Vanderbilt School of Nursing Assistant Professor Leanne Boehm, PhD, RN, FCCM, received an R01 grant of more than $3.6 million over five years to examine, with her collaborators, the efficacy of telemedicine services among people recovering from post-intensive care syndrome. This effort, funded by the National Institute on Aging, is the first PICS longitudinal cognitive impairment intervention study.
The Vanderbilt-led study will build on the burgeoning national effort to unite ICU clinicians and primary care providers in providing comprehensive care for patients starting when they are discharged from the ICU and continuing through transitional outpatient care.
“Following ICU discharge, patients have problems lasting months to years that often go unaddressed,” Boehm says. “Primary care providers—and even ICU clinicians taking care of these patients—do not know much about PICS.”
PICS affects up to 80 percent of intensive care unit survivors with a range of cognitive, physical, mental, and socioeconomic impairments—which may result in a poorer quality of life for sufferers and their caregivers. Studies have found that in a broad group of adult ICU survivors in all age groups, 33 percent to 50 percent develop ICU-acquired dementia—a symptom of PICS—which the National Institutes of Health now designates as Alzheimer’s Disease and Related Dementia. The ICU Recovery Center at Vanderbilt and the Critical and Acute Illness Recovery Organization were developed to establish ICU recovery clinics that address PICS.
“Only recently have we started to characterize what PICS assessment and management looks like across ICU recovery clinics,” Boehm says. “We’re seeing so much variation in what clinics are doing. This made us wonder which screening and intervention elements were the most important in ICU recovery clinics.”
To answer these questions, Boehm and her collaborators, including Dr. Carla Sevin, director of the ICU Recovery Center and co-chair of CAIRO’s post-ICU clinic collaborative, and James Jackson, director of behavioral health at the ICU Recovery Center, have developed a telemedicine-based randomized controlled trial to assess how a structured multidisciplinary ICU recovery clinic intervention can help patients and their caregivers live healthier, happier lives. Sevin and Jackson are recognized international leaders in establishing and implementing ICU recovery clinics.
The study’s multidisciplinary intervention will convene a physician and nurse practitioner, a psychologist or psychiatrist, a social worker, and a pharmacist to evaluate patients in the domains affected by PICS—specifically, the cognitive, physical, mental health, and socioeconomic challenges. Caregivers will be assessed for PICS-family and caregiver burden.
The evaluation will result in a care plan tailored to each patient’s needs and shared with their PCP. “Providers will talk with the patient about their assessment, care plan, what they can expect, and the resources to help them in their journey,” Boehm says. “Our team, all familiar with the ICU experience, have a multidisciplinary view of ICU-started problems and serve as a bridge in the transition of care from the ICU to their PCP or specialists. Our primary aim is to see if this intervention can improve cognition, mental health, physical function, social network, and patient activation.”
The choice to make this a study of telemedicine services was considered intentional. “ICU recovery clinics tend to be at major metropolitan academic medical centers, with limited services for patients in rural settings or those with new or worsening disability,” Boehm says. “Telemedicine helps address targeted access and availability gaps in PICS assessment and management.”
The pandemic made the study’s virtual component possible by rapidly adjusting and adopting digital services. A pilot study conducted by Boehm confirmed that patients, providers, and caregiver groups could engage in telemedicine and were willing to accept care through online platforms. The pilot study also informed best practices for efficient and supportive telemedicine ICU recovery clinic assessments; mental health and socioeconomic discussions will be conducted privately, and broader physical health discussions will be with the full group of providers.
Boehm’s other collaborators include Dr. Nathan Brummel, a former clinical fellow in Pulmonary Disease and Critical Care Medicine at Vanderbilt School of Medicine, Marianna LaNoue, professor of nursing, and Joanna Stollings, a medical intensive care unit clinical pharmacy specialist at VUMC.
There are different ways to become a registered nurse (RN), but most paths take at least a couple of years to complete. If you wish to earn more than an Associate Degree in Nursing (ADN), you can apply to a Bachelor of Science in Nursing (BSN) program at a private or public college. One of the biggest benefits of the BSN is that it allows you to become a nurse and earn a four-year degree.
When you finish your degree and gain some experience, you can apply to advanced jobs and leadership roles that require education from a four-year university. To get you started, the following list provides you with a few of the careers that usually require a BSN. Let these roles inspire you as you apply to bachelor’s degree programs, complete your coursework and envision yourself wearing your nurse’s stethoscope for the very first time.
1. Nursing Management
Many of the experienced nurses with a BSN will work in some type of management position. They may oversee other registered nurses, as well as licensed practical nurses (LPNs), interns or technicians. While nurse managers are well-paid, they are also critical to the operations of every patient care team. When you become a nurse manager, you get the opportunity to lead other nurses. You may work in a hospital, an outpatient facility or another clinical environment.
To begin a career in nursing management, you will need to spend some time working directly with patients as a registered nurse. Along with your bachelor’s level education in nursing and five to eight years of experience, the role requires excellent organizational and communication skills. You should also be interested in the business side of your facility.
A nurse manager’s duties include human resources efforts, coordinating staff schedules and overseeing supplies and budgets. With your responsibility will come a wealth of knowledge and expertise. Some of the most standout nurse managers will further their education and skill set to become a Director of Nursing (DON) or a Chief Nursing Officer (CNO).
Today’s ever-changing healthcare environment means that travel nurses are in high demand. Nearly all traveling roles for RNs require at least 12-18 months of experience in a clinical care setting. However, applicants become even more attractive to healthcare recruiters and top-rated hospitals when they have a four-year nursing degree.
If you are a jetsetter who is eligible to work in different states or countries, the traveling nurse role may be right for you. In addition to competitive pay and benefits, you can also earn perks such as living stipends and free airfare. When you are not on-call, you will be free to explore your destination.
Choose a nursing role in a picturesque natural setting, a renowned patient care center or a town you have always wanted to explore. You are sure to gain valuable memories and experience both at work and outside of patient care. As a bonus, you will also be serving patients in areas with critical care needs. Begin by completing your BSN, gaining experience in the healthcare field and taking advantage of a variety of internships and practicums that show you are a dynamic nurse.
3. Telemedicine Nursing
Like many career fields, nursing is becoming more digital. The rise of telemedicine and virtual visits has created a variety of roles for telemedicine RNs. Many of these nurses will work from home, but it is also possible that you will spend your day in a hospital or doctor’s office.
Responsibilities may include consulting with patients by phone or a secure, encrypted video chat. In addition to advising patients about illnesses or conditions, you may also be charged to educate patients about medications or the management of symptoms. Additional duties for the telemedicine nurse include completing patient intakes, scheduling appointments and providing patient referrals. Depending on the technology and tools available, you may also be able to measure a patient’s vitals.
Since each of these tasks require skill and experience, many facilities prefer a registered nurse with a BSN. When you apply to a remote role, be sure to showcase that you have a bachelor’s degree. Explain how your knowledge, coursework and previous experience will make you successful in the world of telehealth.
4. Public Health Nursing
Nurses are critical in the fight against diseases like COVID-19. The field of public health nursing allows experienced nurses with a BSN to take their career even further, all while serving underprivileged populations in their town or city. When you become a public health nurse, you are responsible for assisting the community with health education and disease prevention. You will also work with other professionals in the healthcare field to improve access to care and help to prevent widespread illness.
Some public health RNs work in the field directly with patients. Others are employees of a government facility, non-profit or community health clinic. You may even be able to find a job at a home health agency, an international health agency or a hospital.
With the right combination of expertise and a bachelor’s degree in nursing, you can find a rewarding job at a company or clinic that meets your career goals and personal needs. Some healthcare professionals like to become Certified in Public Health by the National Board of Public Health Examiners to bolster their resume and garner the highest-paid roles in the field.
Discover Your Ideal Nursing Career
Nursing is a dynamic career choice. As a professional, you can provide yourself with even more opportunities and flexibility when you earn your BSN. As you work on your degree, be sure to apply for internships and practicums at different types of hospitals and clinics. The experience you gain will prepare you to apply for a competitive role in the field. Whether you are interested in emerging roles in healthcare, exciting travel jobs in an interesting locale or a management position, there is a meaningful place for every nurse who earns their bachelor’s degree.
Recent studies by the American Hospital Association on the use of telehealth nursing services have shown that 76% of patients prioritize access to care over the need for human interactions with their health care providers and 70% of patients are comfortable communicating with their health care providers via text, e-mail, or video, in lieu of seeing them in person. This trend toward remote and immediate access is becoming more prevalent in the industry and telehealth nursing positions are becoming more well-known and necessary in the care continuum.
Telehealth nursing assists the health care industry in many ways. According to the American Telemedicine Association, it contributes to reducing health care costs by decreasing hospital admissions and emergency department visits, assisting with managing chronic illnesses, and impacting the nursing shortage by improving nurse utilization.
Telehealth nursing is unique in that it can be practiced almost anywhere from clinics to offices, hospitals to call centers, and even nurses’ homes. It is vital in enabling health care providers to connect with patients across vast distances. These nurses aim to deliver and continuously improve patient access and adherence programs to ensure patients receive the best possible care at every stage of their therapeutic journey.
Below are a few additional facts that you may not have known about telehealth nursing:
RNs have meaningful contact with patients because they do not have other patients to be seen or distractions from others coming in room, etc.; 1:1 uninterrupted time with patients.
They get to build relationships with patients over the course of the entire disease process.
Expertise extends deeper in the field because telehealth nurses have the opportunity to interact with other components beyond the patient including the provider, pharmacy, payer, and others.
Telehealth nurses have the opportunity to learn about rare diseases and state-of-the art therapies in medicine.
Even though the location is not within a hospital, telehealth nurses are still supporting and educating patients in a very designed and specific approach with very clear outcomes.
Telehealth nurses get input and exposure to the business side and operations, growing their acumen in other areas.
Being in telehealth expands one’s expertise because they work with a broader audience of patients and are forced to learn how to communicate with patients over the phone vs. side-by-side or in-person.
Various health systems are adopting telehealth practices because it provides convenient access for patients and focuses on increasing access and patient satisfaction. Telehealth nursing offers the potential to improve efficiency and convenience in our health care system as new delivery and payment models evolve.
I have been telehealth nursing for over six years and I truly believe nurses have an impact on patients and their caregivers. When a patient is first diagnosed with a chronic illness or terminal disease, sometimes our team is their first call. Our team works with purpose by listening to patients and educating them about what to expect throughout their therapeutic journey and providing counsel on properly taking medicine. As a Senior Nurse Manager at Lash Group, a part of AmerisourceBergen, I support the managers and nurses through compassionate communication, empowerment, and working together to ensure patient adherence.
Working in telehealth is exciting because each call is different and you never know what type of situation, question, or comment you will be presented. The utilization of your listening, critical thinking, and assessment skills are critical when it comes to supporting the patient. As a telehealth nurse, your eyes become your ears and you are an expert at identifying even the subtle changes in a patient’s voice. Building rapport is also key. Once trust is established, the patient and the nurse are able to work through barriers together, whether it’s navigating through benefits, obtaining education, or supporting the patient through medication adherence.
Telehealth nurses have a positive impact on the lives of patients every day. For example, one time a patient called in to our program and was adamant about speaking to a manager. She stated she was newly diagnosed, had a lot of questions, and described that if it was not for her nurse, she would have never started on her medication. The nurse thoroughly explained the benefits, answered her questions, and walked her through the prescribing information. She was extremely thankful for the support that she received.
According to sources at the American Telemedicine Association, industry experts estimate that 50% of health care services will be provided by telehealth within the next five years, and the need for these nurses and health care professionals is going to continue to rise. Providing support and guidance to patients is the main role of nurses and telehealth has shown it can improve patients’ access to care and as a result, contribute to successful health care outcomes.
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