Paper vs. Electronic Charting: A Critical Analysis for Nurses (2024)

While some facilities continue to use paper charting, others also use a hybrid system of EHRs and paper charts. More research is needed on how charting systems affect nurses. This blog will discuss the pros and cons of paper and electronic charting from a nurse's point of view.

Paper Charting

Paper charting is one of the traditional ways nurses chart patient information, and some still do. With paper charting, binders or folders are filled with patient information, and there is often a streamlined checklist and note section for additional information to document patient findings. These are handwritten on paper with black or blue ink, not in pencil.

Pros

  • Familiar with some nurses who are accustomed to paper charting or not computer-literate
  • It may promote critical thinking and focus while writing
  • It can be customized to a straightforward checklist or notation with minimal changes or updates
  • Less training is required compared to other complex EHRs

Cons

  • Limited accessibility when only one person can access the chart at a time
  • Paperwork can be lost or damaged
  • Decreased privacy protection compared to secured computer systems
  • It is not sustainable to keep records long-term due to physical storage requirements
  • Prone to reading or spelling errors, leading to an increase in medical mistakes

Electronic Charting

With electronic charting, nurses use EHRs through specific software to document patient information and status updates. EHRs provide a convenient platform to view patient records through a computer, including new doctors' orders, laboratory work, prior records, and other patient history, all in one place.

There are many pros and cons to electronic charting. Studies have shown that approximately 70% of nurses prefer electronic charting to paper charting, while other studies have shown that it can lead to an increased risk of burnout.

Pros

  • Increased accuracy in medical records, leading to fewer medical errors
  • Improved continuity of care between providers and employees, increasing collaboration
  • Increased efficiency for those who are more used to computers
  • It can be designed as a click-based system that saves time
  • Reduces medical errors through support tools, alerts, and notifications
  • Enhanced privacy through security features
  • Safety measures (patient safety and nursing standards) like sepsis warnings and pain assessment reminders
  • Elimination of physical records reduces the risk of loss or damage

Cons

  • A task-driven approach can lead to closed nurse-patient communication
  • Dependency on technology, e.g., computer crashes and system problems
  • Downtime for system updates can cause a delay in patient care and increase the risk of error
  • Electronic charting may not be taught in nursing school, leading to a lack of confident new nurses
  • It takes additional time to train new employees compared to paper charting
  • This creates a necessity to hire a computer-literate person, creating age disparity
  • Impedes face-to-face communication between nurses and patients

The Future of Charting for Nurses

While electronic charting is not mandatory, it is becoming widespread among healthcare facilities. This change comes from a federal recommendation. This recommendation is to switch to an EHR system to protect patient data and information. The cost-benefit analysis for healthcare facilities favors EHRs due to reduced medical errors and improved privacy protection.

Some facilities still choose to use paper charting for their own reasons. These may include the ease of charting for outpatient procedures or decreased nurse and clinician burnout.

One study stated that up to 40% of clinicians who are unhappy with their charting system also feel burned out. An inpatient nurse working in a hospital setting spends approximately 123 minutes in their 12-hour shift working through electronic records.

Other studies have shown that nurses in facilities with full EHR charting experience lower patient mortality and readmission rates compared to those with partial or no EHR use. However, dissatisfaction with the EHR system has been linked to increased burnout and stress among nurses.

It is still being determined whether the federal recommendation to have EHRs will become mandatory, but currently, it is only a recommendation.

Overcoming Charting Barriers

There is a lack of studies on the impact of electronic or paper charting on nurses. Further research is needed to understand the challenges nurses face regarding charting. It is important for nurses to work with nursing leadership about expectations and the reality of charting needs.

Switching from paper charting to an EHR system can take time to transfer data, train employees, and go live. Care must be taken to prevent barriers to patient care during this time. As a nurse, the charting burden can be reduced by getting involved with your nursing informatics team or during changes as a superuser.

25x5 Initiative to Reduce Documentation Burden

The American Medical Informatics Association (AMIA) and the National Library of Medicine (NLM) came together and created a plan to reduce the documentation burden by 75% by 2025. The initiative aims to reduce the burden by 25% within a five-year span. They call it the 25x5 Initiative to Reduce Documentation Burden on U.S. Clinicians by 75% by 2025.

During these five years, AMIA and NLM plan to collaborate to identify the root cause of the documentation burden. Once identified, strategies and plans will be designed to create a solution and enhance nurse and patient outcomes.

Conclusion

Healthcare documentation is changing drastically as new tools and technological advancements continue. There are pros and cons to both paper and electronic charting. Research specific to its impact on nurses' well-being is currently lacking. While EHRs offer a wide range of benefits over paper charting, not all benefits involve the nurse's ease of work.

What type of charting system does your facility use, and how could it be changed to benefit the nurse's well-being at work?

References:

American Medical Informatics Association. (2023). AMIA 25x5. https://amia.org/about-amia/amia-25x5

Cleveland Clinic. (2022). Improving the electronic health record experience for Nurses. https://consultqd.clevelandclinic.org/improving-the-electronic-health-record-experience-for-nurses

FordeJohnston, C., Butcher, D., & Aveyard, H. (2022). An integrative review exploring the impact of electronic health records ehr on the quality of nursepatient interactions and communication. Journal of Advanced Nursing, 79(1), 4867. https://doi.org/10.1111/jan.15484

Harris, R., Deo, J., Sindhi, L., Kambo, N., Cremer, N., & Machin, J. (2023). Electronic Health Records: Qualitative Systematic Review. Canadian Journal of Nursing Informatics. https://cjni.net/journal/?p=12221

Jaber, M. J., Al-Bashaireh, A. M., Alqudah, O. M., Khraisat, O. M., Hamdan, K. M., AlTmaizy, H. M., Lalithabai, D. S., & Allari, R. S. (2021). Nurses views on the use, quality, and satisfaction with electronic medical record in the outpatient department at a tertiary hospital. The Open Nursing Journal, 15(1), 254261. https://doi.org/10.2174/1874434602115010254

Khairat, S., Xi, L., Liu, S., Shrestha, S., & Austin, C. (2020). Understanding the association between Electronic Health Record Satisfaction and the well-being of Nurses: Survey Study. JMIR Nursing, 3(1). https://doi.org/10.2196/13996

Laukvik, L. B., Lyngstad, M., Rotegård, A. K., & Fossum, M. (2024). Utilizing nursing standards in electronic health records: A descriptive qualitative study. International Journal of Medical Informatics, 184, 105350. https://doi.org/10.1016/j.ijmedinf.2024.105350

Lin, H.-L., Wu, D.-C., Cheng, S.-M., Chen, C.-J., Wang, M.-C., & Cheng, C.-A. (2020). Association between Electronic Medical Records and healthcare quality. Medicine, 99(31). https://doi.org/10.1097/md.0000000000021182

Mollart, L., Newell, R., Noble, D., Geale, S., Norton, C., & OBrien, A. (2021). Nursing undergraduates perception of preparedness using patient electronic medical records in clinical practice. Mar - May 2021, 38(2). https://doi.org/10.37464/2020.382.282

Moy, A. J., Schwartz, J. M., Chen, R., Sadri, S., Lucas, E., Cato, K. D., & Rossetti, S. C. (2021). Measurement of clinical documentation burden among physicians and nurses using electronic health records: A scoping review. Journal of the American Medical Informatics Association, 28(5), 9981008. https://doi.org/10.1093/jamia/ocaa325

About the Author:

Breann Kakacek, BSN, RN, has been a registered nurse since 2015 and a CNA prior to that for two years while going through the nursing program. Most of her nursing years included working in the medical ICU, cardiovascular ICU, and the OR as a circulating nurse. She has always had a passion for writing and enjoys using her nursing knowledge to create unique online content. You can learn more about her writing career and services at ghostnursewriter.com

Breann is an independent contributor to CEUfast's Nursing Blog Program. Please note that the views, thoughts, and opinions expressed in this blog post are solely of the independent contributor and do not necessarily represent those of CEUfast. This blog post is not medical advice. Always consult with your personal healthcare provider for any health-related questions or concerns.

If you want to learn more about CEUfasts Nursing Blog Program or would like to submit a blog post for consideration, please visit https://ceufast.com/blog/submissions.

Paper vs. Electronic Charting: A Critical Analysis for Nurses (2024)
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