While the average person probably thinks that nurses working via telehealth is something new that came about during COVID, that couldn’t be further from the truth.
“I have personally been practicing in telehealth for the past eight years,” says Mariea Snell, DNP, APRN, FNP-C, an associate professor of nursing and the director of the Doctor of Nursing Practice Programs at Maryville University. “I think the pandemic changes how people access care in large numbers, but it is not new. Many people with access issues due to physical disabilities or needs have used these systems. Others did not fully understand what it could do until put to the test.”
Georgia Reiner, MS CPHRM, a Risk Analyst at the Nurses Service Organization (NSO), agrees that telehealth has been around for a while. She adds, though, that its use has dramatically increased.
“Some nursing professionals, mainly advanced practice registered nurses (APRNs), including nurse practitioners (NPs), worked in telehealth before the beginning of the pandemic. However, there has been a dramatic increase in the utilization and availability of telehealth services due to policy changes implemented in response to the COVID pandemic,” says Reiner. “For example, an analysis by McKinsey & Co found that telehealth accounted for less than 1% of Medicare services before the onset of the pandemic, but by July of 2021, telehealth services accounted for about 13-17% of claims submitted to Medicare. Additionally, licensing requirements were relaxed in many states, which helped enable nursing professionals to practice across state lines via telehealth, as were requirements that patients have an established relationship with a provider before they could receive telehealth services. However, many of those policy changes are set to expire at the end of the public health emergency, leaving the future of telehealth services somewhat in question.”
Additional Training
If you’ve never worked in telehealth before, you may wonder if it’s necessary to receive additional training before working in it. The answer is yes and no.
“All nurses can participate in telehealth,” says Snell. “They would provide the level of care that each are currently licensed to provide. In the case of a DNP/NP, they would treat patients the same way they would in an office setting.”
However, the training that nurses would and could receive will depend on several factors.
“Nurses and advanced practice registered nurses may receive training through their educational programs on the use of telehealth. If nurses do not receive this training in their educational preparation, they may receive it through their employment or workshops and educational programs. There are certification courses that are available for healthcare providers to take as well,” explains Robin Arends, DNP, CNP, FNP-BC, PMHNP-CE, CNE, FAAN, FAANP, the APRN Program Director at South Dakota State University as well as a nurse practitioner at Avel eCare. She’s published and presented both workshops and talks about all aspects of telehealth—regionally, nationally, and internationally.
Nurses have worked in a variety of settings in telehealth—such as school nursing, critical care, emergency care, specialty care, and geriatrics, Arends says. Be sure to check if the state you’re practicing in mandates training or taking a test before providing telehealth services.
She continues: “Nurses should be trained to use the telehealth equipment to complete the assessment and how to help others at a remote location use the equipment. They should understand how to appear on camera and communicate with patients through technology. Nurses should be aware of the background that the patient sees on camera and any sounds occurring in their environment. Nurses must know and comply with HIPAA, information security, and confidentiality. Nurses should also be aware of licensing requirements as they need to be licensed in the state where the patient is located.”
Because she works as a risk analyst, Reiner takes a deeper dive when explaining the training nurses need and why.
“Nursing professionals working in telehealth need to verify with relevant state professional licensing boards the practitioners — known as “qualified providers” — who can legally provide telehealth services. Nurses must be appropriately credentialed to practice in the state(s) where their patients or clients are located and work under that state’s scope of practice for nursing professionals,” Reiner says.
“Prior to beginning any telehealth work, nurses need to be prepared and have a backup plan in place in case of an emergency or technology breakdown. In addition to obtaining their patient’s/client’s consent before participating in telehealth services, nurses must also clearly convey to their patients/clients the inherent technical and operational hazards that may impede communication, such as:
- System compromise or hardware failure, which could lead to an incomplete or failed transmissions.
- File corruption or other data transmission issues, resulting in less than complete, unclear, or inaccurate reception of information or images.
- Unauthorized third-party access, which may lead to data integrity or information security problems.
- Natural disasters, such as hurricanes, tornadoes, and floods, which can potentially interrupt operations and compromise computer networks.
Whether a nurse can or should provide telehealth services from their residence depends on factors including state regulations, their employer’s policies, and procedures, their home environment and infrastructure, their ability to comply with technical, security, and confidentiality considerations from their home, as well as the nurse’s comfort level with engaging in telehealth practice from their home.”
Challenges
Working in telehealth may seem much easier because it can be done from nearly anywhere. However, there are some challenges to working in it.
“The biggest challenge is that providing services via telehealth is so different from traditional, in-person care, where a patient is physically present in front of the nurse. When providing telehealth services, the nurse relies entirely on technology for the patient encounter. In addition to adhering to traditional clinical standards of care and practicing within the scope of practice authorized by law, there are also technical considerations,” says Reiner. “Equipment and software must be routinely tested, maintained, and updated for quality assurance. Nursing professionals and their employers must also track how well a telehealth program functions carefully. Indicators should capture clinical, efficiency, and satisfaction outcomes, including:
- Patient/client complication and morbidity rates
- Compliance with provider performance criteria
- Diagnostic accuracy
- Adherence to clinical protocols
- Referral rates
- Patient/client satisfaction levels
- Cost per case
- Delays in accessing consultations, referrals, or specialty practitioners
- Average waiting times
Arends says that another challenge is that nurses must remember to maintain licenses in the states where their patients are located—and follow that state’s practice rules and regulations.
Remember Documentation
Just as you would if seeing a patient in person, nurses need to do documentation.
“Telehealth sessions should be as thoroughly documented as all other patient/client encounters. Just because some information may be automatically captured by software doesn’t negate the nurse’s professional responsibilities around documentation,” Reiner states. “Documentation in the patient’s medical record should be in accordance with the same documentation standards of in-person visits—including documentation of all communications with the patient or other providers (whether verbal, audiovisual, or written), clinical observations, orders, test results, and patient education and follow-up instructions.”
Telehealth Helps Nurses Become a Key Player
According to our sources, if you haven’t decided whether to look into providing telehealth, you should.
“Nurses should consider getting into telehealth because this is the direction that healthcare is going in. Incorporating technology in care will continue to develop and will never go back,” says Snell. “It is important to stay current with this trend. You won’t necessarily make more money, but you will be more marketable and have a better work-life balance.”
Arends agrees. “Nurses should consider working in telehealth because there are increasing opportunities in this area of healthcare. Patients saw the benefit of telehealth during COVID and want to continue to receive healthcare through this modality. Telehealth has shown high patient and provider satisfaction. I predict that telehealth will only continue to grow and expand.”
In addition, Arends believes that nurses will become key players in telehealth. “Nurses are the core of healthcare. In traditional settings such as hospitals, they are the first to alert providers to changes in the patient’s condition and are truly the front lines of healthcare. This will continue to be seen in telehealth,” she says. “Many studies have shown that nurses utilizing telehealth for remote monitoring as well as real-time audio video telehealth formats have reduced complications and readmissions and increased access to care.”
The benefits to patients are seemingly endless. “Nurses work where the patients are. Some patients cannot travel to clinics because of weather, physical condition, or other factors. Nurses who work in telehealth can care for patients when the patients are not able to seek care from traditional locations. Like home visits, nurses can visit the patients in their home environment. They can assess how the patient moves and works in their environment. They can assess for safety hazards in the home environment as well.”
Finally, working as a nurse with patients in telehealth can also be immensely rewarding. “The greatest award of working in telehealth is helping the patient achieve the best health outcomes while minimizing barriers to accessing healthcare,” says Arends. “Helping a patient who may not be able to access healthcare for various reasons achieve control of chronic diseases or feel healthier is a huge reward for telehealth. In addition, helping patients meet their personal care goals in their preferred environment is also optimal.”
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