Caring for the EHR Rather Than the Patient: Nurses' Perception of Documentation Burden

Nursing documentation is essential for communication and patient safety, yet the increasing documentation requirements in EHRs have contributed to the documentation burden.

To examine inpatient nurses' perceptions of EHR-related documentation burden and identify specific documentation elements viewed as misaligned with patient care.

We adapted a validated tool, the Burden of Documentation for Nurses and Midwives (BurDoNsaM), which measures nurses' perceptions of EHR burden. The study took place at a large academic medical center in the Midwest, focusing on inpatient nurses in acute and critical care units.

A total of 193 participants responded to the survey, of whom 133 were included in the final analysis. Although 92% (n=122) of nurses agreed that documentation is essential for communication, 88% (n=117) reported that they primarily complete documentation for compliance rather than to support patient care. Nurses' comments highlighted 3 recurring concerns: (1) repetitive entries; (2) care plans rated as the lowest value and perceived as disconnected from actual patient needs; and (3) the frequency of safety rounds was seen as redundant.

Nurses value documentation but view it as a compliance task. Findings highlight pain points in nurses' documentation and expose gaps between required documentation and meaningful clinical work. Addressing redundancy, reducing repetitive documentation, and redesigning care plans can significantly reduce the EHR burden.