Caring from afar: working in telehealth nursing

To work in telehealth nursing you need excellent communication skills and the ability to create a mental picture of your patient based only on what you’re hearing or seeing over a video link. Sarah Harrop explores what this relatively new branch of nursing involves.

Telehealth (or telemedicine) means using information technology and telecommunications to provide virtual healthcare, medical care, and health education services remotely. Telehealth nursing involves using IT and phone technology for remote patient monitoring, collaborating with the healthcare team, and communicating with patients and their families.

As a concept, telehealth services have been around for almost as long as we have had telephones. One notable early use was by NASA in the 1950s to remotely monitor the health of astronauts on space missions (and today telemedicine is still a key part of medical care on the international space station).

With the advent of video conferencing, remote monitoring, electronic health records and other digital health and e-health advances, telehealth technologies gradually expanded. However, the COVID-19 pandemic brought about a step-change in the use of telehealth when lockdowns were in place and people were less able to receive in-person healthcare.

To give an example, the New York University Langone Health System saw a 683% increase in telehealth visits between March 2, 2020 and April 14, 2020. Today, telehealth is a central part of healthcare delivery and nursing practice and a key part of many nursing courses’ training curricula.

What advantages does telehealth offer for patients?

While it can’t entirely take the place of a patient seeing a healthcare professional face-to-face, there are clear benefits to using telehealth in some situations. Here are a few of them:

Easier access to specialists, even if the patient is a long way from healthcare services: e.g. for those living in remote rural areas or deprived urban areas that are under-served by hospitals.

Lower risk of picking up waiting room infections: being in a room with other sick patients can contribute to the spread of infections such as coughs, colds, flu or COVID-19, so remote treatment avoids some of these unintended risks to patient health.

Night-time care for babies and young children: parents can use telehealth services to get an out-of-hours diagnosis or even a prescription if needed in the middle of the night.

Easier for working parents: a telehealth appointment means that parents don’t have to take their children along to in-person visits or pay for childcare while they attend a clinic.

Better management of chronic conditions: patient care in people’s own homes can be more effective than in-person healthcare for monitoring chronic diseases. For example, at-home monitoring tools can transmit real-time readings such as blood pressure or blood glucose levels to clinicians, making it easier to detect new symptoms, worsening health, and potential emergencies.

Rapid emergency psychiatric care: fast connection to a therapist or psychiatrist at any time of day or night via a phone or video call can get people fast help for mental health emergencies, such as high risk of self-harm or suicide.

Better patient monitoring, such as being able to check that a patient is sticking to treatment or interventions. Patients are more likely to attend virtual visits than they are to physically attend a clinic, potentially leading to both better patient experience and patient outcomes.

Of course, telehealth is not always appropriate and cannot completely replace in-person health care. For example, the first consultation between a caregiver and patient usually works best as a face-to-face appointment rather than a remote one. That’s because it is hard to build a relationship with a patient via a screen, and healthcare providers cannot use their sense of touch or smell remotely. Some diseases and conditions, such as bone and muscle conditions can’t be properly examined via a poor quality video or a patchy connection, either. But there’s no doubt that it has an important part to play in modern healthcare and that telehealth is here to stay.

Telehealth nursing careers

So what does it take for a registered nurse to move into the field of telehealth nursing care? The Royal College of Nurses (RCN) cites these as useful skills for a telehealth nursing job with the NHS 111 service – one of the key roles within this field in the UK:

• Clear communication skills, to be able to confidently consult and complete calls.
• An ability to negotiate with patients and other health professionals; the role of nurses working in telehealth involves being part of a multidisciplinary team with pharmacists, GPs and paramedics either face to face or virtually, across large geographical areas, contributing to decision-making about a patient’s care.
• Great listening skills, to listen to both what is said and what isn’t being said. Telehealth nurses use their natural curiosity to fully understand a patient’s situation and they must be able to help patients and their families to navigate the NHS and social care system. 
• Emergency Department and Primary Care backgrounds are both helpful for dealing with this role, as no two calls are the same.
• Competency with IT equipment, so that you can talk and type up brief notes at the same time (although most services voice record all conversations and this makes up most of your consultation and patient record). 
• Broad clinical experience across a variety of settings. 
• Being open to learning new skills
• Providing support to junior colleagues, such as health advisors and call handlers to support them in giving high quality patient care.
• Competency in using evidence-based IT resources and assessment tools. Some of these will be prescriptive and support gaps in knowledge, but others relying on your own clinical knowledge.

Training to be a telehealth nurse

For a registered nurse to train in telehealth nursing as a specialism it can take anywhere from one to 12 weeks depending on the system used and the nurse’s previous experience. Nurses must be able to meet the service’s competencies to ensure patient safety. Call audit is also important to make sure that the nurse is undertaking reflective practice and learning, as well as ongoing Continuous Professional Development to handle the fast-changing nature of the queries received. 

According to the RCN, training usually consists of four elements:

• How to book a patient into an IT system such as Adastra, SystmOne. 
• How to use the telephony system. 
• How to use the clinical assessment tool. 
• Training scenarios and observed call-taking. 
• Where can a career in telenursing lead?

Next career steps for telehealth nurses might be to become a clinical advisor who assists more junior staff or a clinical team leader who clinically runs the shift. With experience, telehealth nurses may work in governance teams for the service.  There are also clinical specialists who are educated to Masters’ level in telephone triage who can take calls and assist others to improve their clinical practice. 

Case study: what it’s like to work in telehealth nursing

Michaela Littlewood is head of nursing and quality assurance for integrated patient care at Yorkshire Ambulance Service. She came to telehealth nursing via working in Accident & Emergency, primary care trusts and public health. Speaking in a video for the RCN, she says this about her work:

“It really plays on all your skills. The real challenge as a nurse is to really use all those skills where you can’t actually touch feel or smell but to paint a mental picture of what the patient is like, especially if you’re not going to be able to see them. For example, instead of feeling the patient to see if they feel sweaty, cold or clammy you have to ask them if they’re feeling sweaty, cold or clammy.

For the majority of roles within NHS 111 or GP out of hours or telehealth you’ll tend to work some kind of shift pattern. You tend to get peaks and troughs just like you would with A&E or community, so it will be busy first thing in the morning or last thing at night.

You take each patient through their episode of care, so it’s no different in many ways to seeing a patient and physically being there. You’ll do a clinical assessment; you’ll plan the care. A large part of the role is assessing the ability of the patient to navigate their way through the care system – so do they understand how to clean the wound, can they get to the place where they access care, if they’re going to manage their care at home do they understand what medications you might have suggested they take? There’s quite a lot because you’re doing it all by voice and by the answers of patients and their family, friends and carers.

It isn’t for everyone – not everybody can create a mental image of how the patient is. Some people find it difficult not necessarily finding out the outcome of every patient.

On a personal level you do get a lot of thank yous over the telephone and  you also get a lot of patients that will disclose a lot very quickly; patients maybe feel a little bit more confident to give you information they haven’t spoken to other healthcare professionals about because it maybe feels a little bit more informal over the phone.

No two days are the same. On every shift - and I’ve been in nursing for 30 years - I learn something different. I would say every patient, at some point, will remind me why I chose to be a nurse.”

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