Taming the EMR Dragon: A Tale of Optimization Triumph Over Nursing Burnout

Increased workloads in ambulatory care paired with critically low staffing levels have contributed to increased burnout of nurses and care providers. According to a meta-analysis by Moy et al. (2021), ambulatory care nurses and providers spend twice as much time on electronic documentation and clerical tasks in the EMR, e.g., EMR in-basket management, telephone encounters, and paperwork, which play a large role in increased workloads leading to an increased in errors, poor documentation quality, threats to patient safety, and ultimately burnout. Social trends of instant messaging and virtual communication have changed patient preferences and expectations regarding communication and care delivery in health care. Additionally, challenges related to appropriate clinical care and a variety of scopes/competencies within the ambulatory care setting add to the complexity of delivering high-quality patient care and meeting patient satisfaction.

Our interdisciplinary team recognized the increased workload as a source of burnout, leading to the need for optimizing workflows, maximizing EMR features, and promoting clinical staff working at the top of their scope. A workgroup was formed, aimed at providing in-person meaningful education to staff focused on appropriate use of smart phrases, actionable items, and EMR efficiency tools. Education sessions consisted of 4-hour in-person sessions held in varying locations throughout the clinic region from September to December 2023. Education sessions were conducted in a manner to facilitate dialogue, feedback, and requests from attendees. The education became a “living document” that was continually updated and honed to the needs of the staff and the scope of their practice. Post-education “at the elbow” support and clinic rounding are scheduled to be implemented during the first quarter of 2024 with a goal of assisting staff with implementing EMR customization tools.

To measure the impact of the education, staff were asked to take pre- and post-surveys regarding their base knowledge and the effectiveness of the education. Pre-survey's confirmed the workgroup's initial suspicion that a deficit in knowledge and practice of actionable items was low-hanging fruit, in addition to the fact that staff feel overwhelmed with their workload and cannot get their tasks completed within expected timeframes. Post-survey data showed that 65% of attendees planned to make changes to their practice. Attendee survey feedback identified a variety of stated optimization methods. Survey data collection is not complete at the time of abstract submission, as education sessions are planned through the end of the year.

Both anecdotal and survey response to education content and presentation format confirmed the need for and value of incorporating optimization, efficiencies, and professional electronic communication into staff training. The need to professionally communicate expectations regarding what platforms are most appropriate for various care needs became an important tool to help reduce burnout and improve patient satisfaction and quality of care.