Exploring nurses' documentation prioritization strategies to alleviate EHR documentation burden: a phenomenological study.

Abstract

Objective: This study aims to understand how inpatient nurses determine and prioritize necessary documentation within the context of the Excessive Documentation Burden (ExDocBurden) in Electronic Health Records (EHRs).

Methodology: A phenomenological approach was used to explore inpatient nurses' lived experiences of prioritizing EHR documentation. Interpretive phenomenology guided the study design, focusing on how nurses prioritize documentation. Purposive sampling recruited 14 registered nurses (RNs) from acute and critical care settings. Data was collected through semi-structured interviews and analyzed using Colaizzi's 7-step and Smith's Interpretive Phenomenology Analysis.

Results: Five themes emerged: (1) Advocating for Quality Patient Care Environment and Patient Needs, (2) What to Document in Near-Real Time Versus What Can Wait, (3) EHR-Driven Documentation and the Erosion of Nurse Autonomy, (4) Unnecessary (Frequent and Redundant) Documentation, and (5) Fear, Frustration, and Punitive Pressure in Charting. Nurses prioritized patient care over EHR documentation and frequently encountered unnecessary and redundant documentation tasks that did not contribute to patient needs. Defensive charting practices driven by fear of litigation further compounded nurses' emotional strain.

Discussion: The study emphasizes the importance of empowering nurses by minimizing non-value-added documentation and enabling them to exercise their clinical judgment. Streamlining documentation processes can help alleviate the emotional and mental strain on nurses, enabling a more patient-centered approach to care.

Conclusion: Understanding how experienced nurses prioritize documentation in the context of ExDocBurden provides valuable insights to ameliorate EHR Burden. Nurses drive quality of patient care; consequently, supporting nurse-driven documentation enhances both patient care quality and organizational needs.