Elevating Nursing Practice through CNO–CNIO Collaboration: A Best Practice in EHR Transformation

GBMC recently embarked on a journey to redesign elements of its Electronic Health Record (EHR) system—specifically tailoring it to address nurses’ documentation needs. At the heart of this initiative is a unique partnership between Angie Feurer, DNP, RN, NEA-BC, Chief Nursing Officer; and Rachael Whiteside, MSN, RN, NI-BC, CMSRN, Chief Nursing Information Officer. Their combined leadership has garnered national attention from Epic, who invited GBMC to share their story as an EHR best practice.

COLLABORATION AT THE CORE: The CNO–CNIO Partnership

A productive and sustained collaboration between the CNO and CNIO has been instrumental in creating meaningful EHR enhancements for nursing staff. This partnership brings together two perspectives:

• Clinical Expertise: The CNO ensures decisions align with patient care priorities and nursing practice standards based on feedback gathered by the nursing workforce.
• Technical Insight: The CNIO translates clinical needs into feasible, user-friendly EHR solutions while staying attentive to regulatory requirements and Epic’s capabilities.

Working in tandem, these leaders established a shared vision: to ease the documentation burden on nurses and optimize their daily workflows. This alignment at the executive level set the tone for interprofessional participation, ensuring engagement from frontline nurses, educators, quality leaders, and IT specialists.

Building a Nurse-Oriented EHR: Identifying the Challenge

Before the project began, nurses faced increasingly cumbersome documentation. Multiple alerts, pop-up reminders, and mandatory fields slowed their workflow and detracted from direct patient care. Anecdotal feedback was consistent with national trends: nurses often felt they were “feeding” the EHR rather than focusing on bedside care.

Key Strategies and Steps

• Frontline Feedback and World Café
  • Structured Listening Sessions 
    Using a “World Café” model, frontline nurses provided honest feedback on what worked, what didn’t, and how the system could improve. Topics spanned from must-have functionalities to “stupid stuff” that could be eliminated.
  • Collaborative Synthesis 
    Insights were grouped into clear categories—existing capabilities underused, policy-related items needing clarity, and purely new functionalities or workflows that would help nurses.
• Roadmap Development
  • Monthly Milestones 
    The CNO and CNIO collaborated to create a timeline from August 2023 through late 2024, identifying key enhancements each month. Initiatives included refining Epic’s “Brain” for improved shift management, redesigning documentation flowsheets, and introducing MACROs (text expansions) to cut back on repetitive data entry.
  • Policy-Guided Documentation 
    A dedicated Nursing Standard Documentation Committee, chaired jointly by nursing leadership and Epic representatives, began translating vague regulations into concrete, easily referenced standards. This helped eliminate unnecessary charting and clarified crucial requirements.
• Education and Training
  • Simplified Orientation 
    Recognizing that many nurses learned on paper or had minimal refresher training, the team shortened and refocused EHR orientation. New hires now receive streamlined modules emphasizing practical workflow tips rather than generic feature overviews.
  • Ongoing Support 
    The CNIO worked closely with clinical educators to create targeted follow-up sessions, reinforcing best practices and addressing unit-specific needs.

Measurable Successes 
Initial efforts have demonstrated clear impacts on documentation time, efficiency, and retention:

• Reduced Documentation Time
  • Flowsheet Time: Decreased from 40 minutes to 37 minutes per shift.
  • Medication Administration: Cut from 22 minutes to 15 minutes per shift.
  • Overall Charting Time: Dropped from 128 minutes to 118 minutes per shift, freeing up more nurse-patient interaction time.
     
• Increased Efficiency and Adoption
  • Use of “The Brain”: Nurse usage climbed by 70% within four months, surpassing internal adoption goals.
  • MACRO Adoption: Usage of text expansions shot up, with some units reporting significant time savings and a marked decrease in redundant clicks.
     
• High Retention and Reduced Travel Nurse Needs
  • Retention Rate: Stabilized at 93%, bolstered by improved job satisfaction due to less “charting fatigue.”
  • Travel Nurse Positions: A 54% drop in travel nurse reliance, indicating better in-house capacity and stronger employee engagement.

By listening to frontline clinicians, translating regulatory requirements into practical solutions, and delivering targeted training, GBMC reshaped its EHR to better serve nurses and patients alike.

GBMC’s recognition by Epic at a national level underscores the significance of a united executive vision for clinical and informatics teams. As more organizations embrace a similar partnership model, they, too, can realize the benefits of increased efficiency, higher staff satisfaction, and more time devoted to direct patient care—ultimately improving overall patient outcomes.