Nursing and midwifery are recognized as stressful professions (Badu et al., 2020; Peter et al., 2020; Wright et al., 2018). The acuity and complexity of patient care has significantly increased, putting extra pressure on nurses and midwives, especially in the context of global shortages in both professions (United Nations Population Fund, International Confederation of Midwives, World Health Organization, 2021; World Health Organisation, 2020). These pressures have been exacerbated by the coronavirus pandemic (Buchan et al., 2022). At the same time that demand for patient care has increased, the volume of clinical documentation required has rapidly expanded and has become burdensome for clinicians (Moy et al., 2021; Padden, 2019). Clinical documentation encompasses the records and reports of the assessment and care of patients during an episode of care.

While accurate documentation is essential to effectively communicate and record patient care, there is evidence that documentation requirements have become burdensome (De Groot et al., 2022; Gesner et al., 2019). For the purposes of this study, we define the burden of clinical documentation as onerous, time consuming and excessive (duplicate or redundant) documentation that inhibits and encroaches on the time available for direct patient care. There is a growing body of evidence that documentation that is intended to assist the provision of safe patient care may in fact hinder it. Documentation burden is associated with increased medical errors, documentation inaccuracies and omissions, and patient safety concerns (Moy et al., 2021). Typically, new documentation is added periodically without a review of all existing documentation and this practice leads to duplication and redundancy that causes clinician dissatisfaction (Bøgeskov & Grimshaw-Aagaard, 2019; Cooper et al., 2021; Paterson et al., 2022) and can negatively impact patient safety when documentation requirements become overly onerous and reduce time for direct patient care (Moy et al., 2021). Recent studies have found documentation burden can also contribute to burnout (Gesner et al., 2019; Gesner et al., 2022; Moy et al., 2021). Both clinician dissatisfaction and burnout are known to negatively impact patient care (Dall'Ora et al., 2020; Montgomery et al., 2022).

Our own investigation of clinical documentation, that included measuring nurse and midwife satisfaction with clinical documentation and conducting a time and motion study to assess work patterns, found high levels of dissatisfaction with documentation, significant issues with duplication and redundancy, and that documentation was taking up to a third of clinician's time (Cooper et al., 2021). The results of our observational study (Cooper et al., 2021), along with widely reported concerns about the volume of clinical documentation in the literature (De Groot et al., 2022; Moy et al., 2021; Paterson et al., 2022), demonstrate the need to develop approaches to address the burden of clinical documentation for nurses and midwives. The aim of this paper is to report on the development of an intervention to reduce the burden of clinical documentation through co-design. The objectives of the study were to:

Evaluate all clinical nursing and midwifery documentation currently in use in a maternity setting, to identify areas of duplication and redundancy,

Determine aspects of nursing and midwifery clinical documentation that could be modified,

Co-design an intervention to make appropriate amendments to nursing and midwifery clinical documentation,

Implement the intervention to nursing and midwifery clinical documentation in practice.