What Is Telehealth (Telemedicine) Nursing? The Ultimate Guide
Telehealth had been increasing exponentially even before the COVID-19 pandemic. In fact, by 2017, 76 percent of US hospitals connected patients and consulting practitioners through telehealth. However, at the beginning of the pandemic, telehealth exploded from less than 1 percent of visits to as much as 80 percent of visits in certain places. Although the use of telehealth has since decreased, a 2021 study found that one in four surveyed healthcare recipients had used telehealth services in the previous four weeks, indicating that the widespread use of telehealth continues.
Are you interested in telemedicine nursing? This ultimate guide to telehealth nursing will help you decide if this specialty is right for you and cover everything you need to know to enter this area of nursing.
What Does Tele Stand For?
Tele is not an abbreviation but rather a prefix—meaning distant, at a distance, or over a distance—which in combination with the word health or medicine refers to healthcare services offered remotely.
What Does Telehealth Mean in Medical Terms?
According to the Health Resources and Services Administration (HRSA), the definition of telehealth is “the use of electronic information and telecommunications technologies to support and promote long-distance clinical healthcare, patient and professional health-related education, public health and health administration.”
Telehealth uses technologies such as the following:
- Facsimile machines
- Electronic mail systems
- Store-and-forward imaging
- Streaming media
- Remote patient monitoring devices, which collect and transmit patient data for monitoring and interpretation
Although often used interchangeably, the terms telehealth and telemedicine have different meanings. Telehealth is a broader concept, encompassing non-clinical services, such as administrative meetings, provider training, and continuing medical education, in addition to clinical services. On the other hand, telemedicine refers specifically to remote clinical services. Telemedicine seeks to improve a patient's health by permitting remote two-way interactive communication between patients and healthcare providers in real time. Examples of telemedicine include: grand rounds through video conferences, transmitting x-rays between radiologists, or helping a healthcare provider present a patient to a specialist for a remote consultation.
Impact of Telehealth in Nursing
Although telehealth existed before the COVID-19 pandemic and had been steadily becoming more prevalent, the shift toward telehealth at the beginning of the pandemic was quick and dramatic.
- Remote patient monitoring increased and was used with pediatric patients for the first time
- Hospice and palliative care visits became virtual
- Patients interacted virtually with both physicians and family members
In that context, not only were nurses expected to adapt to providing remote care, but they were also expected to teach patients how to use telehealth technologies, such as videoconferencing platforms and remote home monitoring equipment.
After this initially violent transition, telehealth has become a widely used and accepted form of healthcare. In addition to being a cost-effective alternative to face-to-face healthcare, it is a way to make specialized healthcare services more readily available and affordable in rural locations.
Despite offering numerous advantages, evidence about the quality of telehealth care compared to in-person care is inconclusive. Furthermore, the following concerns remain regarding the widespread use of telehealth:
- Limited English proficiency and digital literacy
- Lack of access to the internet
- Limited ownership of devices, such as smartphones and tablets
- Social isolation
What Is a Telemedicine Unit in a Hospital?
Approximately three-quarters of US hospitals use telemedicine. However, telemedicine is not a physical hospital unit but rather a way of providing healthcare services. The following examples illustrate how telemedicine is provided in the hospital setting:
- Bedside nurses use tablets and smartphones to connect patients to healthcare specialists and family members.
- Telehealth nurses monitor patients in intensive care and telemetry units remotely. From these command centers, nurses also consult with providers and provide management and direction.
- Nurses coordinate discharge management and care coordination through telehealth technologies.
- Care is also provided virtually from the hospital to remote or isolated areas, pop-up clinics, and homes.
What Is the Role of a Telehealth Nurse?
Just as telehealth is not precisely a hospital unit, it is also not a nursing specialty per se but a way of providing nursing care. Few nurses working in telehealth have trained formally for this role; instead, most have learned on the job how to use telehealth technologies, such as the following:
- Videoconferencing to communicate with patients
- Remote home monitoring to collect clinical data, such as blood glucose levels and blood pressure
- Patient monitoring peripherals, such as a Bluetooth stethoscope and a high-definition camera to collect and deliver data to healthcare providers
Although telehealth roles are diverse, they can be grouped into three main areas: program development and implementation, direct patient and family contact, and nurse-to-healthcare-professional collaboration. That said, a telehealth nurse’s responsibilities may encompass all three of these roles.
Furthermore, telehealth nursing jobs are not limited to hospitals, nor are they all work-from-home positions. Telehealth nurses can work in all the following settings:
- Ambulatory care settings
- Urgent care centers
- Emergency departments
- Federally Qualified Health Centers (FQHC)s
- Government health systems
- Home health services
- Behavioral health facilities
- Long-term care facilities
- Specialty clinics or practices
- Skilled nursing facilities
- Military-field settings
- Insurance companies
- Hospice/palliative care settings
- Free clinics
What Does a Telehealth Nurse Do?
Since a telehealth nurse can work in many different work settings and roles, the duties they carry out can also vary widely. The following are typical responsibilities of a telemedicine nurse for each area they may work in and each role they may carry out:
Program Development and Implementation
1. Telehealth Manager/ Director
- Manages telehealth activities at the site
- Develops protocols, scheduling templates, and consents; assists in technology selection; determines patient populations for telehealth
- Manages the telehealth program, provides ongoing management, and reviews outcomes with the goal of refining and expanding the program
2. Telehealth Coordinator
- Coordinates telehealth operations and delivery
- Implements telehealth encounters in conjunction with standards, guidelines, policies, and procedures
- Educates providers on the telehealth program
- Identifies telehealth candidates
- Manages inventory and utilization of equipment
- Assures program evaluation
Direct Patient and Family Contact
1. Educator/Health Coach
- Educates patients synchronously and asynchronously
- Manages medication
- Reviews test results and provides education
- Reviews patient-uploaded data
- Coaches patients on behavioral changes
- Consults with patients inquiring about the need for an emergency department visit
- Consults with providers to determine appropriate transfer from facilities
3. Discharge Planning/Follow-up
- Manage pre- and post-discharge of chronically ill patients or post-operative patients
- Prepares a patient for a telehealth visit (connection, security, room set up, expectations)
- Uses telephone, videoconferencing, or other web-based technologies
- Manages patients, verifies provider orders and patient consents, and assists patients with participation
5. Bedside Nursing/ICU Nurse
- Facilitates rounds with isolated patients
- Facilitates family contact with isolated patients
- Facilitates virtual visits with specialists from bedside
6. Remote Patient Monitoring
- Tracks patient’s condition at a distance
- Assesses biometric data, such as blood glucose, sent through wearables and home monitoring devices
- Conducts virtual visits with patients
- Manages algorithms to predict care
1. Patient Navigator/Care Coordinator
- Connects the interprofessional team and the patient virtually to navigate care
- Arranges visits via telephone, synchronously or asynchronously
2. Nurse Consultant
- Connects a provider at a point of care to a colleague in another location
- Arranges virtual consults between a nurse expert and a bedside nurse
3. Care Transition Coordination
- Coordinates delivery of care within the practice setting and across healthcare settings through technology
- Coordinates collaboration between providers or settings
4. Case Management
- Arranges virtual access for all the activities that would be done in person, including intake, scheduling, documentation, and payment
- Collaborates with and connects providers and settings
- Provides clinical knowledge to nurses covering current and expanded critical care units using technology, virtual rounding, and increased collaboration
- Manages remote patient telemetry monitoring
How to Become a Telemedicine Nurse and How Long Does It Take
Aspiring telehealth nurses should first become registered nurses (RNs) by either completing an associate’s degree in nursing (ADN) or a bachelor’s of science in nursing (BSN) and passing the National Council Licensure Examination (NCLEX) to obtain a state license as a registered nurse. ADN programs usually take about a year to complete, whereas BSN programs typically take four years. Naturally, many employers prefer hiring RNs with BSNs.
In addition, most employers seek RNs with at least one year of nursing experience. According to this telehealth nurse on Reddit, two to three years is more realistic:
“Telehealth nursing positions typically require you to have at least a year of bedside nursing experience (the average I have seen is 2-3 years). You could look for new grad nurse reviewer 1 positions, etc but they are few are far between. You are also going up against nurses leaving the bedside looking for the same positions with significantly more nursing experience than you will have. Just trying to be realistic with you.” – Reddit user Readcoolbooks
Finally, most nursing jobs require a cardiopulmonary resuscitation (CPR) certification.
Another option RNs have is to pursue a master’s of science in nursing (MSN) or a doctorate in nursing to become a telehealth nurse practitioner (NP). A master’s takes approximately two additional years to complete, and a doctorate can take anywhere from three to six more years.
Telemedicine Nurse Certification
Nurses interested in telemedicine or already working in this area may wish to pursue additional nursing certifications to feel more confident in the care they offer and to give themselves a competitive edge in the nursing job market.
Although not accredited by the Board for Specialty Nursing Certification (ABSNC) or the National Commission for Certifying Agencies (NCCA), many universities are offering online telehealth courses for healthcare providers. The following are some of the certification options currently available:
- The Wehrheim School of Nursing at Millersville University offers an online telehealth certificate course open to all majors and guest students.
- The Christine E. Lynn College of Nursing at Florida Atlantic University offers another online telehealth certificate course, which can be completed in as little as four weeks.
- Texas State University has a six-week online Telehealth Certificate Training.
- Penn Nursing at the University of Pennsylvania offers a self-paced telehealth online course available for all healthcare providers.
- The University of Arizona College of Nursing offers the Rural Telehealth Certificate Program (RTCP).
Additionally, the American Academy of Ambulatory Care Nursing (AAACN) offers an ambulatory care nursing certification exam, which contains content on telehealth nursing. Therefore, nurses interested in telehealth should also consider this certification.
Finally, nurses who already hold the Telephone Nursing Practice certification offered by the National Certification Corporation (NCC) can maintain their certification. However, this exam was discontinued for new applicants in 2007.
How Much Does a Telehealth Nurse Make?
Although a nurse’s salary can vary significantly based on numerous factors, two key factors are level of education and work setting. With this in mind, the following are average salaries for RNs in different settings that employ telehealth nurses:
- Outpatient care centers: $93,070
- Hospitals: $80,260 – $85,020
- Home health care services: $78,190
- Skilled nursing facilities: $72,260
In the case of telehealth nurse practitioners, their higher degrees and specialized certifications qualify them for significantly higher salaries across work settings. The following are the average salaries for nurse practitioners in locations that employ telehealth nurses:
- Hospitals: $122,960 – $131,830
- Outpatient care centers: $129,190
- Home health care services: $133,170
What Is Telehealth Nursing Like?
Telehealth nursing can be drastically different from one job to the next since telehealth nurses can work in so many different settings and roles. Nevertheless, the following experiences of telehealth nurses on Reddit can help illustrate what this nursing specialty is like:
“I work in a clinic so we share charge / triage duties on a rotating schedule . I’ll be triage couple times a month 8 hour shifts and I personally love it but it’s also not my entire all the time job. Some calls are basic lab results/ orders requests but a lot of calls are assessing symptoms and figuring out root cause , proper treatment needed , advice , etc. I have learned a ton as our triage . It’s like a mini puzzle each call and I like figuring out what is actually going on and offering as much assistance as I can before reaching out to the doc.” – Reddit user aliv78
“Mostly chart reviews. I work acute care/inpatient reviewing. So essentially I get a daily census of hospitals I cover, and when people are “due” or there are new admissions, we review their chart with something called MCG criteria to see if they meet for inpatient level of care…I’m much more sedentary, but it’s a step in the right direction. At the very least I can jam out to music or put a movie/show on while I’m grinding out stuff, so it has its perks. There are still days where I’m grinding nonstop, but those are MUCH less than when I was doing patient care, which is was every day grinding...” – Reddit user IndecisiveTuna
Is Telehealth Nursing Hard?
As is the case with all nursing specialties, telehealth nursing has its challenges and disadvantages. However, many of these challenges are drastically different than those of other specialties. The following testimonials of telehealth nurses on Reddit help us understand what makes telehealth nursing hard:
“I did it for a year during covid. My biggest problems would be that I was overbooked constantly (10-13 people an hour sometimes). But more draining would be trying to get an 80 year old to download and use google duo…their dogs barking which sounds like a jet engine in your ear, their tv blaring. You get it…I would do it again if it were like insurance triage or health coaching. Regular, routine care? Hard pass from me” – Reddit user klassy_logan
“I don't get as much exercise as I used to- not on my feet working any more.” – Reddit user TeleRN
Why Choose Telehealth Nursing
Despite challenges, telehealth nursing certainly has its advantages. How does an uninterrupted hour-long lunch break sound? Let’s take a look at why these telehealth nurses on Reddit choose to stay at their jobs:
“I’m a Care Manager at an MCO. I get paid decently, there’s yearly bonuses, caseloads are fairly manageable so far. Extensive training. Overall kind of a boring job but great. We’re 100% remote, many managers including mine allow 4 10 hour days but I choose to do 5 8s to allow myself time in the evenings, and I just really love being off at 4:30. I get 18 days of PTO, 11 paid holidays and even sick days. I take an hour uninterrupted lunch and if I step away from my computer for a few minutes no one is watching me or anything. Overall I like it so far and would never go back to the bedside after this.” – Reddit user newnanny16
“I'm a remote nurse for an insurance company. Do I love my job? not really. It's not a bad gig or anything, but I don't feel a passion for it. It is very low stress, zero critical thinking is involved, and nobody dies if I make a mistake. It's nice because I can focus on my side hustle and homeschool my kiddo during my downtime. I'm salaried and have a list of patients each day that I must contact. That takes about 3 hours of my day and the rest of the time I'm just hanging by my computer, available to any patients that call in, but usually only about 4 -6 inbound calls per day…I miss bedside sometimes, but I was beyond burnt out before I took thus job.” – Reddit user MagazineActual
What Makes a Good Telehealth Nurse: Tips for New Nurses
The entire world was forced into interacting virtually during the pandemic. However, as a frontline worker, your job might not have gone remote even when everyone else was working from home. Therefore, if you are new to telehealth nursing, the following tips will help you excel in this role:
- Pay attention to body language. When interacting through a screen, your tone of voice and facial expressions become even more important than they are in an in-person interaction. You can nod, smile, or even lean toward the screen to show interest.
- Avoid looking away from the camera or shuffling papers since patients may interpret these actions as a lack of interest on your part.
- Although you’ll be tempted to look at the patient’s image or even your own, try to look into the camera so that the patient feels that you are looking at them.
- Wear your white coat if you are an NP or your scrubs if you are an RN to transmit to the patient that the call is a medical visit. If not your scrubs, at least wear solid neutral colors to avoid distracting the patient.
- Make sure your background is organized, clean, and not distracting. Consider using a photo background of an office or placing a screen behind your chair so that patients do not see your home.
- Avoid interrupting noises by silencing phones and not allowing pets near your workspace. Also, attempt to control lighting by ensuring that your face won’t be in a shadow or that there won’t be glare from an open window.
- Don’t use public Wi-Fi since you must guarantee your patient’s privacy.
- Always introduce yourself and your role, making sure the patient understands the purpose of the visit.
- Be friendly and ask how the patient is doing before you begin the formal part of the visit.
- Speak at a normal volume; the patient can turn up the volume on their device if they cannot hear you well.
- Make sure the patient is in a setting where they can discuss their healthcare issues privately or that they feel comfortable discussing their healthcare in front of their present company.
- Speak clearly and be as descriptive as possible regarding the process or care tip you are explaining.
- Use active listening to show empathy and guarantee that you understand what the patient is telling you.
Final Thoughts on Telehealth Nursing
Do you think you have the right personality profile for telehealth nursing? Would you like to work on your own at home? Do you prefer sitting at a computer or talking on the phone to walking from patient room to patient room and then back again? There is no right or wrong answer, just as there is no good or bad nursing specialty. Ultimately, only you can decide which nursing career path is ideal for you.
Would you like to learn about other nursing specialties? You can browse our other ultimate guides to nursing specialties here.