Nursing Perspectives on Documentation Burden in a Veterans Affairs Health Care System

The growing integration of the electronic health record in health systems has contributed to care improvements, yet is increasingly recognized as a source of stress and burnout for nurses. This study, conducted in a southeastern Veterans Affairs health system, used focus groups composed of 51 direct care nurses in shared governance councils practicing across inpatient and outpatient settings to assess their perspectives regarding documentation burden. Qualitative content analysis of focus group transcripts revealed 4 themes: poor usability, uncertainty, nonvalue added to patient care, and risk for error and liability. Fifteen subthemes were identified. Participants perceived much documentation as duplicative, nonimpactful on patient outcomes, and frequently driven by regulatory or quality reporting rather than clinical necessity. The findings reflect current literature and align with the American Nurses Informatics Association's Six Domains of Burden Framework, which underscores documentation burden as a modifiable, systems-level issue. Engaging direct care nurses through shared governance structures may support targeted solutions such as eliminating duplicate documentation, enhancing electronic documentation usability, and clarifying documentation standards. Health information systems redesign must focus on the safety and well-being of both nurses and patients to ensure the provision of quality nursing care and retention of a strong nursing workforce.