative literature review. Stud Health Technol Inform 2019; 264: 1194-1198
    PubMedSearch in Google Scholar
  • 44 Guo U, Chen L, Mehta PH. Electronic health record innovations: helping physicians - one less click at a time. HIM J 2017; 46 (03) 140-144
    CrossrefPubMedSearch in Google Scholar
  • 45 Krist AH, Beasley JW, Crosson JC. et al. Electronic health record functionality needed to better support primary care. J Am Med Inform Assoc 2014; 21 (05) 764-771
    CrossrefPubMedSearch in Google Scholar
  • 46 National Council of State Boards of Nursing. NCSBN's environmental scan: a portrait of nursing and healthcare in 2020 and beyond. J Nurs Regul 2020; 10 (04) S1-S36
    CrossrefPubMedSearch in Google Scholar
  • 47 Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory Manual. Published online 1996
    PubMed
  • 48 Brooks Carthon JM, Hatfield L, Brom H. et al. System-level improvements in work environments lead to lower nurse burnout and higher patient satisfaction. J Nurs Care Qual 2021; 36 (01) 7-13
    CrossrefPubMedSearch in Google Scholar
  • 49 Aiken LH, Sloane DM, Clarke S. et al. Importance of work environments on hospital outcomes in nine countries. Int J Qual Health Care 2011; 23 (04) 357-364
    CrossrefPubMedSearch in Google Scholar
  • 50 Kelly LA, Gee PM, Butler RJ. Impact of nurse burnout on organizational and position turnover. Nurs Outlook 2021; 69 (01) 96-102
    CrossrefPubMedSearch in Google Scholar
  • 51 De Groot K, De Veer AJE, Munster AM, Francke AL, Paans W. Nursing documentation and its relationship with perceived nursing workload: a mixed-methods study among community nurses. BMC Nurs 2022; 21 (01) 34
    CrossrefPubMedSearch in Google Scholar
  • 52 Hobensack M, Levy DR, Cato K. 25 by 5: symposium to reduce documentation burden on U.S. clinicians by 75% by 2025. Appl Clin Inform 2022; Mar; 13 (02) 439-446
    Thieme ConnectPubMedSearch in Google Scholar
  • 53 Shah T, Borondy Kitts A, Gold JA. et al. Electronic Health Record Optimization and Clinician Well-Being: A Potential Roadmap Toward Action. NAM Perspectives; 2020
    Search in Google Scholar
  • 54 Wüller H, Behrens J, Garthaus M, Marquard S, Remmers H. A scoping review of augmented reality in nursing. BMC Nurs 2019; 18 (01) 19
    CrossrefPubMedSearch in Google Scholar
  • 55 Roberts N. How artificial intelligence works. Nurs Manage 2019; 3 (March): 10
    PubMedSearch in Google Scholar
  • 56 UCONN Health Clinical Policy. Documentation – Reduced Inpatient Nursing For COVID-19 Pandemic Response;. 2020
    PubMedSearch in Google Scholar
  • 57 Kirwan M, Matthews A, Scott PA. The impact of the work environment of nurses on patient safety outcomes: a multi-level modelling approach. Int J Nurs Stud 2013; 50 (02) 253-263
    CrossrefPubMedSearch in Google Scholar