Is your EHR hurting your nurses?

And affecting patient care?
By Steve Reinecke
09:58 AM
doctor using tablet with hospital patient

Healthcare organizations continue to face unprecedented change. Electronic health records are altering nearly every aspect of the caregiver-patient relationship – not to mention changing caregivers’ workflows with omnipresent tablets, handhelds, wall mounts and mobile carts. Today, nurses are on the front lines of this transformation. During a typical shift, they spend 35 percent of their time on documentation, or 3.5 hours of their workday entering information at a computer. Despite this, a recent survey from HIMSS Analytics found that 71 percent of nurses would not consider going back to paper-based medical records. What’s more, nurse respondents agree that EHR benefits are good for patient safety: 72 percent believe they improve patient safety and avoid medication errors and 73 percent admit they enable collaboration with other clinicians inside their organizations.

Underscoring every EHR implementation is the goal of doing business more efficiently, and the HIMSS Analytics findings demonstrate nurses’ integral role in helping hospitals achieve this. It is of equal importance that administrators understand the complete picture surrounding the complex systems nurses have to master. If the necessary equipment doesn’t fit within their workflow or is uncomfortable to work on, not only will EHR systems never reach their full potential, but they stand to cause physical strain to caregivers. This limits their ability to execute their jobs and can ultimately impact the quality of care patients receive. In order for organizations to maximize their system implementations and investments, they must evaluate their caregivers’ new workflows and embrace supportive design and devices that improves comfort while also allowing them to deliver a similar or improved level of patient care.

Importance of ergonomics
A recent Ergotron report, “How Digital Healthcare Helps and Hurts Nurses,” surveyed 250 full-time US nurses and found that 49 percent report feeling some level of discomfort while inputting charting data into a computer workstation. One of the most important factors to consider when integrating technology into nursing workflow is the ergonomics of the equipment. Ergonomics refers to the application of scientific knowledge to a workplace to improve the well-being and efficiency of workers. Access to ergonomic equipment in the workplace increases workers’ efficiency and productivity, while helping to reduce fatigue, exertion and musculoskeletal disorders – all side effects nurses can experience during a long work shifts.  Multiple studies have found that a sound ergonomics program helps reduce the number of workplace injuries and absenteeism, and can contribute to overall employee wellness.

Though technology has brought many wonderful innovations to the healthcare system, it also has the potential to introduce improper ergonomics into many clinical settings. Before EHRs, nurses could work on their charting while seated at a nursing station, giving them a break from their active work day. Now, nurses often stand with a computer on wheels when documenting. If the device does not offer standard ergonomic features – such as broad height-adjustment capabilities to adapt a unit to the correct height of the caregiver or negative tilt keyboards – repeated usage over time will add to the nurse’s physical strain.

What’s more, while nurse pain has been well documented, what’s often not addressed is how this physical discomfort directly affects their patient care, or patient experience. Ergotron’s survey revealed that nurses admit to being less friendly or engaging with patients (22 percent), modifying or limiting their patient interaction on the job if their body is hurting (22 percent) or needing to ask for more assistance from other staff (14 percent).

Patient-centered environment
The survey from HIMSS Analytics also revealed that nurses were less likely to think that EHRs help with efficiency and many responded that EHRs did not allow them to spend more time with patients. To create more patient-centered environments, healthcare facilities must find solutions in which nurses can use technology with ease.

Effectively integrating technology into all aspects of the healthcare environment to enhance the patient experience requires attention to positioning the patient, the caregiver and the technology, into a more favorable Triangle of Care alignment, or what Ergotron calls “Patientricity.” Creating a patient-centered environment that is inclusive of technology is only effective when the needs of the patient and medical staff alike are considered – whether documenting at the bedside or reviewing documentation at the nurses station.

When technology is integrated correctly into clinical workflow, it is beneficial to all involved. It promotes increased interaction, satisfaction, safety and efficiency to the patient-caregiver exchange. The patient not only receives the benefit of the face-to-face connection with the caregiver, but the technology becomes a partner in the exchange. When considering this workflow strategy, stakeholders should consider:

  • Avoid inappropriate or cumbersome placement of technology that impedes the efficiency of care, such as a computer mounted in a room but the caregivers back is to the patient.
  • Consider adjustable options that allow caregivers to sit or stand while accessing or inputting data to offer a new level of work flexibility.
  • Avoid skimping on key ergonomic considerations in terms of helping users achieve proper computing postures, and adjustability when manipulating the equipment.
  • Evaluate and better understand the human interaction that needs to take place within the digital workflow.
  • Understand space constraints to determine whether fixed, permanent and dedicated equipment is required, or whether a mobile solution best serves the care-giving requirements.

When nurses feel good, it improves their ability to deliver higher quality of care. Conversely, injuries and physical discomfort directly affect patient interaction. When asked what nurses would change in their work environment to support the prevention of discomfort, pain or injury to themselves and fellow nurses: 28 percent would add a dedicated ergonomics team to help ensure equipment is supportive to staff, and 28 percent would redesign the physical space in the patient rooms and units to better align with clinical workflow and patient needs.

Despite electronic devices being ubiquitous and important tools in health facilities, technology is not always properly integrated into the healthcare environment to help nurses or patients. There are many benefits to exploring ergonomics and patientricity. Besides the inherent productivity gains associated with an ergonomic investment, it also leads to more satisfied employees and patients, increased access to technology, long-term cost reductions and decreased injuries due to poor ergonomics. In order for nurses to take better care of patients, the healthcare system must first take care of its nurses.