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Appl Clin Inform 2025; 16(05): 1799-1814
DOI: 10.1055/a-2750-4422
Research Article

Variations in Nursing Documentation Time in a Mental Health Setting: A Retrospective Observational Study of EHR Usage Data

Autoren

  • Jessica Kemp

    1   Centre for Addiction and Mental Health, Toronto, Ontario, Canada
    2   Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

  • Hwayeon D. Shin

    1   Centre for Addiction and Mental Health, Toronto, Ontario, Canada
    2   Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

  • Charlotte Pape

    1   Centre for Addiction and Mental Health, Toronto, Ontario, Canada

  • Alina Lee

    1   Centre for Addiction and Mental Health, Toronto, Ontario, Canada

  • Bay Bahri

    3   University of Toronto, Toronto, Ontario, Canada

  • Wei Wang

    1   Centre for Addiction and Mental Health, Toronto, Ontario, Canada

  • Sara Ling

    1   Centre for Addiction and Mental Health, Toronto, Ontario, Canada

  • Gillian Strudwick

    1   Centre for Addiction and Mental Health, Toronto, Ontario, Canada
    2   Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

Funding This work was supported by the Canadian Institutes of Health Research, Government of Canada.
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Abstract

Background

Nurses are the largest group of electronic health record (EHR) users in Canada, yet their experiences with documentation burden remain underexplored. While EHR-generated usage data, such as audit logs and time-motion metrics, have been used to quantify documentation time, they are rarely used to better understand EHR inefficiencies and identify potential changes for nursing documentation and workflows. This approach may help address instances of documentation demands detracting from direct patient care and contributing to burnout, which has been largely reported by nurses.

Objectives

This study aimed to: (1) examine EHR utilization patterns and time spent by nurses across clinical venues and nurse types; (2) identify EHR areas contributing most to nursing workload; (3) determine predictors of EHR time; and (4) assess differences in usage patterns across venues.

Methods

We analyzed 12 months of EHR usage data from nurses at Canada's largest academic mental health hospital using Cerner Advance (Oracle Health). Seven metrics were selected in collaboration with a Nursing Advisory Council. Regression and least-squares means comparisons were conducted using R, with venue and nurse type as predictors.

Results

Data from 840 nurses revealed significant differences in EHR usage across venues and nurse types. Mean active time per patient per shift was highest in inpatient (19.3 minutes), followed by emergency (14.8 minutes), and ambulatory settings (6.3 minutes). Registered Practical Nurses (RPNs) averaged more active EHR time (20.1 minutes) than Registered Nurses (16.4 minutes). Documentation time per patient was significantly different across venues (F [3,832] = 71.97, p < 0.001) and nurse types (p = 0.0018). PowerForms time also varied significantly (F [3,818] = 102.1, p < 0.001). These findings support targeted EHR optimization efforts based on clinical context and role.

Conclusion

Significant variation exists in how nurses interact with EHRs, with documentation representing a substantial time burden, especially for RPNs and inpatient settings. These findings emphasize the need for venue and role-specific optimization strategies and underscore the importance of including nurses' voices in EHR design and quality improvement initiatives.

Keywords

nursing informatics - health informatics - clinical informatics - EHR - burnout - documentation burden

Protection of Human and Animal Subjects

This study was reviewed and approved by the Research Ethics Board (REB) at the Centre for Addiction and Mental Health, as well as the University of Toronto.


Supplementary Material



Publikationsverlauf

Eingereicht: 15. Juli 2025

Angenommen: 18. November 2025

Artikel online veröffentlicht:
05. Dezember 2025

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