Nurse dissatisfaction with electronic health records can influence job satisfaction. Common complaints are disruptions in productivity and workflow, a negative impact on communication between nurses and patients; and many say that electronic health records haven’t necessarily improved communication between providers because of delays in charting. Interruptions, insufficient staffing and excessive documentation requirements in EHRs add to delays. Nurses need time for real-time charting to ensure that other health care providers can access up-to-date information on patients.

At Nemours Children’s Health System in Jacksonville, Fla., optimizing clinical workflows to improve patient care and safety, along with increasing caregiver efficiency is a priority. Connie Trusko, R.N., senior director of clinical applications, says, “In the past, our nurses needed to document in two separate applications for collecting patient labs. We optimized the EHR to encompass both application workflows, thereby reducing that documentation from two applications to one.” Clinical pathways were built in the EHR for specific disease conditions that direct consistency with ordering medications, standard diagnostic tests and treatments. Using a version of their EHR optimized for use on mobile devices, Nemours has enabled clinicians to enter documentation, place orders and review results from their iPhones. 

The creation and implementation of EHR tracking boards that provide real-time visualizations of patient information, such as methicillin-resistant Staphylococcus aureus or implants, helps to ensure that antibiotics are ordered promptly. This improves patient outcomes and directly correlates to a decreased risk in surgical infections. 

Checklist

  • Make sure your EHR selection takes nursing workflow into account.
  • Use nursing informatics to analyze impacts on nurse workflow. 
  • Obtain nurse feedback to identify problems with the system that waste time better spent on patient care.
  • Streamline processes to avoid logging in and out, paging through unnecessary screens, duplicate entries and trying to find where to chart something.
  • Provide ongoing training for nurse documentation and access to superusers well-versed in the technology.