When Dr. Danielle Ofri wrote a recent opinion piece in the New York Times, she didn’t pull punches. Like a lot of healthcare professionals, Ofri — an attending physician at Bellevue Hospital and a clinical professor of medicine at NYU School of Medicine — is frustrated by the ballooning workloads of doctors and nursing staff. The administrative burden of healthcare providers has gotten out of control, she argues, and it’s contributing to skyrocketing rates of stress and burnout.
The biggest culprit, according to Ofri: Electronic medical records (EMRs).
A Quick History of EMRs
EMRs have been around since the 1970s, but healthcare organizations weren’t exactly eager to adopt them. At first, they were too expensive. But even after personal computers became widespread and affordable, a lot of organizations dragged their feet on using them, reluctant to make the switch from paper charts to software that already had a reputation for being inefficient and hard to use. To get more healthcare systems and clinics to use EMR technology, the federal government issued a wave of “carrots and sticks,” if you will, by offering incentives to hospitals and healthcare providers who used EMRs according to a set of standards (commonly dubbed “meaningful use”), while also threatening to reduce Medicare reimbursements for those providers who continued to use paper charts.
It worked. EMRs are now the norm in healthcare, but the added rules, benchmarks, and “best practices” have landed squarely on the shoulders of those working on the front lines of patient care -- most notably, nurses.
How Are EMRs Contributing to Nurses’ Stress?
Unfortunately, the widespread adoption of EMRs added to an already brimming workload. One study by the RNnetwork found that nearly half (46 percent) of nurses surveyed said that their workload has increased in the past two years. On top of that, the policy changes that led to more active use of EMRs forced nurses to take on more and more data entry without giving them anymore time or resources to do it. Not wanting to cut corners (and thus risk the health or safety of their patients), nurses end up sticking around long after their shifts are over to get it all done.
Needless to say, with more work to do and less time to do it, nurses are exhausted. Nine in 10 nurses surveyed by Kronos said that they leave work physically or mentally tired, with most pointing to excessive workloads as the primary reason why. That prolonged stress is leading to burnout. In fact, three out of every five nurses surveyed in the Kronos study said they’ve experienced burnout at some point in their jobs.
Given those numbers, it should come as no surprise that a lot of nurses consider leaving the profession entirely. In that same RNnetwork study, half of the respondents said they were thinking about finding a different career, with a quarter of them saying they wanted to leave because they felt overworked. And 15 percent of nurses who said they were considering a career change specifically pointed to paperwork and EMRs as their primary reason why.
What Nurses, APNs, and Their Managers Can Do About It
It’s not an understatement to say that EMRs revolutionized medicine. They’ve helped modernize the healthcare industry by digitizing health records and making them easier to compile, access, and share between practitioners. In a lot of ways, EMRs have made nurses’ jobs easier, but in other ways, they’ve also made them significantly more stressful.
But, for better or for worse, EMRs are now an everyday reality for nursing staff. And while nurses might not always get a say in how much of their time gets dominated by EMRs, there are things that they -- and their managers -- can do to minimize the collateral damage they cause.
7 Stress Management Techniques for Nurses
As you know, there are a number of things you can do to reduce the effects of stress on your body overall, such as exercising regularly, eating healthy foods, and getting enough sleep. But there are also a number of things you can do to reduce — or at least mitigate — the stress fueled by data entry, specifically.
Here are a few stress management ideas to try out:
1) Identify your triggers.
Some things might drain your energy or cause your blood pressure to spike more than others; pay attention to those moments when you’re feeling particularly stressed or drained. Check in with yourself periodically and take note of what’s happening at the time. Then, take steps to address that specific trigger. For example, is there a specific task in the EMR that drives you nuts? See if you can get extra training or a tip sheet on that portion of the software, or ask your colleagues if they’ve found a hack to make it easier to manage. Are you more tired on days when you feel like you can’t get through a task uninterrupted? Talk to your nurse manager about where and when you might be able to input your data in batches. Or keep a sticky note next to your computer to remind you of what you need to do next, rather than pause what you’re doing for time-sensitive but non-urgent tasks.
2) Relax your face.
Ever heard that smiling on the outside can make you feel better on the inside? Neurobiologist and President of the American Institute of Stress Dr. Daniel L. Kirsch says that that can actually backfire. Instead of tensing up your muscles with a fake smile, try smiling inwardly with your eyes and mouth to relax your body and counter the physiological effects of the stress you’re feeling.
3) Take a long, slow, steady, deep breath.
If you feel your blood pressure rising, take a deep breath (or three) to slow your pulse and tell your brain to relax. Breathe through your nose, filling your lungs completely. Then, breathe out slowly through your mouth until your lungs are totally empty. Then do it again. After a few rounds, you should start to feel the tension dial down.
4) Do some visualizing.
If breathing alone isn’t cutting it, add some visualizations into the mix. A favorite of Kirsch’s involves visualizing warm air coming up through holes in the bottom of your feet. As you breathe in, visualize the air traveling up through your legs and into your lungs, and then going out the same way when you exhale. The process is subtle — no one will even be able to tell you’re doing it — and takes only about six seconds to complete, making it an easy way to do progressive relaxation in front of patients or coworkers. The more often you do this, the better it works, Kirsch says, eventually becoming a reflex that automatically calms you down when you start to get stressed out.
5) Get perspective.
You didn’t become a nurse because you love paperwork. You became a nurse because you wanted to help patients. And while EMRs can be frustrating, they are a necessary — and overall beneficial — part of patient care. When you input a patient’s data, make a mental note of all the ways that data entry will help them now and in the long run, says Trisha Fronczek, MS, RN-BC, CCRN, of the Healthy Workforce Institute. Will inputting their old shot records help ensure that they can play soccer in the spring? Will double-checking their prescriptions reduce the chances of them getting the wrong dose or of having an allergic reaction? Reminding yourself of the benefits of EMRs for your patient (and you) can make the whole experience less negative and more satisfying.
6) Invest in your own training.
Take advantage of tutorials or classes on your EMR system, and do what you can to educate yourself on the various tools and shortcuts available. Become an expert in the software and teach others around you. Mastering the platform can make you feel more in control, and that can help reduce the amount of stress you feel.
7) Advocate for change.
Managers or administrators who dictate your workload might not know how the processes and rules they’re writing affect you or your ability to care for your patients. So, tell them; share your ideas and concerns by joining an EMR committee, Fronczek says, or by taking advantage of “town hall” meetings with clinic leadership. Decisions are made by those who show up, so make it a point to be there.
For Nurse Managers/Administrators: 4 Things You Can Do To Help Reduce Staff Stress
Nurses can do a lot to mitigate their own stress, but let’s be honest: That’s just one more thing on their (already overflowing) plate. Managers and organization leadership can do a lot to improve structural or systemic problems that contribute to nurse stress and burnout. If you’re a manager and want to help reduce your nursing staff’s stress levels, here are four simple ideas to get you started:
1) Be familiar with the EMR software your staff uses.
Administrators are often so far removed from clinical care that they have no clue how their decisions impact nurses, Ofri says. She recommends that those in charge spend some time in clinical environments on a regular basis to get a better feel for how things really play out on the ground. Those with active medical or nursing licenses should try to see patients periodically, and non-clinical administrative staff should pick up shifts at the front desk every once in a while. The first-hand experience can help you make decisions and delegate workloads that are more practical and realistic for your staff.
Don’t just pay lip service to your staff’s concerns — really listen to them. Check in with your nurses periodically, Fronczek says, especially when updates are made. Ask them how things are going, whether they have suggestions, or if there’s anything they need. Don’t rely on your staff to step forward when (or before) there’s a problem. Be proactive about getting the feedback yourself.
3) Set up your staff for success.
Your nurses can juggle a lot, but they can do even more when they feel supported and well-equipped to perform their duties. Is the equipment they use mobile and reliable? And is there enough? Do they need more training or tech support for the EMR? Make sure your nurses have what they need in order to do their jobs successfully, Fronczek says.
4) Bring nurses to the table.
Find opportunities to include nurses when decisions are being made. Engage them in the process and ensure that they have the time and bandwidth to really participate. As the end users for the EMR, their voices are crucial.
The Bottom Line: You Have Options
It’s possible not everything listed above will work for you or your organization — and that’s OK. Try new strategies and share successful approaches with your colleagues. Finding even just one tactic that works for you can help you reduce the stress you feel with EMRs and lower your risk of burnout.