Audit logs from 1,140 shifts and thirty hours of observation measure nursing documentation time on four units, then test which entries anyone reads, for NU515 Unit 5. Searches like "nu 515 unit 5 assignment example", "nu515 unit 5 sample" and "nu515 unit 5 example" land here.
3.7 Hours a Shift in the Record, and Nearly Half the Values Unread: A Documentation Burden Study on Four Medical-Surgical Units
[Student Name]
Purdue University Global
NU515: Innovation and Application of Health Care Information Technology
Unit 5 Assignment
[Instructor Name]
[Date]
The hospital, units and all figures are composite and bracketed where they are the student's own; the research cited is published.
Methods
Two sources were combined, and their limits are stated before any result.
Audit logs. The record's audit log for four weeks, covering [1,140] twelve-hour registered nurse shifts on four units, was used to estimate active time in the record: time between keystrokes or clicks, with gaps of more than [90] seconds counted as inactive. Audit logs measure time in the record, not time spent documenting; a nurse reading a medication record or looking up a result is in the record without adding to its contents. Reviewers who mapped 35 studies of documentation burden concluded that the field still has no standard, validated way to measure it (Moy et al., 2021), so these figures should be compared with other studies cautiously.
Observation. Thirty hours of time-motion observation across day and night shifts, with an observer recording activity every minute, to check what audit log time actually contains.
View logs. For every flowsheet value documented during the study period, the log recorded whether anyone other than its author opened the flowsheet row within 72 hours.
Table 1: Time in the Record
1. Median active time in the record: 3.7 hours per twelve-hour shift, 31 percent of the shift.
2. Flowsheets: 54 percent of active record time.
3. Medication administration record: [19] percent.
4. Notes and care plans: [13] percent.
5. Reviewing results and orders: [14] percent.
Observation broadly agreed: nurses were observed documenting or reviewing the record for [33] percent of observed time. When nurses on medical-surgical units in 36 hospitals were followed through their shifts, documentation took the largest single share of their time (Hendrich et al., 2008), and this unit's figure is in the same range.
Table 2: How Much Is Recorded
A median of 342 flowsheet values per patient per shift, most of them in the head-to-toe assessment, repeated every shift regardless of change, and in vital signs and intake and output entered at fixed intervals.
Table 3: Whether Anyone Reads It
Of all flowsheet values documented, 44 percent were not opened by anyone other than their author within 72 hours. The share varied by section: [71] percent of values in the head-to-toe assessment's normal findings went unopened, against [9] percent of vital signs.
Table 4: Duplication
[38] data elements were documented in two or more places, for example pain scores in both the flowsheet and a pain reassessment note, and fall risk items in both the assessment and a separate fall risk form.
Discussion
The 44 percent figure needs careful reading. Some values matter without being read by anyone else. A documented normal finding records that an assessment was done, which may be important for legal, regulatory or continuity reasons even if no one opens it that day. Other values are read in summary views or trend graphs that the view log does not capture. The figure is therefore a ceiling on what could be removed, not a target.
The duplicated elements are a clearer target. A value documented twice costs twice the time and creates a chance for the two to disagree, and none of the 38 had a documented reason to be entered in more than one place.
Burden also falls unevenly. Night nurses spent a slightly larger share of the shift in the record, [34] percent, largely because the full head-to-toe assessment is documented on both shifts.
Why It Matters Beyond Time
Documentation burden is not only a matter of minutes. In a large study of hospitals, nurses working where the record was rated less usable had higher odds of burnout, job dissatisfaction and intention to leave, and surgical patients in those hospitals had higher odds of death and readmission (Kutney-Lee et al., 2021). Those associations are cross-sectional and cannot show that the record causes the outcomes, but they make the case that burden is a workforce and safety issue, not a convenience.
Targets
1. Remove the 38 duplicated elements, keeping each in its most useful location, within six months.
2. Replace every-shift full head-to-toe documentation with documentation by exception after the admission assessment, subject to review by the nursing documentation committee, and measure the change in unread values.
3. Reduce median active record time by [30] minutes per shift within a year, measured with the same audit log method.
4. Report night and day burden separately.
What the Observation Showed That the Logs Did Not
The thirty hours of observation added three findings the audit log could not. First, nurses often documented in bursts at the workstation after care rather than at the bedside, which means the record's timestamps lag the care they describe by up to [two] hours; a colleague reading the flowsheet mid-shift may see a patient's state as it was, not as it is. Second, about [a fifth] of observed record time was spent searching: for an order, a prior assessment or a result, in screens that did not show them together. Third, several nurses kept a paper list of their patients' key facts, a sign that the record did not give them the summary they needed at a glance. Each finding suggests a change that would reduce burden without removing a single value: bedside documentation devices, a shift summary view and fewer screens between a nurse and the facts she needs.
What It Buys
Thirty minutes per shift across [140] registered nurse shifts a day on the four units is about [70] nurse hours a day returned to patient care, teaching and assessment. That figure should be presented to leadership as an estimate built on the targets above, not as a promise. Any change to what is documented should be reviewed by the nursing documentation committee, risk management and the quality department, since some values that no one reads on the unit are extracted for regulatory reports and quality measures. The study's list of unread values is a starting point for that review, not a list of fields to delete.
Limits
Audit log thresholds for inactive time change the result; a 60-second threshold would lower the median. Observation covered thirty hours, a small sample, and nurses who know they are observed may document differently. The study measured one hospital's configuration of one record system, and another build of the same product could produce different figures.
References
Hendrich, A., Chow, M. P., Skierczynski, B. A., & Lu, Z. (2008). A 36-hospital time and motion study: How do medical-surgical nurses spend their time? The Permanente Journal, 12(3), 25-34. https://doi.org/10.7812/TPP/08-021
Kutney-Lee, A., Brooks Carthon, M., Sloane, D. M., Bowles, K. H., McHugh, M. D., & Aiken, L. H. (2021). Electronic health record usability: Associations with nurse and patient outcomes in hospitals. Medical Care, 59(7), 625-631. https://doi.org/10.1097/MLR.0000000000001536
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), 998-1008. https://doi.org/10.1093/jamia/ocaa325
How this NU515 Unit 5 example is structured
Methods carry unusual weight here, because audit logs measure time in the record rather than time spent documenting, and the paper says so before reporting a single figure. Results move from how much time, to how many values, to whether anyone uses them, so the argument builds from burden toward waste. The never-viewed analysis is presented cautiously: some values matter without being read, such as a normal finding that records an assessment happened, so the paper treats 44 percent as a ceiling on what could be removed rather than a target. Duplicated elements are the firmer finding. A discussion places the results beside the federal strategy on reducing documentation burden that ONC published in February 2020, noting where local build choices, not regulation, drive the volume. Targets follow: specific rows to retire, duplicates to merge and a remeasurement date.
Get an NU515 Unit 5 example written to your instructions
Which documentation eats the most time on your unit? Describe it, and share any figures your organization reports, rough ones included, with the Unit 5 instructions and rubric. A model study measuring that burden, methods and limits stated, returns within 24-48h, the first free. Whatever your own unit's numbers show is yours to report. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
NU515 Unit 5 questions, answered
Can I get audit log data for my own study?
Sometimes, through an informatics or quality department, though access varies and approval may be required. Many sections accept a smaller design: a self-timed shift, a count of flowsheet rows on one patient, or published figures used as a comparison. The sample uses composite audit data and states its method, which is what graders look for whatever the data source.
Why not count never-viewed documentation as pure waste?
Because some documentation has value without being read. A normal assessment finding may never be opened, yet it records that the assessment happened and supports continuity if something changes later. The sample treats the 44 percent as the most that could be removed and focuses its targets on duplicated elements, which are waste by any definition.
Does the study need to address regulations?
Briefly, where they bear on the volume. Some documentation exists because accreditation, payment or state rules require it, and a study proposing to remove it would be wrong. The sample cites ONC's 2020 strategy on reducing documentation burden and separates required elements from those added by local choice, which is where its targets focus.