Managing the Cognitive Overload of Nurses

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

I recently interviewed a nurse leader who shared her concerns about the level of cognitive overload experienced by nurses today. She shared the following observation:

So, let’s hypothetically walk in the shoes of a medical-surgical nurse today.  I start my shift with five assigned patients, but by the end of my 12 hours – all five may have been discharged, and I have five new patients. I must remember my priorities for ten patients during the shift. I have to document 5 admissions and five discharges. I am on the phone with families and physicians. I am verbally getting incoming information on two cells (in her hospital) and Epic using their messaging system. By the end of my shift, I am exhausted from trying to keep up with all the expectations. My attention span is already short due to growing up in a wired environment. No wonder this nurse looks at me with an incredulous look when I ask about getting involved with a unit practice council. The cognitive overload is too much and contributes to staff burnout and exhaustion.

Rhonda Collins is an expert in cognitive overload. In a 2020 Nurse Leader article, she wrote that cognitive load can be defined as the amount of information a person holds and processes within working memory; working memory can be thought of as “the ability to remember and use relevant information while in the middle of an activity.” In fast-paced healthcare environments, nurses constantly segment what is essential and urgent as they triage ongoing priorities. When nurses receive too many pieces of information at once, they can become overloaded, making it difficult to segment and focus on critical patient care tasks. It is here where mistakes can happen.

Collins recommends that to reduce cognitive overload, you must minimize input sources. Hospitals that should have a standardized on a single clinical communication and collaboration (CC&C) platform for all clinicians are positioned to employ strategies to address cognitive overload. A comprehensive CC&C platform enables hospitals and health systems to simplify workflows and offload nurses’ need to retrieve, retain, and record information, making communicating and doing their jobs easier. She suggests that as healthcare leaders work to reduce the cognitive load among their nurses, they must remember that communication is urgent and that short-term memory has limits. Recognizing the limitations of memory and attention is the basis for understanding cognitive load and overloading clinicians.  She notes that it is not surprising then that more than half (58%) of the respondents in a survey of clinical and information technology (IT) leaders point to alarms, retrieving data from EHRs, and trying to communicate with fellow care team members via technology as sources of cognitive burden.

Collins observes that EHRs have created additional tasks and distractions for clinicians instead of consolidating and streamlining communication. It is because, at their essence, an EHR system is a tool designed for order entry and storing medical records, not for care teams to communicate and collaborate. With siloed communication mechanisms such as the EHR, mobile apps like GroupMe, text messages, and pagers, nurses spend much time tracking information and people. Without integrated clinical and communication systems, if a nurse receives a patient’s lab value, that data point is standalone information. The nurse must log in to another system to see his prior lab value, which adds to the cognitive burden.

Through my work, I have seen a few organizations intentionally look at this problem. We talk about Artificial Intelligence as a way to streamline work and improve patient safety. Still, we must look at ways to standardize and integrate the communication and collaboration tools we already own. Collins notes that if the correct tools are applied to help structure information, offload the need to retain and replicate data and weed out nuisance interruptions, nursing leaders will help reduce the cognitive burden for their staff. This should be a priority for all organizations.

© emergingrnleader.com 2023

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