1. Lindgren, Lisa BSN, MBA, RN, CEN, NE-C

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For years, the nursing profession has faced a significant workforce shortage with high turnover among experienced nurses, exacerbated by a growing number of aging patients, demanding working conditions, and insufficient new graduates to fill the gaps.1 COVID-19 has only accelerated the crisis. The stresses of the pandemic have led to widespread burnout, prompting millions of RNs to leave the profession.2 In November of 2021, 32% of RNs were considering leaving their current position in the next year-a 10% increase from just 9 months prior.3


Although many of these exits are for personal and professional reasons, they do pose a major problem for the nurses who remain in the workforce. As staffing dips below insufficient levels, nurses are forced to work longer hours. Overworked and fatigued, they're more susceptible to experience mental health issues. More than 70% of healthcare workers in the country have symptoms of anxiety and depression, 38% have symptoms of posttraumatic stress disorder, and 15% have had recent thoughts of suicide or self-harm.4


In the face of this mounting crisis, nursing leaders already have a practical and affordable strategy: telehealth. In my years working in telehealth, I've witnessed that virtual nursing is a high-value, easy-to-implement solution for augmenting existing staff, delivering exceptional patient care, and stretching limited resources further than previously thought possible.


What is telehealth nursing?

For more than a decade, I've worked with Avel eCare to develop telehealth programs that support nurses in various healthcare settings. During this time, I've come across several misconceptions that may stand in the way of telehealth reaching its full potential. My goal with this article is to raise awareness and bring nurses like you a clearer view of what's possible.


There's much more to telehealth than simply delivering online care to patients when an in-person visit isn't possible. It's true: Telehealth nursing does equip RNs with audiovisual communication technology, and sometimes with patient monitoring tools to provide nursing care remotely. But telehealth nurses aren't always patient-facing. Telehealth nurses also perform administrative duties and offer peer-to-peer support. The latter, in my view, is one of telehealth's most promising applications.


Consider a shift supervisor overseeing a 20- to 30-bed unit. With so many patients to care for individually, the supervisor may benefit from additional support. A telehealth nurse can provide the supervisor with specialized knowledge and advice in a nonjudgmental way, away from the bedside where tensions may run high. Many supervisor roles are filled by young, relatively new nurses who are hesitant to seek out seasoned staff for a second opinion due to fear of being viewed as lacking knowledge or fear of suffering workplace belittlement


Telehealth doesn't come without its challenges. Beyond insurance coverage, issues with licensure, for example, create barriers to care and limit access. Most states require clinicians to be licensed to practice in the originating site's state, and some states require clinicians providing telehealth technology across state lines to have a valid state license in the state where the patient is located.


Some nurses remain skeptical of telehealth and feel it may undermine their expertise or even take over their job. Others fear telehealth makes it more difficult to develop trust and emotional connections with patients or provide personalized, hands-on care. The reality is just the opposite. In addition to providing clinical services, remote nurses can reduce the burden of on-site staff by taking on administrative and routine tasks, such as documentation, allowing clinicians to focus on patient care.


Modern benefits of virtual nurses

Filling the gaps

Telehealth nursing offers numerous possibilities to deliver safer, more effective care across a variety of settings. To start, it saves patients' travel time, limits exposure to disease, and expands access to care. Telehealth provides daily monitoring of patient health, leading to immediate feedback for patients, family, and caregivers.5


From schools to ICUs to behavioral health organizations, virtual nurses can fill gaps in the care continuum, reduce unnecessary spending, and ensure access to expert care for vulnerable individuals. Staff retention is top of mind in all healthcare settings, especially as the pandemic continues. Many organizations are turning to temporary solutions to make up staffing shortfalls, but this can get very expensive very quickly.6 Instead of straining budgets, organizations can recognize the cost savings associated with telehealth nursing.


Take the ICU for example. Nurses are all too familiar with this scenario-you're at a patient's bedside when suddenly a critical heart rate or respiratory alarm for your other patient sounds off. You must stop what you're doing to check on the other patient. Remote monitoring solutions allow telehealth nurses to reduce the number of false alarms by acting as air traffic controllers. They can virtually monitor 40 to 50 patients at a time-across multiple facilities. Advanced video technology allows telehealth nurses to see close-up views of patient indicators such as pupil size, skin color, and settings on patient-support devices, such as cardiac monitors. Consent for telehealth services is incorporated into the facility's consent process and meets federal, state, and local guidelines. Any change in the patient's status notifies the remote team and prompts them to review and respond to the patient's new status. In some cases, the situation isn't an emergency at all. For example, a patient's vitals may fluctuate because they're eating lunch. If it's a true emergency, a telehealth nurse can engage on-site staff and immediately deploy an intensivist to help triage the issue.


Aiding mental health

A variety of services are available across acute, primary care, and specialty care areas for telehealth nurses that can actively support full-time staff. The extra virtual hands may make it more likely that clinical nurses will stay on the job-and be happier and more productive while doing so. I've seen the toll this job takes on my colleagues in the nursing profession. We experience so many emotions on the job but expressing our feelings doesn't always come easy.


That's why, after a particularly stressful or difficult encounter, my team brings in behavioral health specialists for a telehealth debrief. The group, limited to individuals involved in the care of the patient, discusses what went well, what could have been improved, and what they're feeling. In small communities, loss often hits close to home. When you're dealing with tragic situations affecting a family member, neighbor, or friend, coping is even more difficult. Telehealth debriefs offer a nonjudgmental means through which the team can address their emotions. While these debriefs are typically held in group settings, we can work with individuals or peer-to-peer conversations.


A mentorship opportunity

Mentorship contributes to professional success, but it often takes a back seat during times of crisis. Overworked nurses in senior positions may not have the time or the emotional bandwidth to provide mentorship to their colleagues, leaving newer professionals to feel isolated and dissatisfied with their career choices.


Telehealth nurses can provide a mentor role in a unique way. Because telehealth nurses are typically experienced, they can pass on their clinical knowledge to less-experienced nurses. Experienced telehealth nurses can also play an intermediary role between the nurse and the physician, encouraging dialogue, strengthening relationships, and avoiding potential miscommunications that could lead to sentinel events, medical errors, and other incidents that adversely affect the health and safety of the patient.


Hybrid nursing care of the future

Telehealth, especially during COVID-19, has become known to make healthcare more accessible and convenient. However, the benefits of telehealth for healthcare organizations and providers, particularly nurses, hasn't received as much attention. Meanwhile, the physical and administrative workload for nurses is at an all-time high. As the nation grapples with the growing shortage of qualified nursing professionals, it's important to embrace new strategies that ensure patients have access to safe, high-quality care. Telehealth nursing services are an innovative way to meet the ever-growing demands of the nursing profession. By taking administrative and clinical burdens off the shoulders of limited on-site staff, virtual nurses can improve job satisfaction, meet the needs of patients, and contribute to ongoing professional development.


Adopting this hybrid on-site and virtual approach will be key for nursing leaders in the future. Exploring the possibilities now will prepare organizations-and their nursing staff-with important skills and competencies needed to meet the challenges facing the nursing profession in the months and years ahead.




1. American Association of Colleges of Nursing. Nursing shortage. 2020. [Context Link]


2. Kaiser Family Foundation. Nursing facility staffing shortages during the COVID-19 pandemic. 2022. during-the-covid-19-pandemic. [Context Link]


3. McKinsey & Company. Surveyed nurses consider leaving direct patient care at elevated rates. 2022. [Context Link]


4. Hendrickson RC, Slevin RA, Hoerster KD, et al The impact of the COVID-19 pandemic on mental health, occupational functioning, and professional retention among health care workers and first responders. J Gen Intern Med. 2022;37(2):397-408. [Context Link]


5. National Library of Medicine. Perspectives of nurses toward telehealth efficacy and quality of health care: pilot study. 2018. [Context Link]


6. Modern Healthcare. Travel nurses saw an increase in pay during the pandemic. Now, they could lose those benefits. 2022. saw-increase-pay-during-pandemic-now-they-could-lose-those-benefits. [Context Link]