Reducing documentation burden to improve nurse and midwife satisfaction: A mixed-methods study

Abstract

Objective

To examine midwife and nurse satisfaction pre- and post- an intervention designed to decrease documentation burden in a maternity setting.

Background

The burden imposed on nurses and midwives by documentation demands are a source of dissatisfaction, resulting in missed care, worsening job dissatisfaction.

Study design and methods

A convergent mixed-methods design (QUAN + Qual). Satisfaction was examined using a survey to collect quantitative data and focus groups to collect qualitative data. The intervention reviewed documentation for duplication, redundancy, and modification, resulting in the creation of streamlined, and user-friendly documentation. Data were collected using a validated tool developed to measure nursing and midwifery documentation burden, and via focus groups to explore satisfaction pre- and post-intervention and changes to documentation.

Results

Following integration of the data, feedback from the focus groups (n = 17) confirmed the survey results from n = 28 post-intervention respondents; participants were satisfied with many elements of the new documentation. The focus groups also highlighted areas where further refinements to the new documentation could be made. The intervention improved midwives' satisfaction with documentation with respect to ease, complexity, and relevance of the documentation. Issues with the time needed to complete documentation following the intervention remain.

Conclusion

Satisfaction with many elements of documentation was achieved, indicating that the focus on removing known sources of dissatisfaction with documentation, including duplication and unnecessary documentation, was effective in a maternity setting. Intervening to reduce duplication and redundancy, and modifying patient clinical documentation, can improve nurse and midwife satisfaction with this aspect of their job.

Reporting method

This article follows the Good Reporting of a Mixed Methods Study (GRAMMS) guidelines.¹

No Patient or Public Contribution

What is already known about documentation burden

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  Clinical documentation is a medicolegal requirement.
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  There is a burden associated with clinical documentation that is a source of job dissatisfaction.

What this paper adds

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  Focusing on removing known sources of dissatisfaction with patient clinical documentation, including duplication and unnecessary documentation, is effective in decreasing nurse and midwife dissatisfaction with this part of their job.
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  How nurses and midwives perceive the continuity, consistency and quality of a maternity patient's care can be improved by removing known sources of nurse and midwife dissatisfaction with patient clinical documentation.
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  The time needed to complete documentation is a source of job dissatisfaction even after acting to improve this aspect of nurses and midwives' work, highlighting the need for continuous refinement of documentation.