Behind the Screen But Not Behind the Scenes: Virtual Nurses Provide Clinical Support, Additional Expertise

Behind the Screen But Not Behind the Scenes: Virtual Nurses Provide Clinical Support, Additional Expertise

Virtual nurses may work from behind computer screens, but their impact is felt throughout healthcare as their expertise is increasingly integrated into patient care and nursing workflows.virtual-nurses-provide-clinical-support-additional-expertise

Since the invention of the telephone in the modern digital age, healthcare providers have used telecommunication tools to bring clinical expertise and care to wherever patients need them. Regardless of the technology, nurses play essential roles throughout telemedicine, usually conveying or using insights or information.

Simply put, virtual nursing is the practice of nursing using telecommunication and telehealth tools and technologies.

Initially focused on increasing access to care in rural and remote areas and responding to the aftermath of natural disasters, telehealth, and virtual nurses have become part of the care provided to thousands of patients across the globe every day. They now support clinical teams throughout the patient care continuum to help ease the overwhelming demands and address serious healthcare issues.

During the COVID-19 pandemic, many care providers considered how telehealth tools could be used in innovative ways in the care of patients. The United States Government Accountability Office reported a 15-fold increase over the prepandemic level in telehealth use among Medicaid beneficiaries. Numbers skyrocketed from 2.1 million in the year before the pandemic to 32.5 million from March 2020 to February 2021.

Teresa Rincon, PhD, RN, FCCM, is a pioneer in virtual nursing. In 2003, she was one of the first nurses to practice from behind a camera as part of a teleICU. Today, she is an assistant professor at UMass Chan Medical School and its Tan Chingfen Graduate School of Nursing in Worcester, Massachusetts, and a senior telehealth consultant with Blue Cirrus Consulting, Greenville, South Carolina. She recently served as editor for a symposium of articles on virtual nursing for AACN Advanced Critical Care, a journal published by the American Association of Critical-Care Nurses (AACN). 

When Rincon became a virtual nurse, there were fewer than 1,000 teleICU beds in the United States. Over 20 years, that number has grown 20x, with an estimated one in eight ICU patients now monitored remotely.

The level of technology acceptance has created opportunities to apply the virtual nursing model to virtuallyanywhere,” she said. The ability to leverage clinical expertise across and despite geographical boundaries is an efficient and cost-effective way to ensure safe, timely, and effective care in critical situations and routine care delivery.”

Immediate Access to Clinical Support

Virtual nurses regularly assist with tasks that do not require physical proximity to the patient, such as patient-family education, completing admission and discharge tasks, and participating in two-person verification processes.

During a patient assessment, a remote nurse and an on-site nurse can efficiently work in tandem, with one managing tasks that require physical proximity to the patient and the other completing tasks such as clinical documentation, patient-family education, and expert nurse surveillance.

Virtual nurses provide an additional layer of clinical support to nurses at the bedside. At the push of a button, bedside clinicians have immediate access to additional nursing support.

This ease of access gives bedside nurses peace of mind, knowing that an experienced fellow nurse is not only assisting in monitoring for changes in a patient’s status but is available to collaborate and assist with care at a moment’s notice.

Virtual nurses serve as valuable mentors to novice nurses as they develop into competent and confident clinicians. They also may support travel or agency nurses to help bridge knowledge gaps caused by a lack of familiarity with specific facilities and policies. In addition, peer-to-peer collaboration can help on-site colleagues feel more supported.

Lisa-Mae Williams, PhD, RN, CCRN, is the chief nursing officer at Intercept Telehealth, Weston, Florida.

In addition to caring for patients, virtual nurses are helping to address the experience gap by providing an extra layer of support and expertise to the on-site team,” Williams said. Knowledge and expertise are precious commodities, especially when caring for critically ill patients.”

Beyond the ICU

Virtual nurses and tele-critical care (TCC) programs have become more pervasive, thanks to technological advances, modalities expansions, and the number of patients served.

Weve seen significant growth in the number of tele-critical care services, as they expand beyond traditional critical care areas, including to emergency departments, medical-surgical units, and even home-care settings,” said Fiona Winterbottom, DNP, MSN, APRN, ACNS-BC, ACHPN, CCRN, clinical nurse specialist, at Ochsner Health in New Orleans.

Advances in technology have led to increased use of mobile carts, which bring the expertise of intensivists and TCC nurses wherever they may be needed. In the emergency department, they can proactively manage patients waiting for hospital admission, providing earlier access to interventions and improving outcomes.

Remote clinicians can also support rapid response teams to help stabilize a patient with a deteriorating condition. The patient can often remain in their current unit and avoid transfer to an ICU. An added benefit is that the mobile cart can stay in the patients room, allowing the virtual nurse to continue monitoring them for a defined period.

There are also opportunities to create an observation space in the emergency department where patients who need short-term care for diabetic ketoacidosis, drug/alcohol overdose, allergic reactions, and other issues can get the expert care they need without being admitted to another unit.

Beyond the hospital, wearable devices and monitoring kits that link to an on-call automated system and a mobile app can help patients self-manage at home with a medical support system.

Unlimited Options

Ryan Morcrette, BSN, RN, CEN, is the director of virtual care and clinical communications at St. Lukes University Health Network in Pennsylvania and New Jersey.
 
The concept of virtual nursing will continue to mature along with the technology to support it, and were going to look back and wonder how we ever provided healthcare without this asset,” Morcrette said. It will become second nature for patients, bedside nurses, and other clinicians.”

“As we look to the future, we have to think about how to harness the knowledge and skills we need to improve the care we provide to patients. We need innovative solutions to manage the impacts of the global nurse staffing shortages successfully,” Rincon said. Thanks to telehealth technologies, an expert can be located anywhere in the world and connect with someone who needs their assistance.”

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Peering into the Post-COVID Nursing Curriculum

Peering into the Post-COVID Nursing Curriculum

Nursing education after COVID will rely more on technology and digital tools than ever. Simulation and online learning will be part and parcel of the curriculum for nursing students. It will also be more competency-based as the new AACN Essentials further integrate into nursing curriculums.

But what about the content of the curriculum?

Nursing education, according to Mary Dolansky, Ph.D., RN, FAAN, Sarah C. Hirsh Professor, Frances Payne Bolton School of Nursing and Director, QSEN Institute at the school, may include instruction on telehealth, an emphasis on systems thinking, stress on leadership, and a focus on innovation and design thinking.

Nursing education after COVID

Mary Dolansky, Ph.D., RN, FAAN, is a Sarah C. Hirsh Professor at the Frances Payne Bolton School of Nursing and Director, QSEN Institute at the school

A Look at Nursing Education After COVID

Telehealth

Understanding how to use telehealth in nursing is key, according to Dolansky. The Frances Payne Bolton School of Nursing at Case Western Reserve University, Cleveland, developed a series of four modules on telehealth so that all students received a basic foundation in telehealth nursing, including telehealth presence. It included teaching on using Zoom or the phone to assess and evaluate patients. She notes that interactive products that give students a feel for how such interactions occur and practice them can provide an excellent education.

Systems Thinking

Another aspect of post-COVID nursing education involves systems thinking, says Dolansky. This involves “really getting students to think beyond one-to-one patient care delivery and about populations. We need to create more curricula for nurses out in primary care sites and nurses out in the community, and that has not been a strong emphasis in schools of nursing. Instead, we focus mainly on acute care.”

More specifically, students should learn, for instance, how to use data registries to look at areas of patient need. One COVID example, notes Dolansky, would be to use registries to identify long-term COVID patients. Another could be to use a registry or database to discover what patients have followed up on their chronic disease since, during COVID, many patients stopped visiting healthcare providers.

Emphasizing Leadership

In the post-COVID curriculum, developing leadership skills may become more critical. “What we observed in the COVID crisis,” says Dolansky, “was an opportunity for nurses to stand up and speak out more. We were the ones at the frontline and had the potential to be more innovative and responsive. Many great nurses did step up and speak up, but we need to ensure that every nurse can speak up for patients in future crises or even advocate for our patients now. Nurses can be the biggest advocates for patients.”

Every school of nursing probably has a leadership course, Dolansky notes. But ensuring that there are case studies from COVID as to how nurses did stand up and speak out and how that made a difference would be a fundamental curriculum change.

“We want to prepare our students that you will be a leader and you will be on TV talking about how you are innovating and adapting to the changing needs of the health of our population. And COVID was a great example for that.”

Innovation

Post-COVID, nursing education needs to help students with innovation and design thinking, notes Dolansky. Over the past 10 years with QSEN, “what we’re trying to advocate is shifting the lens of a nurse from direct patient care delivery, which has been the focus of nursing, to shifting a little bit to systems thinking.”

Critical thinking, notes Dolansky, focuses on making decisions for an individual patient. Design thinking and innovation are more about “looking at the system in which we work and empowering the nurses to fix the systems. This is key to quality and safety, but it’s also key to the need for our nurses to contribute strongly to the health of the future population. They have to be at the table to respond to these crises. We need them to have the skill set of being a leader, standing up, being at the table and when they’re at the table, having ideas, being creative, and knowing how to test them. And having the technical skills to use the technology is probably where most of the solutions will be for the future.”

QSEN and Competencies

With the latest AACN Essentials, there is a drive for competencies in nursing education, notes Dolansky. The Essentials: Core Competencies for Professional Nursing Education, approved by the AACN in April 2021, calls for a transition to competency-based education focusing on entry-level and advanced nursing practice.

While revising the Essentials began before the pandemic, the experiences and learnings from the pandemic greatly impacted the work, notes a recent article in Academic Medicine. As a result, the Essentials includes population health competencies that specifically address disaster and pandemic response and will better prepare the next generation of nurses to respond safely in future events, the article says.

Now, a crosswalk has developed between QSEN competency statements and the 2021 AACN Essential Statements, notes Dolansky. However, she notes that the AACN is taking the QSEN foundation and moving it forward, stating to the public that “the nursing profession has these competencies that are providing safe quality care to the public.” Since 2012, the QSEN effort has been based on the Frances Payne Bolton School of Nursing.

“Own Their Competency”

In the culture of nursing education, students now need to be educated to “own their competency,” says Dolansky. “Students will see that competency development is part of their lifelong professional development.

Three Trends That Will Shape the Nursing Profession in 2022

Three Trends That Will Shape the Nursing Profession in 2022

At the end of each year, there are changes predicted for the following year in terms of the health care industry. Jennifer Flynn, CPHRM, Vice President of the Nurses Service Organization (NSO), gave us information on the top three trends that will shape the nursing profession in 2022.

You’ve identified 3 trends you believe will shape the nursing profession in 2022: Staff Shortages, Travel Nursing, and Telehealth. Why are these three the most prevalent?

We’ve seen constant change in the health care industry. And, never more so then in the last two years. These trends in nursing have great benefits for the facility and the patient, but may increase liability risks for nurses.

While telehealth has its benefits: patients have increased access to care, and they manage some chronic conditions better, especially where remote patient monitoring replaces many routine in-person visits. Telehealth saves patients’ time of travel and waiting in the office which, some studies have shown increases their overall satisfaction.

For nurses, telehealth does provide more flexibility at a time that is most convenient for patient and nurse. However, there are some parts of telehealth that can increase a nurse’s liability risks, such as, providing care to those patients where visits must be in-person. Clinically speaking, you can’t perform all nursing functions virtually, but nurses need to know which patients must be seen in-person versus virtually. Nurses needs to be aware of which patients have barriers to virtual care. While broadband connections are improving, not every patient has access to a good connection. Lastly, licensing laws and reimbursement may limit a nurse’s ability to practice across state lines or be reimbursed for telehealth services.  It is the responsibility of the nurse to know the rules of telehealth in their state.

For some, travel nursing is a dream job enabling you to see the country while still enjoying the rewards of providing treatment and care to patients. For others, the endless adjustments of unfamiliar environments may make it not the right career choice. As with any job, there are pros and cons. Some liability risks nurses face with travel nursing are: the constant learning of policies and procedures at each new facility and assignment–though you may be contracted with a particular unit during your travel nurse experience, you may find yourself in even further unfamiliar territory when you have to float to another unit.

Many facilities will send the travel nurse first to float to an understaffed unit, again, learning the policies and procedures of that floated assignment. Lastly, you will need to check your licensing laws–travel nurses may have to have multiple licenses in order to practice. And, each state where you work will require you to hold an active and unrestricted license for that state.

Safe nurse staffing is essential to both the nursing profession and to the overall delivery of treatment and care. Adequate staffing levels ensure better care for patients and reduces nurse fatigue, prevents burnout, and increases patient satisfaction. However, inadequate nurse staffing can endanger patients. Research shows that shortages and inadequate staffing are linked to higher rates of infections, patient falls, medication errors, and even mortality. This is because nurses have too much work to juggle and cannot spend enough time on each patient, resulting in missed care. While staffing was a topic of discussion well before the pandemic, the COVID-19 pandemic has exacerbated the nursing shortage in the United States. Nursing leaders say nurses are tired and frustrated from being asked to work overtime. Some are even considering leaving the profession. Safe nurse staffing affects the ability of all nurses to deliver safe, quality care in all practice settings.

Everything You Need to Know About Telehealth

Everything You Need to Know About Telehealth

If you hadn’t heard of telehealth before the coronavirus pandemic, you probably know about it now. Medical providers are trying to move as many of their appointments to virtual means as they can. While telehealth options have been around for years, this is the first time it’s been implemented on such a wide scale. Since many people want to know exactly what telehealth is and how it works, we answer all your telehealth FAQs. Ever wonder about security concerns and how providers diagnose symptoms like the coronavirus via video call? We’ve got you covered.

What types of telehealth are available?

There are three main types of telehealth interactions that you might have with your provider. They are:

  1. Live consultations, which are usually held over video conferencing.
  2. Asynchronous messaging, where you send your provider text or pictures and they respond as they are able.
  3. Remote monitoring, when the patient uses at-home devices to measure vitals such as blood glucose and then sends them to a provider for an examination.

A telehealth appointment usually refers to the first option, i.e. scheduling a video call with your provider (white lab coats and nursing scrubs not required), but your telehealth interactions will usually span all three categories.

Is telehealth secure?

Given all the privacy concerns surrounding technology, many people are understandably concerned about the security of their virtual visits. The security will vary depending on the service(s) that your provider uses. If your doctor is part of a larger hospital network, they may contract with a major telehealth provider or use a proprietary system, which should be more secure. Smaller practices may use more general-purpose virtual meeting software, such as Skype, which usually have looser privacy restrictions. Investigate the privacy policies of the services that your provider asks you to use, and you can also ask your provider about implementing security features such as encrypted data transmission.

Is telehealth covered by insurance?

This depends on your insurance, your provider, and the telehealth system they use. In general, telehealth services provided directly by a doctor or a hospital are more likely to be covered, though not always. Even if the virtual visit is covered by insurance, patients may still have a co-pay or another charge. If it’s not covered, patients can choose to pay out of pocket for the entire visit. Common per visit fees range from $50 to $80, while other platforms charge an annual membership fee.  If you’re on Medicare or Medicaid, thanks to some recent changes, Medicare will cover telehealth services and Medicare Advantage plans may waive or reduce cost-sharing.

How can I find a telehealth provider?

If you already have a provider, check with them first to see if they have existing telehealth or upcoming telehealth options due to coronavirus. Depending on what insurance you have, you might also be able to filter your provider search on the insurance portal to only show providers that provide telehealth options. Some telehealth service websites, such as Teladoc Health and MD Live, will let you search for providers on their website. If you find doctors via the latter route, you’ll need to contact their offices to see if they accept your insurance before you make an appointment.

What are some advantages of telehealth?

Telehealth offers several benefits over regular appointments. For one, it protects both patients and providers from the transmission of germs (very important in the age of coronavirus). It also eliminates the need to secure transportation and elder or child care. Plus, it reduces the time spent in waiting rooms and on the road. Telehealth appointments save patients and providers money as well as time. They also give providers more flexibility to set their own schedules and schedule appointments when it’s most convenient for everybody involved.

What are some disadvantages of telehealth?

However, telehealth does have some drawbacks. Obviously, some visits simply need to be completed in person. Patients can’t just grab a stethoscope and listen to their own vitals. There can also be issues of access, as not everyone has a smartphone or laptop and a stable internet connection, which are necessary for video consultations. The inconsistency of insurance coverage for patients and reimbursement for providers can also cause headaches and complicate what would ordinarily be a simple visit.

Can I get a prescription via a telehealth appointment?

Yes, doctors can use telehealth to write or renew prescriptions. If you just need a refill on an existing prescription, you might be able to request it by messaging your doctor and eliminating the need to book and pay for an appointment. If it’s a new prescription, or you’re not sure what medication you need, you’ll probably need to book a quick appointment for a diagnosis. They’ll still have to call in the prescription at a local pharmacy, so you’ll have to venture out to pick it up or arrange to get it delivered.

Can coronavirus be diagnosed via a telehealth appointment?

Because the symptoms can vary so widely from patient to patient, and also overlap somewhat with those of other common infectious diseases (including the flu), the only way to confirm that you definitely have coronavirus is to get a test that involves taking a swab in person. However, you can use a telehealth appointment to discuss your symptoms with your doctors and determine whether you need a test or if you’re just suffering from allergies. In fact, many hospitals have set up a coronavirus hotline specifically for this purpose. Your doctors can also talk you through quarantine best practices and how to keep those around you safe.

If you need to talk to your doctor right now, odds are that you’ll be making your visit virtually via telehealth services. Keep these FAQs in mind to make sure that your visit is covered by insurance and your privacy is secure. Welcome to the future of medicine!

9 Benefits of Remote Health Care

9 Benefits of Remote Health Care

Telehealth has slowly been making inroads over the past couple of decades, and the spread of the coronavirus pandemic has only escalated its adoption. Doctors have been told to hold every visit possible remotely in order to cut down on the chances of spreading the virus between patients and medical providers.

While in-person doctor’s visits have been the standard for generations, telehealth offers several benefits that in-person appointments simply can’t match. In fact, telehealth can reduce costs and barriers to access for both doctors and patients. If you’re new to the idea of telehealth, here are nine benefits that you need to know about remote health care.

For Patients

1. You don’t have to worry about transportation.

Getting to and from the doctor’s office can be a large barrier. Even people with reliable vehicles have to make arrangements with their households to use the car, as well as taking both travel time and gas into account. Patients who use public transportation or ride-sharing options have to account for many more unknowns, including unreliable transit schedules and routes that may not take them directly to the doctor’s office. By letting you stay in your home, telehealth visits make it easier to talk to your doctor and increase access to care.

2. You don’t have to find elder or child care.

For adults serving as primary caregivers, getting away from the house can be tough, even if they’re not officially employed. In that case, they have to arrange for their partner to stay home, or if that’s not possible, find or hire other people to watch their children or parents while they go to the doctor. This added expense and hassle serves as a barrier that keeps people from getting to the doctor’s office. Remote health appointments remove the need to find elder or child care for dependents, making it easier to virtually visit the doctor.

3. You’ll waste less time.

Time is a major consideration in scheduling and attending doctor’s appointments. You have to factor in not only the length of the appointment itself, but also transportation time and time spent in the waiting room. Between everything, many patients must sacrifice two or three hours of their day just to talk with their doctor for 15 minutes (or less!). Some people simply can’t get that much time off of work, which makes them reluctant to visit the doctor. Remote appointments eliminate transportation time and significantly reduce delays as well. No more wasting an hour in the waiting room while the minutes tick past your appointed time.

4. It reduces your chances of catching an illness.

We’ve all had the experience of sitting in a waiting room during cold and flu season, listening to other patients around us coughing and coughing and coughing. Simply due to the concentration of sick people, in-person doctor’s offices increase the odds of spreading germs. Plus, if you’re already visiting the doctor because you’re sick, your compromised immune system can make you more vulnerable to picking up more germs. Taking appointments from the comfort of your own home keeps you safe and prevents you from spreading any potentially contagious illness to other people.

5. It’s increasingly covered by insurance.

More and more insurance companies are covering telehealth visits, and as the cascading effects of coronavirus encourage more processes to move online, this trend will only continue in the future. While once considered a luxury, remote doctor visits will soon become as mundane as visiting a typical office for both you and your insurance company.

For Providers

6. You can see more patients.

Because of the increased efficiencies and reduced downtime between appointments, telehealth systems allow you to see more patients that you otherwise would not. Some physicians also use the time they would have spent commuting to extend their office hours, letting them see even more patients. For example, some patients who can’t get off work during the day might be able to hop on a call with you at night for half an hour. (And none of them will know if you’re wearing pajama pants under your white lab coat.)

7. You don’t have to leave your house.

Many of the same benefits that apply to patients are also a boon to physicians. Staying at home eliminates health care providers’ commutes, which saves time and money that they can use to see more patients. Telehealth doesn’t just limit patients’ exposure to germs. It also limits physicians’ exposure, which keeps them healthy and eliminates the chance that they might carry germs between patients. Finally, telehealth visits can ease the burden on physicians and their families who are also caring for children or relatives at home.

8. It reduces costs.

By increasing the number of patients and decreasing overhead expenses, telehealth visits save money. These savings are especially important for physicians who own their own practices instead of working for a big hospital. While you might need to initially invest in setting up or subscribing to a secure telehealth system, remote visits will quickly pay for themselves as they become more popular. In fact, telehealth might actually open new opportunities to bill for activities that were previously uncompensated, such as follow up phone calls.

9. It improves patient engagement and reduces no-shows.

A doctor’s primary goal is to improve patient outcomes, and telehealth can accomplish this on several levels. Unfortunately, the patients most in need of doctor visits are often the ones who struggle the most with getting time off work, finding elder or child care and securing reliable transportation to and from the doctor’s office. Telehealth can help break down these barriers and result in a wide variety of benefits like reducing no-shows and diverting unnecessary visits to the ER. Ultimately, all these benefits ease the strain on the whole health care system.

Now, don’t hang up your nursing scrubs quite yet. There will always be a need for in-person doctors’ visits. But incorporating a telehealth option into your practice can benefit both you and your patients greatly.

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