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Cognitive Overload Among Nurses: Exploring Causes, Risks and Solutions

By Rhonda Collins, DNP, RN, FAAN, Chief Nursing Officer, Vocera

Every year around Nurses Week, May 6 to May 12, I write a CNO Perspective Report in which I examine a topic I think is important to nurse leaders.

Last year, the report explored cognitive overload and its impact on nurse well-being and patient safety. Because of the COVID-19 pandemic these critical topics have garnered more attention and generated much needed awareness.

How cognitive overload can lead to medical errors

As humans we parse and make sense of what is going on around us through the act of segmenting. Nurses in a hospital environment constantly segment what is urgent as they manage multiple patients and shifting priorities. When a nurse receives too much information at once from multiple people and systems, it becomes difficult to segment and to focus on the most critical patient care tasks. It is here where mistakes can happen.

How hospitals can minimize cognitive overload

Nurses cannot control the amount of information coming at them, nor how it is delivered. Hospitals need to find ways to offload the need for clinicians to retrieve, retain, and record information, and make it easier for them to collaborate. When a single clinical communication and collaboration (CC&C) platform is used, hospitals can simplify workflows by taking five measures to reduce cognitive load.

1. Contextualize information

Nurses must often solve complex problems without full context. They might have a small piece of standalone information, like a lab value, but it doesn’t tell the whole story. A strategy for countering this problem is to provide patient identifiers with notifications, along with an information chain of relevant context. Vocera technology helps relieve the burdenof segmenting information by attaching contextual information to the patient’s record so it’s easy to access. Lab values, vital signs, and other data such as sepsis risk indicators are attached to the profile of a patient who is the focus of a notification or request.

2. Deflect distractions to allow focus on critical tasks

It’s common for a nurse’s attention to be split among multiple information sources. Interruptions and distractions can lead to cognitive overload. With Vocera technology, a nurse can put his mobile device on Do Not Disturb and divert extraneous information to voicemail. He can listen to messages when his brain has working capacity available to segment the information. When a matter is truly urgent, a caller can break through Do Not Disturb. He also can set reminders and forward incoming calls to other people in a group.

3. Provide a single source of information and standard communication protocols

Clinicians often struggle to communicate with each other. They are hindered by barriers such as multiple standards, conflicting protocols, and disparate communication tools. The difficulty of communicating is a drain on working memory. With Vocera technology, a nurse doesn’t have to use short-term memory to sort out what system to use to contact the doctor. The software platform allows a hospital to create a standard protocol and unify communication for clinicians and ancillary staff, using the same nomenclature.

4. Offload the need to retrieve, retain, and record information

Redundancy of documentation is a problem in medical care. When a nurse must write the same information four times in several different places while juggling information about six different patients, she is more likely to make a mistake. Vocera technology lets nurses offload the need to retrieve, retain, and record certain information so they don’t need to carry it in short-term memory. The platform provides a single source of aggregated information that is accessible to the entire care team and doesn’t need to be replicated again and again.

5. Weed out extraneous information

Weeding refers to removing extraneous information from the conversation. With weeding, what is removed is just as important as what is allowed through. Perhaps a nurse doesn’t need to receive a patient’s vital signs every 15-30 minutes if a patient is stable or be notified when a patient’s SpO2 has dropped down to 88% if the patient normally sats at 88%. When it comes to management of secondary alert and alarm notifications, Vocera technology accomplishes extraordinary weeding by allowing nuisance notifications to be filtered out. Clinicians receive only the information on which they need to act.

Before COVID-19, nurses had to manage cognitive overload. During both routine days and stressful times, healthcare workers experience cognitive burden. Identifying ways to lessen that burden by simplifying workflows with assistive technologies can reduce the mental and emotional stress on those who dedicate their lives to caring for patients.


Rhonda Collins, DNP, RN, FAAN, is the Chief Nursing Officer at Vocera, where she works closely with nurses, physicians, IT professionals and other hospital leaders around the world to improve the lives of patients, families and care teams by simplifying workflows and improving clinical communication. A nurse for more than 30 years, Dr. Collins is a co-founder of the American Nurse Project dedicated to elevating the voices of nurses across the country through interviews, an award winning book, and a feature length documentary.