Documentation capture

As nurses raise their voices, research shows they’re overloaded

A HIMSS study commissioned by Nuance has highlighted some of the challenges driving nurses into professional overload—from the length of their working hours to the scale of their administrative workloads. It asks nurses where new technology can help and shines a light on the potential impact of advances in speech recognition.

Nurses understand the importance of their work like no one else. So when nursing professionals make the decision to take industrial action, as many Australian nurses did this month, it’s hard to underestimate the strength of feeling involved. And those ICU nurses (one of whom had the message “On strike – Burnout” written on her scrubs) are far from alone.

In recent weeks, nurses have joined protests and strikes across the country, across the ditch in New Zealand, and across the world. In the UK, The Guardian reports that up to 25,000 frontline NHS nurses are being trained to become activists and support strike action—should ministers continue to resist demands for better pay.

If these are desperate actions, they are born of desperate times. As the International Council of Nurses (ICN) noted back in January, the world is “short of six million nurses”, and COVID-19 has only increased the physical and emotional stress on this already overstretched workforce. Indeed, ICN data shows that since the first wave of the pandemic, the proportion of nurses reporting mental health distress has risen from 60% to 80% in many countries.

The huge load that our nurses currently shoulder—and the effect on their wellbeing—is further evidenced by a recent study commissioned by Nuance and conducted by the Healthcare Information and Management Systems Society (HIMSS).

The prevalence of high nursing workloads

The study included an online survey of nurses from Australia to Europe. Its findings show how common it is for nurses in many nations to work long hours. For example, HIMSS found that high proportions of nurses in the following countries reported working more than 40 hours per week, with for example, 20 % in Australia to up to 47% in France.

As HIMSS’ report notes, scientific research has associated weekly workloads of over 40 hours with a greater risk of “frenetic” burnout. And, of course, it’s not only nurses that are put at risk by excessive nursing workloads. It’s the patients in their care.

In Queensland, academics recently compared patient outcomes in hospitals with minimum nurse-to-patient ratios to those in hospitals with no such policy. It found “substantial evidence that patient outcomes are more favourable in hospitals with better nurse staffing.”

The path from overload to burnout

As I discuss in the HIMSS report, living in a state of constant overload can be deeply damaging for any healthcare professional.

If we define overload as an excessive amount of clinical work, undertaken in a defined period of time, persistent exposure to that excessive workload causes us to develop the symptoms of burnout. Both our physical and psychological strengths are challenged. Our in-built resilience is pushed to breaking point. Simply put, we stop being able to cope.

Perhaps unsurprisingly given the study’s wider findings, 99% of the nurses who completed HIMSS’ online survey reported that their job had, at some point, made them feel burned out. Most of those surveyed (52%) said they experienced feelings of burnout “a lot”.

The factors pushing nurses beyond their limits

HIMSS also conducted complementary, qualitative research, interviewing healthcare professionals from ten countries to better understand the factors pushing them beyond their limits. The nursing professionals involved highlighted a range of issues, from the unpredictability of their working days to increased patient and administrative demands.

“A big driver for stress is the administrative workload,” said Mette Maria Skjøth, Senior Project Manager and Registered Nurse at Odense University Hospital, Denmark. “Nurses and clinicians have to comply with high reporting demands nowadays and many of this reporting goes back on clarifying what they have already done instead of the data being used forward.”

These words reinforce the results of HIMSS’ online survey, in which 73% of nurses said they believe the administrative burden of clinical documentation significantly contributes to healthcare professional overload.

Clinical documentation: One area where technology can help

Many of the root causes of nursing overload are difficult, even impossible, for individual healthcare providers to address themselves. But recent advances in technology have created new opportunities to lighten this particular burden.

AI-powered speech recognition technology, especially when hosted in the cloud, has the potential to reduce the time and effort involved in clinical documentation, and in turn, help to reduce nursing workloads and stress.

It allows healthcare professionals to create accurate documents—from admission and ward round notes to outpatient letters—simply by speaking. Because we speak much faster than we type, this can instantly streamline the clinical documentation process.

The impact can be quite profound. One independent study, in which the technology was introduced to an Emergency Department environment, found speaking to be 40% faster than typing, estimating the average time saving for each patient to be about 3.5 minutes. Amortised over a one-year-period, across all healthcare professionals and all case mix, this amounted to 389 days of clinician time in the study hospital.

The need to ask as well as listen

As nurses across the world raise their voices in protest, healthcare employers and national decision-makers may have no choice but to listen. But the smartest will go one step further and actively seek the help of nurses in identifying and addressing the causes of overload. And where technological solutions exist, they will involve nurses in evaluation and implementation, ensuring innovations are firmly aligned to needs and deliver the greatest possible benefit.

As Dr Clair Sullivan, Program Lead, Queensland Digital Health Academy Research Group, University of Queensland, and Chief Digital Health Officer, Metro North Hospital and Health Service, Australia told HIMSS, “Invest[ing] into digital tools and processes to streamline bureaucracy, for example [to] reduce the documentation workload.” is a factor that could prevent stress and overload.”

Survey methodology

Nuance Communications commissioned HIMSS to survey clinicians in ten different countries, between November 19, 2020 and February 26, 2021. 443 clinicians participated. 416 clinicians from Australia, Belgium, Denmark, France, Germany, Norway, Sweden, and The Netherlands responded to an online survey. 27 clinicians from these countries, Finland, and the UK, were also interviewed as part of a qualitative telephone survey. (Detailed methodology available in From overload to burnout. What clinicians think.)

Read the report to find out more

Visit our research hub to download a copy of the HIMSS report. You’ll also be able to learn more about using speech recognition to reduce the burden of clinical documentation.

Dr. Simon Wallace

About Dr. Simon Wallace

Dr. Simon Wallace is the Chief Clinical Information Officer (CCIO) of Nuance’s Healthcare division in the UK and Ireland. Simon has worked as a GP, hospital and public health doctor in Brighton and London. His interest in health informatics began in the 90s when he spent a year at the King's Fund investigating the impact of the internet on shared decision making between patients and their healthcare professional. For the past 15 years, he has worked for a range of organisations including Bupa, Dr Foster, Cerner Corporation and GSK across a range of technologies which include electronic patient records, telemedicine, mobile health and lifestyle devices. Simon has a keen interest in the voluntary sector, recently completing a 7 year term as a Trustee for Fitzrovia Youth in Action, a children and young people’s charity based in London.