Telehealth Nursing: What to Know

Medicine and healthcare are always changing. More and more, emerging subspecialties in every area allow for specific and unique focus for patients. That means new opportunities for nurses.

One of the newest methods of patient care is telemedicine (also called telehealth). The American Medical Association (AMA) states, “Telehealth, telemedicine and related terms generally refer to the exchange of medical information from one site to another through electronic communication.” The Centers for Medicare and Medicaid Services (CMS), which determines CMS coverage and payment, defines it as “Real-time, audio-video communication that connect physicians [and licensed staff] and patients in different locations.”

NOTE: Although telemedicine and telehealth are often used interchangeably, there is a difference. Telemedicine is usually restricted to clinical services, while telehealth is a broader term that incorporates healthcare education and disease prevention.

Telemedicine isn’t really “new”

Although telemedicine is now mainstream, it isn’t exactly new. It began in the late 1950s at the University of Nebraska, when clinicians sent real-time video neurological examinations across campus to medical students. The big breakthrough came in 1960, when the National Aeronautics and Space Administration (NASA) and the Indian Health Service started a wide-scale telemedicine scheme. With expanding satellite communication, in 1972, NASA began to serve hospitals and small communities in Alaska.

Small steps increased the capability of telemedicine. When the Internet began to explode in the 1990s, the world had access to online data. Health care providers could now transfer large data files and connect with patients who also had the ability to use the Internet. Connection was still slow, expensive, and unreliable, but the potential was powerful.

Then came COVID-19

Remote health care continued after reliable Internet access became available, but growth was slow. Insurance policies across the states were inconsistent and often provided little coverage.

With the outbreak of COVID-19 in 2020, sheltering in place and physical distancing were mandated. Telemedicine became a necessity to protect patients and health care professionals and patients from exposure to the virus. CMS and insurance companies covered the cost of remote appointments to allow continuity of care.

The benefits of telemedicine

As the pandemic recedes, both providers and patients continue to realize the value of telemedicine. Current information technology supports a different way to access health care, from small private practices to major health systems. Telemedicine is not an alternative form of medicine, but a different model, delivering the same care as a traditional model.

The American Telemedicine Association predicts that by 2030, more than 50% of health care services will be conducted virtually. Research shows that 50-75% of people say that they are willing to have digital/virtual health interactions with health care.

Benefits of telemedicine and telehealth include:

• The ability to meet with health care providers and specialists from any location, improving the scope and quality of patient care.
• Reduction in cost, especially for patients in remote/rural regions, or those that must take time from work, arrange for childcare, or pay transportation/travel expenses.
• Improved safety and reduction in disease transmission. Children, elderly, and people with compromised immune systems are at high risk in visiting clinics or hospitals for care.
• Nurses can be more effective, offering education and following up with patients in a less stressful way.
• Providers can cut costs in areas, such as large office space, because only patients who need in-person care come to the facility. Staff can often work from home for consultations.
• Referrals and appointments with specialists are easily arranged, resulting in the ability to easily handle a larger patient load.
• Patient satisfaction is higher when they don’t have to travel, park, and sit in a waiting room. They also have more access to services, such as disease-specific classes, that they can attend from home.

Nursing role in telemedicine

According to the American Academy of Ambulatory Care Nursing (AAACN), the telehealth nursing practice is a subspecialty of ambulatory care and “uses the nursing process to provide nursing care and access to healthcare for individual patients or patient populations via phone or other technology, occurring in multiple healthcare settings.”

Interested in being part of a telemedicine team? Here are some of the tasks and responsibilities you may be assigned:

• Telephone Triage is a traditional -- and essential -- task that nurses have done since telephones were invented. The nurse accepts calls from patients and determines the best way to handle the patient’s symptoms or urgent needs.
• The nurse uses established clinical guidelines and algorithms during the triage calls. You also pull up the patient’s file, ask them pertinent questions, and direct them to the appropriate treatment professional or facility.
• Remote monitoring of blood pressure, blood glucose, cardiac status, respiratory status, or other measurements or assessments of wearable devices. This allows patients to remain at home and receive state-of-the-art medical care.
• Following patients long-term, from diagnosis to treatment to end-of-life. The nurse can become the primary contact for patients and their families.
• Individualized care of chronic and acute conditions that prevent emergency department visits and hospital admissions.
• Education and support for patients and their families to promote healthy behaviors and lifestyles.
• Maintaining communication by video, phone, and texts, depending on the patient’s preference and access to internet and devices.
• Evaluation of interventions and creating care plans that can quickly adapt to the patient’s condition.
• Coordinating care transitions as the patient’s condition changes.

Requirements to become a telehealth nurse

Telehealth is not for an entry-level nurse. It’s a specialized area of Ambulatory Nursing that requires extensive knowledge and understanding of disease processes and their management. Continuing education is crucial to remain current in treatment of conditions.

Nurses need a strong background in medical-surgical nursing, or in the area that the physician group practices (OB-GYN, oncology, orthopedics, pediatrics, etc.) Experts suggest a minimum of three years of bedside nursing, but more may be required, depending on the specialty and if certification is necessary.

Of course, expertise in technology is essential. Besides having ultra-reliable, high-speed Internet access, you must be familiar with electronic medical records, including charting. Depending on your employer, you may be responsible for purchasing and maintaining a computer, phone, printer, and scanner.

You may be required to have a nursing license in each state that you serve patients. If you’re fortunate to live in a Compact Nursing State (Nursing Licensure Compact (NLC) is an agreement between states that allows nurses to have one nursing license that gives them the ability to practice in other states that are part of the agreement.), this will be simple.

Scheduling is similar to a hospital. Telehealth is often available to patients 24/7/365, so shifts are assigned, including weekends and holidays.

If you work from home, you will need a dedicated workspace that is quiet and free of distractions. In theory, you can work from anywhere, but it’s essential to be able to provide the highest quality of care at all times.

The demand for telehealth nurses is rising

Telehealth nursing has tremendous potential and represents a growing career opportunity for nurses with relevant experience and skills. As Americans are aging, and requiring more care for chronic and acute conditions, the need for new ways to meet their needs is increasing. With the ability to bridge gaps in care, provide ongoing patient support, and improve well-being for patients, telehealth will permanently change the delivery of care.

Pay for telehealth nurses is similar to an ambulatory nurse. Education, experience, skills, certifications, and geographic location will influence your salary. According to Salary.com, the 2023 average annual salary range for a Registered Nurse in the U.S. is $90,829, with a range of $83,810 and $101,752.

About the Author

Winona Suzanne Ball

Nursing Adviser, RN | MHS, Governors State University, IL
Full member of the American Nurses Association. Learn more