Nursing has been named “America’s Most Trusted Profession” for the 20th consecutive year in a row. And oh, what a year it has been! The global pandemic and increasing staffing shortages have only added to the work nurses are called to do. Nurses are demanding change, stressing that these conditions lead to errors, patient injury, and even death. Studies estimate that medical errors in the U.S. may account for up to 251,000 deaths each year. Medical errors and accidents are the nation’s leading cause of accidental death, according to data from the U.S. Centers for Disease Control and Prevention (CDC).
Every human being makes mistakes. Nurses are no exception to the rule. However, studies show that a flawed system causes most medical errors. Hospitals and agencies like the Veterans Health Administration (VHA) uses a multi-disciplinary team approach called Root Cause Analysis (RCA). RCA studies healthcare-related adverse events and close calls. RCAs are meant to support the nurse’s practice and don’t point the finger of blame at the individual who made the error. The goal is to find out how and why something happened to prevent it from happening again. This practice establishes a Culture of Safety where the focus is on prevention and not punishment.
One cause of medical errors is clinical cognitive overload. When people become overwhelmed with too many pieces of information at once, we have difficulty processing and segmenting that data. Nurses are not immune to this phenomenon. Rapidly changing protocols, stressful work environments, and moral injury can all lead to cognitive overload, making it difficult to focus on the task at hand.
Cognitive overload in nursing defined
Cognitive overload in nursing happens when the emotional demands placed on nurses exceed their mental capacity for handling them. Imagine what would happen if a cart was overloaded with bricks, exceeding the weight limit approved for the container. It would break. The same holds for nurses under extreme mental stress because of the pressures of their jobs.
Nurses are bombarded daily with alarm notifications, alerts, calls, and texts while trying to care for patients. Complex or incomplete patient information can complicate matters. Toss in the higher acuity levels worsened by the ongoing Covid-19 pandemic and it comes as no surprise that some nurses have reached a breaking point.
“The face of nursing in the United States is quite different than it was before Covid,” said Dr. Diane Cannon, DNP, MHA, RN, a nurse with 25 years of clinical experience. “Covid was the straw that broke the camel’s back.”
Since February 2020, 18 percent of healthcare workers – nearly half a million – have left the job since Covid-19 hit, according to data from the U.S. Bureau of Labor Statistics (BLS). The greatest shortage is for Registered Nurses (RNs), with the BLS projecting 194,500 openings each year for the next decade. Compare those figures with the number of new RNs entering the field each year at 155,000, and it paints a clear picture of ongoing nursing shortages. It is one of many reasons why healthcare facilities must address clinical cognitive overload in nurses.
Why cognitive overload happens in the clinical environment
Nurses must oversee the health and well-being of several patients at once. During times of peak disease and illness – such as a global pandemic – the nurse-to-patient ratio can increase even higher. When clinicians are responsible for many patients at once, they encounter a constant influx of information they must process to do their jobs efficiently and safely. Nurses encounter three types of cognitive load during a typical shift:
- Intrinsic cognitive load describes the effort nurses expend to complete a task or solve a problem. Stress factors can diminish working memory, increasing the likelihood of mistakes in administering patient care.
- Extrinsic cognitive load comes from the working environment. When nurses are bombarded with information and have little control over how they receive it, it can add to their mental surplus.
- German cognitive load refers to how much effort nurses must expend to understand new information being tossed at them quickly. Categorizing information and putting it in the proper place is a crucial component of nursing care. Missing information can make it impossible to gain the complete picture of a patient’s needs, increasing the burden to deliver safe care without access to the comprehensive data required to complete the task.
Healthcare leaders must work to reduce the cognitive load among nursing staff because short-term memory has its limits. “Nurses are leaving the bedside because they are disillusioned by the profession or see no path forward,” said Dr. Cannon. “A lifelong continuing learning culture is needed to overcome clinical cognitive overload without burning out nurses and causing them to leave the field.”
How cognitive overload leads to errors
Humans use their short-term memories to categorize new information and file it away for safekeeping in our brains. Short-term memory lasts between 15 and 60 seconds, depending on the type of content consumed. Nursing staff – especially hospital-based nurses – constantly must segment what is most important and urgent when delivering patient care. They rely on their short-term memories as part of the process. Receiving too many pieces of information at once overloads the brain, making it difficult to perform this task. When nurses lose the ability to process necessary data, patient outcomes suffer. It’s also when mistakes in patient care happen, which can lead to serious injury or death.
Research supports the notion that multitasking in this manner reduces efficiency and performance. The human brain can only focus on one job at a time if it is to perform the task successfully. The result can be a negative effect on patient outcomes. Nurses are constantly inundated with new information and requests. Overloaded and overwhelmed for long periods, nurses find themselves unable to give complete attention to every single patient care task. When that happens, medical mistakes can follow.
Nursing leaders must learn to recognize the signs and symptoms of clinical cognitive overload before it reaches the level of negatively impacting patient care.
Solving the cognitive overload dilemma
Using a mix of resources can help healthcare leaders solve the clinical cognitive overload dilemma. Combining content, on-the-job learning, and competency demonstration with technology designed to seamlessly support the efforts is one of the most effective ways to achieve this goal. Case in point: Blue Pearl Specialty + Emergency Pet Hospital. While they specialize in animal care instead of human care, the methodology for correcting mental overburdening is the same.
Steve Baker, Director of Training of Nursing Care at BluePearl, and his organization launched the skills-based leveling program CareerTrax in September 2021. Powered by skills management software from Xapimed, BluePearl met its goal of training and retaining skilled employees, including veterinary technicians. “CareerTrax is a complete game-changer to how we approach on-the-job training and career pathing as an industry,” said Baker. Previously, veterinary medicine relied on paper checklists, caseload exposure, and top-down initiatives to guide training. CareerTrax flipped that approach by providing veterinary staff with a transparent roadmap and defined a set of expectations for skills development and career pathing.
Human healthcare can use the power of Xapimed technology to achieve similar outcomes. Xapimed’s program replaces the need for paper documents and filing cabinets, which are not mobile. An added benefit is the software makes it easier to track who is doing the mentoring and who is driving the culture. It also can determine if learning is being self-assigned or if progression is being driven in other ways. “Competency is so much more than checking off a hands-on skill on a checklist,” said Dr. Cannon. “Nurses also need the soft skills like communication and the ability to think on their feet to use the skills they learn in any situation.”
Hospital clinicals for nursing schools were reduced or even eliminated in some cases because of Covid-19, making it difficult for nurses in training to gain sufficient hands-on experience before they enter the workforce. Academic-practice partnerships evolve as an incredible way for nursing programs and hospitals to collectively ensure this training occurs. According to the American Association of Colleges of Nursing (AACN), “Academic-Practice Partnerships are an important mechanism to strengthen nursing practice and help nurses become well-positioned to lead change and advance health. [They] create systems for nurses to achieve educational and career advancement, prepare nurses of the future to practice and lead, provide mechanisms for lifelong learning, and provide a structure for nurse residency programs.”
Using technology in the moment can make this process smoother for the mentor and the nursing student. Here is where Xapimed works its magic. “It ensures competency and then follows through to help nurses continue to hone their skills until they reach expert level,” said Dr. Cannon. High-risk, low-volume procedures require ongoing training and competency. Xapimed can help nurses retain that knowledge during those gaps.
How Xapimed puts communication at the forefront
Among the first steps healthcare leaders must take to tackle clinical cognitive overload is to address the gap between communication and documentation. One of the ways to achieve this includes giving nurses control over how – and when – they communicate with the healthcare team, their leaders, and the organization. Then, leaders must create solutions that enhance nursing workflow rather than distract from it.
Xapimed can ease the burden of tracking skills, verifying skills, and managing skills and competencies for nursing teams. It replaces paperwork and extra jobs associated with outdated methods, which can reduce the number of mistakes nurses make and improve patient outcomes. The tool can be customized to provide digital checklists and resources that can be accessed as needed. Automating onboarding and simplifying tasks frees up nurses’ mental space and time, thereby reducing their cognitive overload. In addition, Xapimed has an audit tool that can be used during a Root Cause Analysis, should an adverse event occur.
Other innovative ways nursing leadership can use Xapimed to ease cognitive overload include:
- Point-of-care skills verification methods speed up competency recognition. Nurses can request skills sign-off from supervisors during a real-time demonstration of capabilities. Educators and preceptors also can assess nurses during task completion.
- Annual skill recertification can remind nurses and nursing supervisors which skills require recertification to reduce the stress of last-minute skills renewals. Recertifications can also be set to renew earlier, for example, every three or six months, for low-volume, high-risk skills.
- Clinical exemplars use workflow automation to efficiently verify nursing skills.
- Educator and preceptor dashboards and workflows eliminate error-prone manual systems that can lead to missing vital competency checks by taking a team approach to skills management.
“Training is education, and tools can empower people,” said Dr. Cannon. “Xapimed’s tools create transparency in the process and allow nurses to take their level of proficiency with them, so they don’t have to keep starting over at level one when they change jobs or advance in their careers. It’s a verifiable, visual pathway that explains how they got trained and who verified that training each time.”
Discover how Xapimed can tackle clinical cognitive overload among nurses in any healthcare setting by signing up for a demonstration with one of our competency experts.