In April 2020, in-person medical visits fell by 52% while telehealth visits leapt 4000%, according to a recent study published in the JAMA Network Open. This shift during the COVID-19 pandemic changed many people’s perception of remote consultations, increasing both acceptance of and appreciation for the practice. Though patients have returned to in-person visits again, it’s clear telehealth nursing and other forms of remote healthcare services have gained traction across the country.
To prepare for the growing use of telehealth, nurses should consider how to build the skills needed for this increasingly important healthcare delivery model.
Professional Goals for Nursing
Telehealth nursing offers many benefits to patients and clinicians alike. To start, it saves patients travel time and can limit their exposure to disease. However, telehealth can also pose challenges. These challenges, ranging from managing technical issues to finding effective methods of communication, make unique demands on nurses.
Nurses need to develop specific skill sets and knowledge that prepare them to effectively deliver healthcare services virtually. For example, during in-person visits, nurses often use a patient’s nonverbal communication, such as body language, to catch misunderstandings and pose relevant questions. Telehealth visits limit the nonverbal communication nurses can pick up on.
To compensate for this limitation, nurses can learn new techniques that help address potential communication gaps during telehealth visits. One method, called teach-back, creates a communication feedback loop that helps telehealth nurses check for understanding. Nurses ask patients to repeat back the information or instructions the nurse has shared, allowing nurses to clear up confusions and locate misunderstandings.
Today, professional goals for nursing should include building telehealth skills. Nurses can develop these skills in formal and informal ways.
Ways to Develop Telehealth Nursing Skills
Returning to school to earn a more advanced degree can serve as a great tool for gaining competency in telehealth nursing. Many nursing programs have begun to integrate coursework in evidence-based practices for delivering healthcare services remotely. Some programs also teach nurses ways to ensure patient confidentiality in online environments.
Licensed practical nurses (LPNs) and licensed vocational nurses (LVNs) may consider pursuing bachelor’s degrees in nursing that offer this type of coursework. Likewise, registered nurses (RNs) can look for Master of Science in Nursing (MSN) degree programs with courses that focus on ways to adapt nursing practices to telehealth models, or that address ethical and legal issues that can arise in telehealth nursing.
Nurses can build telehealth skills in less formal situations as well. Other ways to explore telehealth nursing include:
Read Articles and Listen to Podcasts
Nurses can find an array of articles and podcasts addressing telehealth and best practices. Reading these articles or listening to these podcasts can help nurses keep up to date with relevant conversations and innovative approaches to telehealth.
The following sources publish materials and broadcast shows on telehealth issues that can prove useful to nurses wanting to learn more on the subject:
Telemedicine and E-Health: This peer-reviewed journal covers everything from advances in telehealth care to its impact on healthcare access.
Journal of Telemedicine and Telecare: A leading publication in the field, this journal explores ways different healthcare systems use telehealth. It also features studies on clinical trials of telehealth applications.
TBHI Telehealth Blog: Sponsored by a telehealth training institute, this blog covers various topics ranging from teletherapy to tools for remotely monitoring older patients.
Telehealth Talk: This podcast brings on telehealth professionals who offer advice and support to clinicians new to telehealth. They also share stories about their own journeys in the field.
My Telehealth Podcast: Produced by South Carolina Public Radio, this podcast looks into the different ways clinicians use telehealth. It also presents stories of telehealth successes and challenges.
Participate in Discussion Groups or Forums
Discussion groups and forums offer nurses an opportunity to ask questions, listen to experts, and discover new information about telehealth innovations and practices. Discussion groups and forums that nurses may want to join include:
ATA (American Telemedicine Association) Member Groups: Members of ATA can join one of their discussion groups, which cover topics such as telehealth technology and pediatric telehealth.
Telehealth Community: Participants on this forum share insights and ask questions about topics such as optimizing telehealth services and methods for using telehealth for acute care.
Join Telehealth Organizations
Telehealth organizations can serve as a great resource for nurses. They often publish reports on telehealth, sponsor conferences, and publish support materials, such as telehealth practice guidelines and webinars.
Notable telehealth organizations include:
American Telemedicine Association: This organization focuses on telehealth policy issues, but its website also posts the latest research on telehealth and provides a resource page with recordings of conferences and webinars on various telehealth subjects.
American Nurses Association (ANA): Although not exclusively a telehealth organization, the ANA focuses on supporting nurses across specialty areas and practice settings, which includes telehealth. By joining, nurses can access online nursing communities and discussion groups, mentorship programs, and numerous professional development opportunities (some of which are free to members) that can help them develop telehealth skills.
American Academy of Ambulatory Care Nursing (AAACN): Like the ANA, the AAACN doesn’t exclusively address telehealth nursing. However, the AAACN serves as an authority in telehealth, as they’ve published the book Scope and Standards of Practice for Professional Telehealth Nursing to support nurses striving to enhance their telehealth skills. The AAACN offers a myriad of articles and practice resources in telehealth as well as a telehealth nursing practice special interest group. Also noteworthy, the AAACN ambulatory care certification exam includes telehealth-specific content.
Telehealth and COVID-19
The history of telehealth long predates COVID-19. However, not until the pandemic did many people gain awareness of it. A recent McKinsey & Company report shows that, as of July 2021, telehealth use had soared to levels 38 times higher than pre-pandemic levels.
McKinsey consumer research found that many of those surveyed view telehealth favorably. About 40% said they plan on using telehealth for future healthcare needs. Prior to the pandemic, only 11% of those surveyed said the same.
When COVID-19 cases spiked in April 2020, up to 17% of outpatient medical visits shifted to telehealth, according to McKinsey. From June 2020 to July 2021, the rate has remained stable. These numbers suggest that telehealth is here to stay. Additionally, some regulations created to make telehealth more accessible in the middle of the pandemic have since become permanent.
Professional Development for Nurses
The dramatic expansion of telehealth in a relatively short amount of time means healthcare professionals need to get their skills up to speed. Nurses and other clinicians caring for patients via telehealth must understand what standards of care and best practices look like in virtual situations. This requires nurses to invest time and energy into professional development focused on telehealth.
Key Telehealth Skills for Nurses
A paper recently published in Telemedicine and E-Health maps out the skills telehealth clinicians need to deliver quality care. Reviewing these competencies that are fundamental to maintaining patient safety and care can help nurses make thoughtful choices about their professional development.
Competency areas discussed in the paper especially relevant to nurses include:
Using Telehealth: Are Patients Ready?
Nurses need to understand the appropriate times to use telehealth and the appropriate technologies to use in various situations. They also need to learn about the best ways to ready patients for telehealth services, making sure they recognize how telehealth visits differ from in-person visits.
Remote Clinical Evaluations
Effectively gathering clinical information is an important part of providing high-quality care. The information-gathering process conducted during telehealth visits differs from that of in-person visits. Nurses need to learn techniques for skillfully acquiring sufficient information from patients during telehealth visits. They also need to learn methods for properly performing physical examinations remotely, while keeping in mind the limitations of their remote physical exams when making assessments.
Communication via Telehealth Technology
Without the right techniques, communication can be severely compromised during telehealth visits. Nurses need to learn methods for building rapport with their patients remotely and gaining their trust. Nurses also must develop strategies for avoiding miscommunication, which can happen more easily in remote situations.
Professionalism in the Virtual Sphere
Nurses should consider what professionalism looks like in a virtual environment. In addition to appropriate greetings, closings, and tone, nurses must develop a good “web-side manner,” which is an approach that enhances patient comfort and trust and promotes better communication. It involves paying close attention to various aspects of a telehealth visit ranging from sufficient lighting, appropriate body language, and proper positioning in front of a camera.
Information Technology Proficiency for Nurses
Telehealth involves the use of technology. Nurses need to be sufficiently proficient in the technological tools of telehealth so they can both use them effectively and troubleshoot technical problems in a timely manner.
Legal and Privacy Concerns
Nurses should learn about the risks and liabilities they confront that are specific to telehealth nursing.
They must also familiarize themselves with the methods used to ensure patient privacy and security, and be prepared to explain these details to patients.
Patient Safety When Choosing Telehealth
Patient safety should always play a primary role in any healthcare model. Nurses need to learn when to switch from a telehealth exchange to an in-person visit. They must also develop skills for responding to emergencies in remote situations and gauging the reliability of remotely obtained patient data such as weight and blood pressure.
Telehealth Professional Development Opportunities
To become proficient at caring for patients virtually, nurses can turn to telehealth professional development that addresses a range of relevant topics. Nurses can take advantage of many online resources to meet this need. Online education can help prepare nurses for remote work by exercising their communication skills in virtual situations. It may also give nurses a chance to develop a greater awareness of some of the communication pitfalls that are characteristic of remote interactions and, in turn, prepare for them.
The following resources offer learning opportunities that cover telehealth technology and telehealth concepts. Some can help fulfill continuing education requirements needed for certification renewal in several states. The resources below also provide guidance on virtual assessments, toolkits that build telehealth skills, and information on events and conferences related to telehealth.
TTAC (National Telehealth Technology Assessment Resource Center): TTAC provides interactive toolkits that teach practitioners how to use different telehealth technologies. The site also has a telehealth learning section with videos on everything from mobile health apps to preparing patients for telehealth visits.
The National Consortium of Telehealth Resource Centers: Funded in part by the Department of Health and Human Services, the consortium has 12 regional centers. Each center provides telehealth information specific to its region. Centers also offer webinar series and event listings, and resource pages with links to telehealth training modules, toolkits, and articles.
American Academy of Ambulatory Care Nursing (AAACN) Telehealth Products: Nurses can sign up for virtual AAACN learning sessions presented by telehealth nurse experts. Nurses can access some sessions for free, while they must pay for others.
Telehealth Nursing Practice Education Resource Directory: AAACN members can gain access to the organization's telehealth resource directory. Nurses can search the directory to find educational opportunities that can improve their effectiveness in telehealth.
CORE Concepts in Telehealth Certificate Program: The American Board of Telehealth offers a general certificate program in telehealth, not exclusive to nurses, but which may still provide nurses with valuable knowledge. The program addresses clinical, operational, regulatory, and ethical issues in telehealth.
AMA Ed Hub: Though the American Medical Association’s Ed Hub principally targets physicians, its Coronavirus Education Center offers several telehealth learning opportunities valuable to nurses. Many of these continuing education offerings are free, and nurse practitioners may use them to fulfill licensing renewal requirements in some states.
ANA Continuing Education: The ANA offers both free and paid-for telehealth webinars and online courses that nurses can find through the ANA continuing education page’s search engine. Most offerings can serve as credit toward continuing education requirements required by some states for licensing or licensing renewal.
Benefits of Telemedicine
Using technology to remotely diagnose and treat patients has many benefits. During the height of the COVID-19 pandemic, telehealth helped ease many patients’ concerns about exposure to the virus, and it gave people access to much needed mental health care. This example highlights only a couple of the many advantages telehealth nursing offers. Others include:
Increases Peace of Mind
Telehealth allows for remote monitoring of patients. This means nurses and other healthcare providers can track important health information from patients, such as vital signs, outside of clinical settings. With telemonitoring, nurses can keep tabs on patients recently released from the hospital or those at high risk of having a stroke or heart attack, increasing peace of mind for everyone.
The ongoing collection of patient information allows healthcare providers and the patients themselves to quickly respond to problems. It can also allow patients to recover at home, freeing up hospital beds for those with more acute illnesses.
Improves Access to Care
Millions of people live at least 30 minutes from a hospital. This can complicate matters when it comes to getting needed healthcare. Patients without transportation or with limited money to pay for transportation may put off or even skip medical appointments or trips to the emergency room. Telehealth visits remove that extra bit of friction that might keep patients from seeking care.
Additionally, many people in rural areas lack access to specialized care that can often prevent disease progression and hospitalization. With telehealth, patients can access the best specialists regardless of their location.
Telehealth can improve efficiency, saving healthcare facilities money they can then spend on training, staffing, and technology. For example, telehealth reduces the number of appointment no-shows, which can eliminate scheduling problems and the costs associated with them.
For patients, telehealth visits can lower child care and travel expenses, as well as minimize how much time they take off from work. Telehealth visits can also limit unnecessary visits to the emergency room, which can save patients large sums of money.
Eases the Nursing Shortage
With aging baby boomers needing increased care and a large portion of the nursing force soon eligible for retirement, the American Association of Colleges of Nursing projects a significant nursing shortage in the coming years. Burnout from the COVID-19 pandemic has only exacerbated the situation.
Telehealth can help ease this shortage by balancing a nurse’s workload. Telehealth helps nurses save time, save energy, and work more efficiently. For example, telehealth technologies can facilitate more effective and interactive methods for educating patients about their care.
In addition, some telehealth technologies allow hospital patients to order their own meals or adjust their room temperature, eliminating the need for nurses to handle these tasks. This can free up time for nurses, giving them more flexibility to take care of other tasks and reducing their feelings of overwhelm.
Take Your Telehealth Nursing Skills to the Next Level
Telehealth offers undeniable benefits to both healthcare providers and patients. However, it also requires nurses to develop the right skills and knowledge regarding telehealth technology and best practices when it comes to caring for patients remotely. As telehealth nursing continues to expand, well-prepared clinicians will enjoy increased opportunities as well.