There is ongoing discussion about physician burnout and stress, but doctors aren't the only ones under pressure.
A 2020 nursing survey found that almost two-thirds of nurses (62%) experienced burnout as well.
Three years later, another survey (PDF) conducted by McKinsey and American Nurses Foundation revealed that the burnout rate hadn't improved. More than half (56%) of nurses reported experiencing symptoms of burnout, such as emotional exhaustion. Well more than half (64%) indicated they feel “a great deal of stress” because of their jobs, that 2023 survey found.
Insufficient staffing, high patient loads and too much time spent on administrative tasks all contribute to nurse burnout, according to the McKinsey survey.
To tackle that last challenge, electronic health record giant Epic developed a free curriculum for nurses and medical assistants to help cut down on clicks when using EHR software.
The Nursing SmartUser classes, led by an Epic trainer, offer 60 "tips and tricks" to help streamline nursing workflow, Emily Barey, R.N., who has served as Epic's "chief nurse evangelist" for nearly 23 years.
The new training program launched this week, in time for National Nurses Week, which runs May 6-12.
"There are now 1.7 million nurses using Epic and in a desire to try to reach them all and make sure that they're all happy, the SmartUser program was developed as a way for nurses to access Epic directly for training and support. It is a tool with a public-facing website where nurses can sign up on their own to learn workflow efficiencies and tips to save a minute here or there," Barey said.
Minutes saved on doing administrative work in the EHR can add up, she noted.
"It might make the difference between leaving your shift on time, or staying late, or having a chance for a five-minute conversation uninterrupted with your patient, versus working at the workstation and doing clinical documentation," she said.
The curriculum and training was developed in collaboration with nurses, Barey said.
The courses focus on charting and tools in the EHR and cover areas like flowsheets activity to reduce clicks and scrolls, tips on personalizing a nurse's Epic workspace and pointers on InBasket organization and streamlining schedule activity.
"One of the most popular tools that we've seen is the macros, so that ability to create your own one click that turns into many rows of flowsheet documentation," Barey said. Epic EHR macros refer to pre-set documentation tools that automatically populate flowsheets with common information to save users' time.
"It's amazing how many organizations have actually turned that tool on, but many nurses haven't fully taken advantage of that. It's really saved a lot of time for anyone who has used it. That's a good example of a hidden gem that our health systems have done a great job of enabling, but maybe has not made it that last mile," Barey said.
The courses also offer training on how to add custom tasks and reminders to Epic's Brain tool, a feature for inpatient nurses that presents a timeline view of each assigned patient's orders, events, and requirements.
"The Brain is almost like a schedule of events, your Outlook calendar of sorts, the nurse's Outlook calendar for the day. We have done a lot of work to try to streamline that and give nurses the ability to own their practice and using the Brain to be able to do that. Part of the curriculum is around making the most out of the Brain and really personalizing it so that every nurse feels like they are empowered," Gregg Springan, MSN, R.N., Nurse Executive at Epic, told Fierce Healthcare.
While Epic develops features and tools to help nurses be more efficient when using the EHR, one challenge is the "last long mile" to get those features to the bedside of every nurse, Barey noted. "It takes a village to get there which is the other reason why we're offering this course for free," she said.
"I thought the class really filled a void in nurse training and will help healthcare organizations with strategies to improve training efficiency, which is especially valuable in today’s challenging budget constraints," Anne Petroski, MSN, R.N., NI-BC, Manager of Acute Informatics at Oregon Health & Science University told Fierce Healthcare.
Two of the four one-hour webinars are focused on inpatient workflows, one covers more general nursing workflows and one focuses on clinic-based workflows. Medical assistants who support clinical teams can attend the ambulatory-focused session.
Nurses can sign up for the courses with single-click access through the Epic Earth portal, Barey noted.
The training program also benefits Epic's ongoing tech development progress, Springan said.
"Our trainers are listening to what's working and hearing comments and feedback and then bringing that right to our research and development team," he said.
The industry has become more aware that doctors often face so much administrative work, like documenting patient visits or dealing with insurance, that they increasingly finish that work at home during after-hours, a practice referred to as "pajama time."
But this type of overtime work happens for nurses as well, Barey said, and it can impact nurses' wellbeing and career satisfaction.
"In terms of balancing the wellbeing of nurses with the care that needs to be delivered, everyone wants to do a good job and also be able to leave on time to get to their kids' soccer game or leave on time to go to the yoga class, whatever it is that fulfills you and helps give you the energy to come back tomorrow for your patients. I do think we have that in common. It's just measured slightly differently," she said.
Nurses working in hospital settings are challenged with caring for multiple patients at the bedside at any given time.
"You persistently have to reprioritize. It's persistently having to think through, 'How do I do all this for four or five people at one time and still feel like I've got some autonomy in pacing this day both for the safety and high-quality care, but also for me to really be able to do it in a healthy way?" Barey said.
The "holy grail" is to take advantage of artificial intelligence and voice-enabled tech to develop completely hands-free, keyboard-free documentation and charting, she noted.
Epic is working with startups like Abridge to make progress on that goal. The EHR company is collaborating with Abridge, an AI medical scribe company, and Mayo Clinic to develop generative AI ambient documentation workflow for nurses. Abridge's product integrates into existing Epic inpatient nursing workflows.
Nurses at Mayo will help design and test the solution and prioritize the workflows where the AI tool will have the highest impact, Shiv Rao, M.D., CEO and founder of Abridge, told Fierce Healthcare back in July.
"When we think about AI charting, whether it's ambient or drafting notes or hunting and gathering to create a patient's story and a nice synthesis, AI charting is already starting to give more time back to nurses to really do the care that they want to give at the bedside," Barey said.
She added, "I do think classes like SmartUser are intended to make sure that every second that we can add up in an efficiency trick does add up and then gets accelerated with the AI charting."
But, AI needs to be introduced in a way that fits within nurses' workflow, Springan noted.
"If that is not the case, then we're introducing AI just for the sake of introducing AI, and it won't be successful. I think SmartUsers is the first iteration of us getting this out in front of nurses so that we can raise all boats. We also think that it will continue to grow and we will be offering additional content. In the future, maybe some tailored content around artificial intelligence and how it intersects with clinical practice," he said.
As AI adoption grows, Barey predicts that in a year the "tips and tricks" offered in the nurse training program will be focused on AI-enabled documentation. "It will be all about nursing out loud and how to get the most out of the conversations with your patients to have that win-win of patient engagement and a great day, and then reducing documentation burden. This is just the beginning, and it'll evolve as our tools evolve," she said.
As advances in AI and automation technology continue, there are opportunities to capture the nurses' "narrative voice" in the work of their patient charting, Springan said. "Over time, we will also be able to capture their voice better, better represent what it is, what interactions they're having with patients, and give them credit for all of the work that they're doing without having to ask them to click another thing."