A Brief History of Telehealth Nursing

Did you know that Alexander Graham Bell used his own invention to call for medical attention? He may not have called a nurse but when he injured his hand, he picked up his telephone and called his assistant, Mr. Watson, for help. It is a cute story, a fun fact for sure, but it barely hints at just how integral remote access to healthcare has become since then. Telehealth nursing was born not long after Mr. Bell made that call and has since expanded to the use of fax, e-mail, internet, video monitoring, and interactive video services. Any service typically provided by a nurse that can also be delivered via this technology is within the domain of telehealth nursing.

As access, quality and cost-effectiveness of healthcare delivery has improved, so has the demand for telehealth nursing practice (TNP). TNP has come a long way since the late 1970s when HMO’s used telephone triage and advice services to control access to consumer care. At that time, telehealth nursing was not quite on the radar. In 2017, as increases in healthcare costs show no sign of slowing down, telehealth nursing can include surveillance and monitoring for disease management, care management and clinical prevention programs.

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Around the turn of the millennium, the National Council of State Boards of Nursing introduced the Nurse Licensure Compact, which would allow for “mutual recognition” of a nursing license between states that participate. Telehealth nurses still must adhere to state law and without proper licensure can still be restricted from practicing across borders. With the NLC enacted into law, telehealth nurses that live in and are licensed by a participating state are permitted to practice in any other member state without having to obtain additional licensure. Right now, twenty-five states make up the NLC. The trend is encouraging and necessary for telehealth nursing to continue to grow nationwide.

In 2004, the American Academy of Ambulatory Care Nursing (AAACN) established these traits and responsibilities of a telehealth nurse:  

  • Professional Knowledge: When receiving a clinical call, the telehealth nurse is expected to employ their full professional knowledge and to assess the needs of the caller using critical thinking skills.
  • Interpersonal Skills: Trust is key to obtaining pertinent information, especially when the patient is not present. Therapeutic interactions depend on effective interpersonal communication skills.
  • Technical Skills: A telehealth nurse can carry the first two over from daily practice. The ability to operate the tools of telehealth is essential and exclusive to TNP. Guidelines and protocols are set in place for this reason and must be followed.
  • Documentation of Telehealth Encounters: One such protocol will certainly involve accurate documentation of each telehealth encounter. Each instance should reflect the actual or potential health needs of the patient.
  • Personal and Professional Development: Opportunities always exist for developing the necessary knowledge and skills for TNP. They should be taken advantage of.

Speaking of professional development, as of 2007, the AAACN’s Ambulatory Certification Review Course, as well as its Ambulatory Care certification exam, both include a telehealth component. Ambulatory care nursing is a general term referring to all nursing provided on an outpatient business, to patients who do not require an overnight stay at a hospital. AAACN backs up its support of TNP with a telehealth track at its annual conference and a long of list of professional resources.

If you or someone you love is a nurse, then you already know that mastery of technology, excellent communication skills and a commitment to continuing education have always been part of the job. A telehealth provider must keep up with rapidly advancing technology which requires strong connections to the people that will be using it. Nurses have always been recognized as fighting the good fight, “in the trenches”. Nothing less should be expected of the telehealth nurse.  

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