By Rose O. Sherman, EdD, RN, NEA-BC, FAAN
As we seek ways to help reduce the workload of nursing staff, the documentation burden is high on the list of the most consuming activities of RN time. In today’s fast-paced clinical environment, nurses are expected to deliver exceptional care while juggling increasingly complex documentation requirements. Studies and workflow analyses suggest that nurses spend 25% to 35% of their shift on documentation tasks. That translates to roughly 3 to 4 hours per 12-hour shift, depending on the unit, acuity, and staffing levels.
This documentation burden is one of the strongest use case arguments for Artificial Intelligence. Ambient listening uses AI-powered voice recognition to “listen in” on clinical conversations between nurses and patients. Unlike traditional dictation tools, it doesn’t require manual activation or structured commands. Instead, it passively captures the dialogue, interprets it using natural language processing, and generates clinically accurate documentation—automatically. It can be like a silent partner that listens, understands, and writes your notes for you. You then go in and review and revise what was captured.
I first encountered Ambient Listening two years ago in my primary care physician’s office. He was using Nuance DAX (Dragon Ambient eXperience) during our yearly visit. DAX listens to patient-provider conversations and generates structured clinical notes in real time. He taped our conversation and then showed me the Epic Record with the clinical notes captured by DAX in it. I was amazed at the quality of the note – he made very few revisions. He absolutely loved the technology and felt it had made his primary care visits so much more personal when he was not sitting in front of a computer entering data. His most significant issue in training DAX is that he talks too much and tells stories that DAX sometimes misinterprets. I asked him at that time what would happen if the provider didn’t speak much and failed to capture key information. Funny you should say that, he said, because that is precisely what is happening with some of our young Docs – their verbal communication skills are weak and this technology is not working as well with them.
I did not think any more about this until a recent conversation I had with one of my workshop participants. We had just finished our discussion about how to help younger staff who grew up in a text/internet/social media environment and have weak conversational skills. She told me that they are testing Ambient Listening on her unit to help nurses with their documentation. As we designed the pilot she said, we totally overlooked the need for strong verbal communication skills as a necessity in an Ambient Listening environment.
The notes captured from seasoned nurses she said were excellent. The notes captured from their novice nurses lacked many data points needed because their verbal communication skills with patients were very weak and they said very little. Inconsistent phrasing and skipping over key details was resulting in missing chart entries. When a nurse’s communication was vague, fragmented, or lacked clinical specificity, the AI struggled to accurately capture the clinical intent, identify key symptoms, assessments, or interventions and distinguish between casual conversation and chart-worthy content.
Armed with this new information, they went back to the drawing board and started robust communication classes. They chose to use TeamSTEPPs, an evidence-based framework developed by AHRQ that teaches high-reliability communication strategies that reduce ambiguity. It worked and they saw improvement. Interestingly, they were finding that ambient listening can help improve communication. When nurses review auto-generated notes, they may become more aware of how their phrasing impacts documentation. Over time, this can lead to more intentional, precise communication.
This story served as a great example of why new initiatives like the introduction of Ambient Listening only succeed when built on a strong infrastructure. I would anticipate that over the next five years, we will begin to see widespread adoption of Ambient Listening to reduce our documentation burden. It holds great promise but our workforce needs to be prepared to effectively use it which includes improving our verbal communication skills.
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