Nurses get around the table
We have just published a follow-up report, with a forward from the Royal College of Nursing (RCN) to our roundtable event which drilled into challenges of clinical documentation facing nurses and how they can be overcome. The roundtable was chaired by Anne Cooper, chief nurse, NHS Digital and was attended by nurses from primary, acute, mental health and community services.
Scaling the challenge
Our starting point was to acknowledge the scale of the challenge. According to an online poll 73 per cent of nurse respondents said they went home late because of clinical documentation and a third said clinical documentation takes 20 to 40 per cent of their time. One nurse referenced a University of Nottingham research paper which called for new ways to be found to minimise and streamline existing documentation to ensure that records are complete, timely and person-centred.
So, there can be little doubt that meeting the daily documentation demands in line with the Nursing and Midwifery Council’s code has an impact on patient care. The challenge is that well-written and factually accurate clinical records are a fundamental part of delivering quality healthcare.
Part of a bigger system-wide issue
At the same time, we must recognise that documentation is part of a system wide issue. Nurses are playing a pivotal role in healthcare delivery working in many different settings, using a wide range of technologies to support patients in their care. They are running their own clinics, prescribing drugs and taking on some of the work of managers as well as taking on many of the roles that used to be undertaken exclusively by doctors.
Factor in the change in medical and nursing culture (which makes patients, parents and carers partners and co-producers in their care) and there is more communication than used to be required in today’s healthcare environment.
Possible solutions to the NHS workforce under pressure
We discussed solutions to these patient record keeping challenges and the role that technology and software, such as speech to text, can play. We found that the best technology implementations followed an approach where providers are willing, at the outset, to listen to the challenges faced at the frontline and have the flexibility to work with NHS staff.
The roundtable heard from nurses who said that although electronic health records should help meet the challenge, they often fail to bring documentation benefits because nurses are simply typing the same information that used to be written by hand. Instead of taking the opportunity to ask what information really needs to be recorded, the reality is that paper forms are duplicated electronically.
Let nurses lead the way
Involving nurses early on in technology projects must be a high priority. For example, technologists from leading digital technology companies could shadow nurses and help them re-imagine clinical documentation. However, the technology must support the nurse, not the other way around. Nurses won’t engage with it unless it fits their purpose. They know what they need from the technology and it is up to suppliers and healthcare providers to listen.
The question for every nurse facing the daily clinical documentation challenge is – how many are willing to listen?