Award Date


Degree Type


Degree Name

Doctor of Nursing (ND)



First Committee Member

Alona D. Angosta

Second Committee Member

Cheryl Maes

Third Committee Member

Jay Shen

Number of Pages



Rapid adoption and implementation of the electronic medical record (EMR) in health care has contributed to worsening burnout among healthcare providers (HCPs), particularly primary care physicians. Other HCPs such as nurse practitioners (NPs) and physician assistants (PAs) who provide primary care have been equally affected by the increased clerical burden related to the increasing documentation requirements from payers and are at risk for burnout. Rates of burnout in NPs are currently not well known. Burnout has been linked to decreased quality of care for patients. Inadequate training and lack of skills in the use of the EMR have contributed to HCP and burnout. Lack of awareness of specific quality measures and lack of documentation of clinical quality outcome measures have affected provider, organizational and health plan performance in value-based payment models.

The purpose of the Doctor of Nursing (DNP) project was to implement a training program for HCPs to increase EMR functionality to improve performance on quality measures and ultimately, quality of care. Improving efficiency through training and improvement of workflow is part of an ongoing support for HCPs to reduce information technology-related stress and burnout. The project’s setting was a local medical group in the southwest part of the United States consisting of physicians, NPs, and PAs. The medical group participated in value-based payment models and significant revenue was dependent on how well the clinical quality measures were met.

The technology acceptance model (TAM) was the theoretical framework used for development of the training program content. The model positively related use of a technology application to the user’s perception of ease of use and perception of usefulness. The Maslach multidimensional theory of burnout provided the theoretical basis for the construct of the burnout phenomenon. The Physician Work-Life Single Item Questionnaire was developed from this theory and was used to assess perceived burnout among healthcare providers.

Twenty-four participants completed an online survey assessing perceived ease of use and usefulness, self-reported skill and use of the quality functionality, and perceived burnout. HCPs in the medical group (n =33) attended one of three training sessions led by the DNP student. The training sessions took place between September 1, 2020 and October 4, 2020. The training included a brief presentation followed by demonstration of click by click workflows for use of the quality tab function and quality measure report. An evaluation tool based on the Kirkpatrick model was completed by the providers immediately following the training session. Participants completed the same online survey following completion of the training program. Performance reports for the medical group as a whole were obtained prior to the training implementation and then again following completion of healthcare provider training.

Descriptive statistics and independent t-test were used to analyze data obtained from the pre- and post-implementation surveys. Results showed improvement in self-reported skill in the use of the quality functionality in the EMR. The evaluation tool responses indicated participants felt the training was appropriate in content, applicability, and presentation. The learning objectives were felt to be relevant and the learning objectives of the training session

were achieved. Perceived burnout did not demonstrate a statistically significant change in this small sample. There were small improvements in performance on most of the nine quality measures, most significantly on microalbumin/creatinine ratio for diabetics.

This DNP project supported that HCPs related EMR stress to increasing burnout. The training program was successful in achieving its learning objectives, but performance measures did not improve as much as hoped, perhaps due to the rapid new patient visit volume seen by the medical group and records lag. The conclusion was system changes and ongoing organizational support for reducing clerical burden for HCPs were needed to truly address burnout, so HCPs are able to provide high quality care and improved outcomes for their patients.


burnout; electronic medical record; healthcare provider training

File Format


File Size

1.1 MB

Degree Grantor

University of Nevada, Las Vegas




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