If you ask nurse practitioners how they spend most of their time at work, their answer will be “charting!”
Not only do nurse practitioners (NPs) assess, diagnose, and treat patients, but they also have to document the findings. On top of that, nurse practitioners also have to analyze diagnostic data, review past medical documentation, and address the never-ending patient messages.
With so much to do in a day, it can feel impossible to stay caught up on charting. After all, so many nurse practitioners stay late at the office or end up bringing charts home. But there are a few easy changes nurse practitioners can make to improve their charting and get their time back! We will take a look at 4 charting tips for nurse practitioners.
1. Use smart phrases and templates. Utilizing smart (also known as dot) phrases is a very easy charting tip for nurse practitioners to implement. Smart phrases are commonly used words or phrases that nurse practitioners constantly type/dictate into a chart note.
For example, non-pharmacological education for diabetic patients, common medication side effects, and at-home care for an upper respiratory illness can easily be created into a smart phrase. Once the smart phrase is created, the nurse practitioner can then simply implement it into the charting system.
On the other hand, templates are the format or structure of a chart note. Templates can be made for common chief complaints or diagnoses seen in your practice. This will allow you to have a typical history of present illness, a “normal” physical exam, and common discharge instructions. Patient-specific updates can then be made in the chart note.
So, for example, school sports physicals have very specific questions that need to be addressed. There is a routine physical exam that is completed. The plan of care is typical for most student-athletes. So if you often see school physicals, create a template that is specific to this type of visit. It will be much easier to change the abnormal findings than it is to start fresh with a new chart note each visit.
Utilizing smart phrases and templates is a charting tip for nurse practitioners that requires upfront effort, but it can save so much time in the long run.
2. Set boundaries with patients. Another charting tip for nurse practitioners is to set boundaries with patients. Nurse practitioners need to protect their own time and energy. We cannot pour from an empty cup, and if we are completely depleted, we cannot take care of others.
There are several instances when APRNs need to set boundaries with patients. One example is in the exam room. Patients come in for a chief complaint and often have a list of other ailments to discuss. This can create an even longer office visit, and push you further behind, followed by more charting. Setting the agenda from the start of the office visit and letting patients choose what 2-3 topics they want to discuss can help protect the nurse practitioner’s time. Also, encourage the patient to schedule another clinic visit to have enough time to address the additional concerns.
Another example is in the patient messaging feature within the electronic health record (EHR). While patient messaging is convenient and improves provider-patient communication, there are a few downfalls. Oftentimes, patients will share new onset symptoms or conditions via the patient messages. These concerns should really be addressed in an office visit so nurse practitioners can properly assess, diagnose, and treat the patient. Nurse practitioners should set boundaries with the patients and not allow these topics to be addressed over the patient messages.
3. Create problem-focused notes. One of the time management challenges nurse practitioners face is creating lengthy, comprehensive chart notes. Adding this extra information, also known as “note bloat,” takes more time and energy. Not to mention long chart notes are more challenging for other health care providers to read and review. This is why I recommend nurse practitioners create problem-focused chart notes.
In order to create problem-focused chart notes, NPs should become aware of how they document and make a cognizant effort to keep chart notes short and sweet. I encourage nurse practitioners to complete chart audits on their own chart notes. Review what information could have been removed and make an effort to correct it when writing future chart notes. Creating problem-focused notes is an impactful charting tip for nurse practitioners.
4. Allow time to recharge. As counterproductive as it sounds, nurse practitioners should give themselves time to rest and recharge. It is so easy to feel overwhelmed, stressed, and exhausted after a long work day. And the last thing nurse practitioners want to do is work another 2-3 hours in the evening just trying to catch up with the charting.
It is so important to ensure there is time to recharge before the next workday. Allowing time to actually do the self-care, to rest the mind, and to relax can go a long way when trying to stay productive. A clear mind is a sharp mind. It is so important to take time to recharge so nurse practitioners can implement other charting tips and stay productive during the workday.
Excessive charting is the top cause of work-life imbalance which leads to nurse practitioner burnout. If nurse practitioners make an effort to utilize smart phrases/templates, set boundaries with patients, create problem-focused notes, and allow time to recharge, they can improve their charting and get their time back.
Erica Dorn is a nurse practitioner.