Preparing Nurses for Roles in Telehealth: Now Is the Time!

Carolyn M. Rutledge, PhD, RN, FNP-BC; Tina Gustin, DNP, RN, CNS

Disclosures

Online J Issues Nurs. 2021;26(1) 

In This Article

Abstract and Introduction

Abstract

With the COVID-19 pandemic, the method for delivering healthcare changed overnight. Telehealth became a primary method of delivering care. Suddenly, nurses were expected to utilize technology with very little, if any, training in telehealth. All evidence suggests that telehealth is here to stay. As such, it is now time for healthcare providers to reflect on best practices for telehealth, and for nurse educators to ensure that graduates are prepared to function in the new telehealth arena. This article provides an introductory overview of the history of telehealth nursing; uses for telehealth with the COVID-19 pandemic; new awareness of telehealth challenges, and nursing roles. We also discuss sites that require a telehealth nurse and the Four P's framework for telehealth education.

Introduction

Spring 2020 created a paradigm shift in healthcare. For years, the healthcare profession, most specifically nursing, has prioritized the in-person relationship with patients in lieu of telehealth visits. Telehealth, as defined by the Health Resources and Services Administration (HRSA), is "the use of electronic information and telecommunications technologies to support and promote long-distance clinical healthcare, patient and professional health-related education, public health and health administration" (U.S Department of Health & Human Services DHHS, 2020, para 1).

While the National League of Nursing (NLN) provided a vision for preparing nursing students for technology, the focus was on electronic health records (EHR) and informatics, rather than telehealth for the provision of care (NLN, 2015). Even though the American Association of Colleges of Nursing (AACN) essentials for BSN (2008), MSN (2011), and DNP (2006) education addressed technology in broad terms, there was minimal reference to virtual health and no mention of telehealth (AACN, 2020). Because of the limited emphasis, few nursing education programs integrated telehealth content within the curriculum. When the COVID-19 pandemic hit, healthcare professionals, including nurses, were not prepared to pivot to delivering care through telehealth technologies.

Nurse educators had failed to prepare nursing graduates with the needed skills to optimize their role in telehealth delivery. This gap has left the registered nurse (RN), Clinical Nurse Specialist (CNS), Clinical Nurse Leader (CNL), and nurse managers/directors without the skillset needed to plan, implement, deliver, and evaluate telehealth programs. Even now, emphasis is being placed on providing training in telehealth to primary care providers (PCPs), such as nurse practitioners in advanced practice nursing programs, as opposed to RN, CNS, and CNL programs (Chike-Harris et.al., 2020; National Organization of Nurse Practitioner Faculty [NONPF], 2018; Rutledge et al., 2017; Van Houwelingen et al. 2016). As such, this article will focus on telehealth for nursing to include these overlooked groups of nurses (RN, CNS, and CNL).

It is now time to re-evaluate where the profession of nursing stands regardingtelehealth. It is time to embrace this new paradigm and prepare nurses to not justsupport telehealth efforts, but to take the lead in its integration within healthcare. It is time for nurses to promote and optimize the efficiency, effectiveness, andimplementation of telehealth. The door has been opened for telehealth as a vitalmethod to provide healthcare. All indications suggest that it is here to stay.

Nurses who utilize telehealth are expected to maintain their same scope of practice, however, with the added use of telehealth technologies. Through telehealth practice, the nurse uses a variety of technologies, such as videoconferencing to communicate with the patient; remote patient home monitoring to collect clinical data (e.g., blood pressure and blood glucose levels); and peripherals such as a Bluetooth stethoscope and a high definition camera to collect and deliver data to providers. The nurse practicing telehealth promotes patient wellness; assesses patients and provides care in remote or disadvantaged settings; manages chronic conditions; provides transition of care; and supports end of life care. The value of telehealth to the patient and healthcare settings is increased when the care is provided by a skilled, empathetic nurse prepared to deliver nursing care through technologies (National Council of State Boards of Nursing [NCSBN], 2014).

Most telehealth preparation for nurses occurs not during their academic training, but during clinical orientation for jobs or during a nurse residency program (American Academy of Ambulatory Care Nursing [AAACN], 2018). As a result, when society needed to embrace telehealth in response to COVID-19, healthcare professionals, including nurses, were caught without the needed training. Currently, the AACN supports the use of telehealth in nursing practice, but the organization has yet to mandate that telehealth be incorporated into nursing curriculum (AACN, 2020).

As seen with the COVID-19 pandemic, telehealth delivery is practiced in all settings and requires the support of many professions. The nurse has a vital role in much of this delivery. As such, nursing programs must begin to integrate this content into their curricula. The purpose of this article is to provide insight into: 1) the history of telehealth nursing, 2) roles in telehealth available to nurses, and 3) education that is needed to prepare the nurse to participate in and advocate for telehealth.

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