Telenursing: What Are Telehealth And Telenursing?

You have most likely done telenursing, even though you were probably not paid for it. Indeed – because you are a nurse – family and friends have called you up for advice on some health issue? You asked them about their signs and symptoms and then advised on the best course of action.

Telenursing is when technology is used to provide nursing services remotely. There are many different types of telenursing, and it has been around for longer than most people realize. However, it has been brought into focus this year with the COVID-19 epidemic. 

In this article, you will learn more about what telenursing is, where and by whom it is practiced, what its benefits are, and also the pitfalls you need to avoid.  

Growth of Telehealth Services

Telehealth is any service where healthcare is delivered remotely through the use of technology.  It improves the efficiency as well as access to health care.

In the early days of telenursing, registered nurses were employed in call centers at hospitals or managed care organizations to triage patients over the telephone.  After inquiring about symptoms, the nurse would advise patients whether an urgent visit to the emergency room was necessary, whether they could wait until the next day to consult a health care practitioner, or how to manage the situation at home.  

While this service is still provided in many centers, technology developments have expanded telehealth nursing possibilities far beyond basic triage.  Today voice calls can be replaced by live video conferencing for consultation, diagnosis, and advice. Patient records, scans, and other information can be maintained electronically and transmitted digitally for evaluation. There is also an ever-growing number of digital tools, wearable devices, and mobile apps for remote patient monitoring of, for example, blood pressure and blood glucose.

Telehealth has expanded dramatically during the COVID epidemic because of the need to protect health care providers against infection and reduce patient visits to crowded health care facilities.

Earlier in the year, the US government changed Medicare rules to allow more providers to receive Medicare payments for virtual consultations.  It is estimated that the telehealth market for 2020 will be around $175 billion, compared to $45 billion in 2019.  With the greater awareness of telehealth services and their benefits, both health care providers and the public are likely to continue to make greater use of these services even after the epidemic.

Types of Telenursing Services

There are many different types of nursing services can be provided remotely.  The basics of the nursing process – assessment, planning, intervention, and evaluation of outcomes – still apply. The only difference is that the care is provided remotely, rather than in person.

The following are some of the services which lend themselves telenursing:

• Triage. As already mentioned, telenursing is used extensively at call centers for triage to determine the severity of a patient’s condition and advise accordingly.
• Pre-operative. Pre-operatively the nurse can complete that part of the patient assessment, which doesn’t require physical presence, including personal details and a full medical history.  Based on the information obtained, further laboratory and other investigations can be ordered, and plans can be made in advance to meet particular needs once the patient is admitted.
• Home care during illness or recovery. Patients who either do not require hospitalization or are recovering at home after an illness or surgery can be monitored, advised, and educated via telenursing. Through video calls, a nurse can, for example, assess wound healing and teach wound care. A recent study found that telephone calls with specially trained nurses significantly reduced the level of anxiety in patients with COVID-19 who were recovering at home.
• Consultations for minor ailments. Many minor conditions for which patients routinely visit doctor’s rooms could be successfully diagnosed and treated via remote consultations, particularly with the availability of video conferencing.  Examples are common pediatric conditions, uncomplicated allergic skin reactions, and minor injuries.
• Care for patients with chronic conditions. A significant growth area for telenursing is in the care and monitoring of the aged with chronic conditions.  Nurses can monitor these patients’ well-being through regular video conferences as well as via digital monitoring devices. The nurse will also pick up on their need for additional health services such as that of a dietician, physical therapist, or optometrist, and then act as a coordinator between the patient and different health services. 
• Mental health care. Telehealth services are widely used for crisis intervention and suicide prevention. Via telenursing services, patients with mental health and substance abuse problems can be evaluated regularly, and the nurse can also be on call should the client face a problematic situation. This is particularly valuable in areas where there is a shortage of mental health resources.

Advantages of Telenursing

The benefits of telenursing are clear from the range of services that nurses can provide remotely.

One of the main advantages of telenursing is that it can bring health services to areas where there is a shortage of health care staff or where it is difficult for patients to access health care.  Fewer doctors choose to practice in rural areas, and rising costs are causing many smaller hospitals to close down. Telehealth has been used for over two decades in Australia to provide health care to sparse populations in remote areas.

Furthermore, telenursing is how the potential critical shortage of nurses in the future can be counteracted.  In a day’s work, one nurse can consult remotely with many more patients than through home visits.

This is particularly valuable as the number of aged persons with chronic conditions continues to increase. Telenursing can improve follow-up care and help to keep patients out of the hospital. Should the patient develop a problem, the nurse is also just a call away.

It was found that remotely monitored patients in the UK with diabetes, heart disease, and chronic lung disease had 18% fewer hospitalizations and a 50% lower one-year mortality than those who were not monitored.

Besides being more convenient for the patient, it was evident that telenursing is cost-effective in terms of both resources and time. It brings savings to both health care providers and the client.  For example, telenursing consultation costs about 80% less than a visit to an emergency room.

How to Become a Telehealth Nurse?

Telehealth nurses are employed in various settings, including hospitals, trauma centers, crisis hotlines, outpatient facilities, and even doctor’s offices. Some telenurses are also self-employed, running their private practices.

With the technology available today, many of these nurses can work from home, making it an ideal job while raising children or for qualified nurses who are physically disabled.

Besides being licensed to practice in your state, you don’t need a specific qualification to provide telenursing services, but you do need to work within the scope of your practice. Currently, these services are provided across the country by LPNs, RNs, and APRNs.  APRNs would be more likely to be self-employed, providing services in the area of their specialty.

Telehealth nurses often obtain Ambulatory Care Nursing Certification (RN-BC) because they are provided mainly to ambulatory care settings. This certification is provided by the American Nurses Credentialing Centre of the American Nurses Association.

In the US, registered nurses providing telehealth services currently earn an average of $72,200 per year, with most salaries are ranging between $70,000 to $76,000. Nurse practitioners providing telehealth services earn an average annual salary of $103,220. These nurse salaries are slightly below the current national averages for all registered nurses.

Cons of Telenursing

Potential drawbacks for the provision of telenursing include:

• Nurses may only provide telehealth services to patients who reside in the state where the nurse is licensed to practice. However, the Nurse Licensure Compact – which allows nurses to hold a multistate license – is going a long way in addressing this issue.
• Telehealth nurses must consider all the usual legal and ethical requirements of practice, and telenursing does present several unique challenges. For example, because patient information is transmitted and stored digitally, you need tight security measures on your computer system to maintain patient privacy and confidentiality.  You also need to ensure that the patient’s privacy is maintained throughout telephonic or video consultations.
• Technological issues may interfere with service delivery.  The equipment used either by yourself or the patient might malfunction during a consultation, and it will have to be rescheduled.  Patients, especially seniors, might not have access to the necessary technology or know how to use it.  
• You could face issues with payments by a patient’s medical insurance as not all insurers have updated and clarified their rules relating to telehealth services.

Future of Telenursing

Telehealth services have grown tremendously during 2020 because of the COVID-19 epidemic and resulting changes in the policies and rules governing payment for these services. Generally speaking, the public has also become much more used to working and communicating remotely using videoconferencing technology.

To a large extent, health services will always require in-person contact between the health care professional and the patient. However, there is also more widespread recognition of the potential uses of telehealth services, especially with the advanced technology which is currently available.

Telenursing – with its benefits of cost containment, efficient use of the nursing workforce, increased number of persons served, and prevention of readmissions – is likely to become a new growth area in the profession.