Special Topic Burnout: Improving Nurse Documentation Time via an Electronic Health Record Documentation Efficiency Tool

Background: Nursing documentation burden is a growing point of concern in the United States healthcare system. Documentation in the electronic health record (EHR) is a contributor to perceptions of burden. Efficiency tools like flowsheet macros are one development intended to ease the burden of documentation. Objective: Evaluate if flowsheet macros, a documentation efficiency tool in the EHR that consolidates documentation into a single click, reduces the time spent in documentation activities and the EHR overall. Methods: Nurses in the health system were encouraged to create and utilize flowsheet macros for their documentation. Flowsheet documentation and time in system data for nurses’ first and last shift in the evaluation period was extracted from the EHR. Linear regression with control variables was utilized to understand if utilization of flowsheet macros for documentation reduced the time spent in flowsheets or the EHR. Results: The results of linear regression showed a significant, negative relationship between flowsheet macros use and time in flowsheets (AOR = -0.291, CI = -0.342 - -0.240, p < 0.001). Flowsheet macros use and time in system also had a significant, negative relationship (AOR = -0.269, CI = -0.390 - -0.147, p = <0.001). Subgroups for department specialties showed time savings in flowsheet activities for medical surgical, critical care, and obstetrics units, however a significant relationship was not found in emergency and rehabilitation units. Conclusion: Utilization of flowsheet macros was associated with a decrease in the amount of time a nurse spends in both flowsheets and the EHR. Adoption and time savings varied by the department setting, suggesting flowsheet macros may not be applicable to all patient types or conditions. Future research should investigate if the time savings from this tool yield benefits in perceptions of nurse documentation burden.

Publication History

Received: 04 December 2024

Accepted after revision: 10 April 2025

Accepted Manuscript online:
11 April 2025