- Despite the post-COVID shift to virtual care, many organizations have yet to prioritize telehealth-specific nurse training and support.
- Telehealth nursing comes with a slew of unique challenges, but many nurses have been thrust into telehealth roles with very little, if any, training in telehealth-specific workflows.
- Without clear protocols to follow and ongoing support, telehealth nurses may end up confused, less confident in their work and distracted from their primary focus: providing quality care.
- Technology — especially conversation intelligence tools that offer real-time feedback and guidance during virtual visits — can help maintain consistent telehealth quality standards and give nurses the support they need to do their work with confidence.
One of the few positives to come out of the COVID-19 pandemic was a greater public appreciation for the hard work and sacrifices of frontline healthcare workers, especially nurses. We saw not only a flood of kind words and goodwill toward nurses, but also renewed discussion around the toll this work can take on people and the ongoing crisis of burnout in healthcare.
At the height of the pandemic, such discussions understandably centered on nurses in critical care settings, but with the worst of COVID now behind us, another group of care professionals deserves our attention: telehealth nurses.
While most organizations have improved their implementation of telehealth in the last two years, many have struggled to offer telehealth nurses the ongoing training and support they need to do their work confidently and efficiently. This leaves telehealth nurses in a sink or swim situation, unsure of where they stand, what’s expected of them or whether their organization is committed to their success.
Here I take a look at some of the unique challenges of telehealth nursing, the importance of addressing them and how technology can offer the ongoing support telehealth nurses need to do their best work.
Telehealth nursing: A trial by fire
It’s hard to overstate the speed with which the healthcare industry pivoted to virtual care during the pandemic. Organizations had to set up new technology, shift resources and hastily train staff to accommodate a (hopefully) once-in-a-lifetime paradigm shift, with some providers facing an increase in virtual visits of 2,000 percent or more in a matter of months.
Two years on, demand for telehealth services shows no signs of returning to pre-pandemic levels. And while many organizations have gotten comfortable taking care of the basics — connecting to video calls, scheduling appointments and the like — fewer have prioritized optimizing telehealth workflows and offering ongoing training and support to nurses on the front lines.
As Carolyn Rutledge and Tina Gusti outline in a paper on preparing nurses for roles in telehealth in the Online Journal of Issues in Nursing, many nurses have been thrust into telehealth roles with very little, if any, training in telehealth-specific workflows. And when telehealth training is offered on the academic side, the focus is typically on primary care providers (PCPs), such as nurse practitioners, with those in RN, CNS, and CNL programs frequently overlooked.
This results in confusion and unclear expectations that not only make telehealth nurses less confident in their work, but also distract them from what should be their primary focus: providing quality care. This obviously creates a less-than-ideal experience for patients; it’s also worth noting this can lead to disillusionment and poor job satisfaction among nurses. Given the highly competitive telehealth labor market, that’s a risk few organizations can afford to take.
As telehealth optimization consultant Christian Milaster puts it in a piece on why clinicians (still) don’t like telehealth: “Whereas many critics of telehealth are quick to point to technology problems, the vast majority of telehealth breakdowns actually relate to the workflow. Or rather, the lack of well-defined workflows.”
Unfortunately, as the American Telemedicine Association notes, though telehealth nursing is a unique form of clinical care delivery, it still has not been recognized as a nursing specialty or subspecialty by many nursing organizations.
This is reflective of a common mindset that lumps together in-person and remote care and has resulted in a failure of organizations to build workflows tailored to the nuances of telehealth nursing.[gravityform id=”4″ title=”true”]
But nursing is nursing…right?
It’s easy to view telehealth nursing as essentially no different from traditional nursing. Telehealth visits, one may think, generally follow the same structure and require the same practitioner skill set as in-person visits — they just take place over a video or phone call instead of in an office.
But it’s not that simple. Along with needing to adapt to the technology central to virtual care, telehealth nurses face several unique challenges that, without the proper workflows and support, can limit their productivity or make it more difficult to ensure clinical effectiveness.
To start, telehealth nursing can come with a heavier workload. This may seem counter-intuitive since we’re more likely to think of an overworked nurse as someone sitting exhausted on the floor of an ER than someone in front of a computer screen. But some forms of virtual care require additional administrative steps or communication that add to a nurse’s burden.
For example, a recent study in the Western Journal of Nursing Research found that patients using remote vitals monitoring devices to track blood glucose and blood pressure levels at home between appointments, “received almost twice as many ‘nursing activities’ [via telehealth] as patients who received usual care.”
Such extra activities included adding vitals data to electronic health records, adjusting medications, evaluating vitals monitoring data and educating patients on trends, as well as reminding patients to self-monitor and transmit data. Patients receiving this care via telehealth also received more ongoing communication from nurses.
“We can’t expect nurses to use these tools successfully without better understanding the impact it will have on their workload,” Chelsea Howland, an author of the study says. “If the nurses are completing twice as many tasks via telehealth, should they be responsible for half as many patients?”
Telehealth can also present challenges when it comes to evaluating patients and establishing trust and rapport, making clear, telehealth-specific workflows and best practices paramount to positive clinical and patient experience outcomes. For example, telehealth nurses sometimes need to make determinations about a patient’s health status and the need for an escalation without physically touching or assessing the patient. Without clear guidelines on when and how such escalations should take place, nurses are left in a limbo or unable to provide consistent care.
The unique medium of telehealth also demands clear guidelines, training and feedback around how to address patient concerns around issues such as privacy. For example, Rutledge and Gusti noted that inexperienced telehealth nurses, lacking adequate training, often struggled with the “unique cultural nuances and telehealth etiquette required for a virtual visit,” leading to negative patient feedback, adding that “many nurses were unprepared to address sensitive issues via telehealth, such as a patient’s discomfort or concern about privacy.”
Plus, while some case studies show that virtual care can improve continuity of care, this is largely dependent on each organization’s planning. Unless continuity of care is built into an organization’s workflows, patients may end up connecting with different providers each time they use a telehealth service. This can create a disconnect between patients and nurses and make it more likely that medical issues go unrecognized or untreated.
As these examples demonstrate, telehealth nursing carries a number of unique challenges that must be addressed via ongoing training and clear, consistent workflows and best practices (and tools that support them). Without these, telehealth nurses simply lack the support they need to do their best work.
As Christian Milaster details in a piece on clinician engagement in telehealth: “The single-most important mindset for making telehealth work for clinicians is to focus on their experience as a user: enabling clinicians to practice on top of their license.”
The right time for the right tech
With telehealth firmly established as a major form of care delivery that presents unique clinical, tech and operational challenges, now is the time to invest in tools and workflow design that give telehealth nurses the support they need to do their work with confidence.
There’s no shortage of tech solutions that promise to streamline and optimize telehealth delivery, from automated call transcription and triage to reimbursement and patient surveys. However, the vast majority of these solutions are either designed specifically for physicians or are meant to cover a broad range of contact center agent workflows ranging from sales to customer support. Telehealth nursing workflows are either neglected entirely or expected to fit neatly into a general “call operator” bucket.
But a one-size-fits-all solution won’t do. As Milaster puts it: “The reason why surgeons have highly customized surgical tools is to increase their efficiency and efficacy. For the same reason, clinicians should have the best customized telehealth solution that supports the way they need to practice medicine.”
Luckily, however, the underlying technology that powers these tools can be used to create solutions tailored to the needs of telehealth nurses.
In face-to-face interactions, care professionals are wholly reliant upon medical records and notes taken during or after a conversation. In virtual care, however, all communications and workflows can be captured digitally. This means telehealth teams are in the perfect place to employ new AI solutions to extract key information from patient-nurse interactions and assess how closely interactions align with an organization’s best practices.
We can use AI not only to generate accurate call transcripts for better record-keeping, but also to analyze live conversations and create smart notes that cover patient symptoms, medical history and previous interventions in real time. This alone can save telehealth nurses hours of time and energy (indeed, many nurses spend half their day on this sort of documentation).
Conversation intelligence can also draw on each organization’s care quality standards to anticipate the needs of nurses by surfacing the right information at the right time, improving the efficiency of interactions both in real time and long term (for example, to automatically present nurses with relevant educational materials, saving them from sifting through hundreds or thousands of knowledge base articles).
Such tools can also be invaluable for ongoing training and coaching. Conversation intelligence can analyze nurse-patient interactions and compare them against an organization’s best practices to surface insights on an individual team member’s successes and areas of opportunity, allowing for truly personalized and evidence-based coaching and performance evaluation.
This can go a long way toward creating consistent care delivery, whether an organization is onboarding a new hire or establishing new protocols for existing staff. These tools can ensure that not only are expectations clear for telehealth nurses, but also that no matter which nurse a patient speaks with, they will always have a high quality interaction.
Taken together, these tools can not only help alleviate the nursing admin burdens — allowing nurses to focus their energy on patients instead of paperwork — but also give them more confidence that they’re meeting their organization’s quality standards or feedback on where they can improve. With this support, nurses should feel more confident and capable and able to focus on patient care.
“When clinicians can focus on patient care,” Milaster says, “then the commitment by clinicians for telehealth is easy to come by.”
By now it’s clear: Telehealth isn’t going anywhere, and neither are telehealth nurses.
While organizations have smoothed out the logistics of video conferencing and patient scheduling, much less progress has been made on developing an infrastructure that addresses the specific needs of telehealth nurses and fuels their continued professional growth.
Instead of making do with one-size-fits-all solutions, healthcare leaders must recognize the unique challenges faced by telehealth nurses and invest in the tools, training and other resources that will empower them to support their patients confidently and efficiently.