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Join nurse practitioner Erica Dorn as we delve into practical strategies to enhance charting efficiency. From leveraging smart phrases and templates to setting boundaries with patients, Erica shares valuable tips to streamline the documentation process. We’ll explore the impact of excessive charting on work-life balance and nurse practitioner burnout and discuss the importance of allowing time for self-care and recharge.

Erica D, the NP Charting Coach, is a family nurse practitioner and the creator of The Nurse Practitioner Charting School. She specializes in helping overwhelmed nurse practitioners improve their charting skills, enabling them to achieve a better work-life balance and finally stop charting at home! She can also be reached on YouTube and Instagram.

She discusses the KevinMD article, “Save time with these 4 charting tips.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Erica Dorn. She’s a nurse practitioner. Today’s KevinMD article is “Save time with these 4 charting tips.” Erica, welcome to the show.

Erica Dorn: Thank you for having me, and thanks for all the support that you offer clinicians with your resources and articles and podcast.

Kevin Pho: All right, well thank you again for writing and coming on the show. So let’s start by briefly sharing your story and journey.

Erica Dorn: Yeah, so my journey started back in 2015. At the time I was working as an RN on a busy acute care floor, and I became burned out in health care. I really struggled with just feeling mentally, emotionally, physically exhausted. I just was not showing up for myself or my family, and I started to feel detached from my work with patients, from my family and friends, and also from myself.

So, fast forward, I was able to overcome that burnout, and I went and got my family nurse practitioner certification. Around the time of the pandemic I realized how many nurse practitioners were burned out, and that’s when I started The Burnout Nurse Practitioner.

When I was working with these nurse practitioners, I quickly realized that work-life imbalance was the number one cause of burnout, and the number one cause of that was charting. As you know, providers, we have so much to do during a busy day, and the charting always seems to just bombard us and take up a lot of time. A lot of nurse practitioners are staying late at the office, they’re bringing their charts home, just disrupting that work-life balance, and that was ultimately causing their burnout.

So I put together The Nurse Practitioner Charting School, to provide charting and time management tips for nurse practitioners to work on the charting so they can have that better work-life balance.

Kevin Pho: So I think your story certainly resonates not only with nurse practitioners but with clinicians across the health care spectrum. Of course, I talk to a lot of physicians on this podcast, and they write on KevinMD, and charting for them of course is a leading cause of their burnout as well. And I’m interested in hearing your tips as well. But before we do, when you were an RN and you mentioned that you were burned out, and then you became a family nurse practitioner, tell me, did that affect the burnout that you were facing as an RN?

Erica Dorn: So I first had to overcome that burnout before I went back to nurse practitioner school. I mean, my burnout was so bad that I was contemplating leaving health care altogether. So if I had done that, I wouldn’t have even gotten my nurse practitioner degree. So that was something that I really had to work on, overcoming the burnout before becoming an NP. And so far I’ve been able to prevent burnout as a nurse practitioner.

Kevin Pho: And when you talk to other nurse practitioners, are we talking about those primarily in primary care specialties, are we talking about nurse practitioners in specialist roles, or is it across the spectrum?

Erica Dorn: It’s across the spectrum. I mean, I work with all types of nurse practitioners, and a lot of the issues are the same. A hospitalist NP versus primary care, urgent care, specialty care, we all face a lot of the same issues.

Kevin Pho: And before we go into your charting tips, tell us some scenarios or stories that you yourself are facing, or that you’re hearing from your fellow nurse practitioners, about how charting is contributing to their burnout. What are some stories you could tell us?

Erica Dorn: Yeah, so the big one is just the amount of work that we do during a day. Seeing the patients, getting the chart signed, but then you also add on analyzing your diagnostic tests and calling patients with those results, reviewing past medical documentation, the never-ending patient messages, which is kind of a new thing.

And then really just, health care in general, there’s a push to see more patients in a lesser amount of time. A lot of the appointments are 15 minutes, and sometimes those are double booked. So it’s just a lot of work that nurse practitioners and clinicians have to do.

Kevin Pho: So are you hearing a lot of nurse practitioners do what a lot of physicians do, where they take their charts home at night? We have the proverbial pajama time, where after perhaps the kids are off to bed and it’s like 10, 11 at night, then they finish their charts. Is that a common scenario?

Erica Dorn: Yes, very much so. And that, like I said, can really lead to burnout, because you’re overwhelmed, you’re stressed, you’re thinking about all of these charts that you have to do. You’re not present with your family. A lot of times you forgo the self-care, or the exercise that you know you should be doing. And you’re staying up late, waking up early, just really disrupting that time to rest and recharge. So yeah, that ultimately causes burnout.

Kevin Pho: So your KevinMD article is “Save time with these 4 charting tips,” and I’m sure that these tips are going to be applicable not just to nurse practitioners but to any clinician who’s using an electronic health record as well. So for those who didn’t get a chance to read that article, tell us what it’s about.

Erica Dorn: Yeah, so I have a ton of different tips that I share through The Nurse Practitioner Charting School, but just to highlight a few.

Using templates can be very beneficial. Using smart phrases or dot phrases can save a ton of time. I have a comprehensive list of smart phrases on my website, so you can copy them into your own EHR and adjust them for your own practice, and that can save a ton of time. I use them for your HPI section, a normal exam, your review of systems, procedures that I do, and then instructions as far as diabetes education, discharge instructions, that sort of thing.

The other thing a lot of nurse practitioners, and I’m sure other providers, tend to do is overchart, and just have a long note. So I recommend focusing on problem focused chart notes, very short and sweet, straight to the point. You don’t want to add too much information, so that can take less time when you’re doing problem focused notes.

Another tip is to set boundaries with patients. A lot of times patients will come in with six, seven issues that they want to discuss, and so you just have to set that boundary and be honest and say, I would really like to give this issue the proper time and attention and workup, please schedule a follow-up appointment. I also have patients choose the top two issues that they want to talk about during that clinic visit, so that’s allowing them to focus on just the two most important things.

Another tip that I had, and we kind of mentioned this, is just allowing yourself that time to rest and recharge. When you get a full night’s sleep, when you do physical activity, when you spend that time with your family, your brain can finally rest and recharge, and then you have better mental clarity, better focus, and it helps you stay productive during the day.

Kevin Pho: So let’s dissect a little bit of what you said. The first thing you said was things like dot phrases. For those who aren’t familiar with dot phrases, those are like macros, right, that you would type into your electronic health record. You could type dot HPI, for instance, and it can give you a template or common things that you would type regularly, just within that dot phrase.

Are you finding that nurse practitioners have to create these dot phrases all from scratch? Do systems just give them these dot phrases? Because you’re a third-party kind of central repository for these dot phrases. Do you find that nurse practitioners come to you and say, this is something that we just have to do ourselves, and it’s so great that we have this repository, health systems generally don’t help them in that respect?

Erica Dorn: Right. Yeah, I mean, I’m not sure about physicians, but nurse practitioners did not learn how to chart in school very much. We had just a really short lesson, and so I didn’t even know that smart phrases or dot phrases existed. And so once I got into practice and learned them, I created my own.

Most EHR systems have that capability, to use smart phrases or dot phrases. It depends on the charting system. Some of them have some prebuilt ones that providers can use, and I recommend always adjusting for your own practice so it does sound like your own words. But there are a lot of things that we constantly find ourselves charting, whether that’s the education for a diabetic patient, or certain medication instructions. And so it’s just realizing what you’re constantly typing over again and again, and creating that smart phrase, so the next time you go to document it’ll take a lot less time.

Kevin Pho: What about the option of typing versus dictating? A lot of electronic health records give that option, and when you dictate it there’s some voice recognition software that can populate the fields. What’s your recommendation for that?

Erica Dorn: Yeah, so that’s something I’m really excited about. But I personally type my notes, because I am a fast typist. I have the templates and the smart phrases, and so the bulk of my note is in when I open that template already.

You can use dictation. A lot of systems, you have the template but then you dictate the HPI or that sort of thing, so that can definitely save some time. It’s really just about clinician preference and what works best for you.

But as far as the AI, that’s an up and coming thing. The way these systems work is the voice recognition. They are abstracting what you as the provider and the patient are saying in that clinic visit, and then abstracting that into a SOAP note format. So then you can just copy and paste that into your own charting system. So essentially the AI is writing the chart note for you.

There are some programs that are integrating into the EHR, and so that’s very helpful, you don’t have to copy from the web browser into your own system. But, for example, Freed AI is a separate website, and so it’s very easy, you can just start using it yourself, you don’t have to worry about setting up the EHR integration, you can just use it right away. They offer some free visits too, so you can play around with it and make sure it works for your own practice.

I’ve been very impressed with the proper information that is being abstracted. It cuts out a lot of that conversational information that’s not important. I’ve also been impressed with just the medical jargon and spelling and that sort of thing as well. So I think the AI is going to become a big factor in the future of health care, and I think it’s a great way to help clinicians get their charting done quicker so they don’t have to chart at home.

Kevin Pho: Now, you mentioned that you type your notes using your smart phrases. Do you have your notes done by the end of the visit, or do you wait until the patient leaves the room before you finish your note?

Erica Dorn: Yeah, so when I started using Freed AI, it writes that part for me. What I used to do was take my computer into the room and try to type out the whole HPI so I could get it done before the end of the visit. But now Freed AI writes that for me, so then I can just copy and paste it into the charting system. I have my normal physical exam in there, so if I need to make any changes I do that, add my diagnosis, and then the plan of care as well.

So I try not to chart too much when I’m talking with the patient, because I want to give them that time and attention. When I come out of the patient room, then I will put in my smart phrases, clean up the note, fix all of that, put the information in there, and then sign it right after the patient visit. Which is a great way to increase your productivity, and just have that mental clarity. You can sign the note off and clear it from your mind, and so that’s a really good way to stay on top of the charting.

Kevin Pho: All right, so give me a success story where you really helped one of your fellow nurse practitioners who came to you with all these charting problems. You helped that nurse practitioner with smart phrases and whatever tips that you gave, and really made a difference in that nurse practitioner’s life. Tell me an example where you moved the needle with these charting tips.

Erica Dorn: Yeah, so I have a nurse practitioner I worked with, she was working in primary care. Now, she was not seeing 30 patients a day, she was seeing about 12, 14 patients a day, which to some people sounds crazy, how can you be behind on your charting seeing 12 patients a day?

But we went through her own issues. She needed to set some boundaries with patients. She needed to work on signing the chart notes right after the patient visit, so that she could stay focused. We also talked about just using the smart phrases and the templates. And so she was able to have her chart notes signed and not have to chart at home, because before, she was spending her evenings staying up till 2:00 in the morning on the night before her charts were required to be signed. And so now she just got that time back, and she was able to spend her evenings with her family.

And it wasn’t that she made huge changes or anything. She just implemented one of the charting tips that we had talked about at a time, got really comfortable with that, and then was able to move on to the next tip. So that was a great success story. It just doesn’t matter if you’re not seeing 30 patients a day, there are still some things you can work on, you can definitely gain that time back.

Kevin Pho: Now, you mentioned that when you were burned out you were considering leaving health care entirely. Are you specifically hearing of nurse practitioners leaving the field and leaving clinical medicine because of charting issues?

Erica Dorn: Yeah, that has been a big issue for nurse practitioners. A lot of them are also considering going back to bedside as an RN, which we’re capable of doing. But we go through our schooling, we get that advanced degree, and a lot of people think that it’ll be better hours, better pay, and then with this charting they’re having to work overtime that is not paid. If you’re salaried, you’re not getting paid to chart on the weekends or in the evenings. And so that has definitely caused a lot of the burnout, and a lot of them considering leaving health care.

Kevin Pho: We’re talking to Erica Dorn. She’s a nurse practitioner. Today’s KevinMD article is “Save time with these 4 charting tips.” Erica, we’ll end with some of your take-home messages you want to leave with the KevinMD audience.

Erica Dorn: Yeah, so I just want nurse practitioners and providers to know, you are not alone with your burnout. There are a lot of people struggling with burnout, and so just start having those conversations with other providers. I have a Facebook group, The Burnout Nurse Practitioner, that has thousands of nurse practitioners in there, and it’s just nice to have that support and to know you don’t have to go through it alone.

Kevin Pho: Erica, thank you so much for sharing your perspective and insight, and thanks again for coming on the show.

Erica Dorn: Thanks for having me.