Documentation audits have an impact on the nurse’s professional role and psychological wellbeing: A rapid systematic review

BACKGROUND: Audit and feedback cycles are central to quality improvement to improve patient outcomes, costbenefits and workflows. Nurses are frequently audited to identify gaps between current and best-practice. Little is known about the impact on nurses.

PURPOSE: To understand the impact of audit and feedback processes on the professional role and psychological wellbeing of nurses.

METHODS: A rapid systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines. Key search terms, e.g. audit, feedback, burnout, motivation, and wellbeing were searched (CINAHL, MEDLINE, PsycINFO, Google Scholar) from 2009 to March 2021. Pre-eligibility selection criteria, data extraction and quality assessment were guided by PRISMA.

RESULTS: The search revealed 717 manuscripts; five studies met inclusion criteria, underscoring that this is an emerging area. The professional role of the nurse was impacted by audit and feedback in that it informed patient safety and was an opportunity for professional development. Nurse engagement was responsive to content and delivery and aligned with perceived motivation of the audit. Nurses’ wellbeing was impacted, in relation to nurses’ satisfaction, retention, burnout, stress, motivation and wellbeing.

CONCLUSIONS: Audit and feedback were revealed to have an impact on the professional role of the nurse and on nurse wellbeing. Nurses were more positively engaged in quality improvement processes when the perceived function of the audit was for self-improvement, shared patient goals, and evidence-based practice, compared to when the audit and feedback processes were perceived negatively or weren’t transparent.

IMPLICATIONS: The nurse experience of audit warrants further investigation in order to understand impacts on clinical care outcomes.