A Day in the Life of a Telecommuting NP
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In the world of healthcare, nurse practitioners (NPs) have the capacity to serve in a variety of roles based on their training in advanced practice nursing. In the realm of direct patient care, NPs can serve as autonomous practitioners, work independently under the supervision of an MD, work as an essential member in a team-based system of care, and can also serve fully in a support role to specialized physicians.
According to the American Association of Nurse Practitioners (AANP), 69 percent of all certified NPs deliver primary care, 95.7 percent prescribe medications, and the majority care for vulnerable populations by accepting patients with Medicare (82.9 percent) and Medicaid (80.2 percent). In addition to providing direct patient care, AANP also asserts that NPs are leaders in healthcare who can fulfill roles in mentorship, education, research, advocacy, and administration. While an imagined NP’s day is often face-to-face and in-person with patients, there are many NPs that serve people through the practice of telemedicine or telehealth.
Well before the coronavirus pandemic rocked our planet, the world of medicine was exploring how to use communications technology to bring quality care to patients in rural-, military-, prison-, and disaster-zones, and other vulnerable or hard-to-reach places. Although the exploration of telemedicine dates back to as early as the 1950s, the first telehealth successes began in the late 1980s, when advances in computers and communications technology finally made them robust enough for the job.
Just before the pandemic, telemedicine was evolving as a tool to reform healthcare, helping to make care more accessible, convenient, effective, and affordable for patients. Before the coronavirus, telehealth was a bit harder to implement, utilize, and incorporate into models of care as there were strict regulations for the technology in place to ensure the safety of patient information.
In the wake of the pandemic, however, with a need for more distancing, there has been a temporary relaxation of regulations that allow providers to use non-HIPAA compliant forms of communication (FaceTime, Facebook messenger, Google Hangouts, Zoom, etc.) to provide telemedicine services. While these regulations may eventually become more strict, this temporary loosening is opening the door for more telecommuting positions within healthcare.
With the expansion of telemedicine as a tool in healthcare reform and a necessary part of keeping the coronavirus from overwhelming our medical systems, more and more NPs may find that their days looking and feeling like the descriptions that follow.
Work Environment of a Remote Nurse Practitioner
A 100 percent telecommuting NP works in a software-based virtual environment in the physical location of their choice. While many telecommuting NPs work from home, others may choose to work in a private space outside the home as well.
The only real requirement of a telecommuting NP’s physical work environment is that they have the capacity to connect to the internet and maintain patient confidentiality throughout the duration of virtual, email, phone, and/or video-based visits. Hours for telecommuting NPs can vary quite widely and include 9:00-to-5:00, on-call, 24-hour, and overnight shifts.
In some circumstances, the telecommuting part of an NP’s job is not full-time. In this case, the NP may spend part of their work hours in physical locations such as physicians’ offices, hospitals, and outpatient care centers.
Clinical and Non-Clinical Teams of a Remote NP
The clinical team of a telecommuting nurse practitioner will mirror the clinical team of an NP practicing in face-to-face settings. The members of an NP’s team will vary depending on the state (or states) in which an NP is practicing, the size of the practice, the services being rendered, and the individual NP’s role within the organization. Telecommuting NPs may work with other clinicians and providers directly, within a team-based care model, or on the basis of a referral.
A clinical team for a telemedicine NP can include:
- The Clinical Director of Telehealth/Telemedicine Program
- Physicians Assistants (PAs)
- Registered Nurses (RNs)
- Medical Assistants (MAs)
- Care Managers/Coordinators
- Social Workers
- Mental Health Practitioners
- Behavioral Health Specialists
In addition to the clinical team, a telecommuting nurse practitioner will rely on and work with non-clinicians as well. An NPs non-clinical team interactions depends on the length of time the telemedicine system has been in place, the NP’s level of responsibility in ensuring the telemedicine system is operating correctly, and the NP’s role within the telemedicine ecosystem.
An NP’s non-clinical team may include:
- Compliance Officers
- Billers and Coders
- IT Specialists
- Telemedicine/Telehealth Educators
- Project Managers
- Technology Directors
- Staff Supports/Assistants
Typical Daily Responsibilities of a Remote Nurse Practitioner
There are ways in which the daily responsibilities of an NP practicing in a physical location and an NP practicing telemedicine are similar or the same. Due to the interaction with patients being over digital or voice-based mediums, there are responsibilities that telehealth NPs may have that fall outside the scope of traditional work as a nurse practitioner.
Daily responsibilities for telecommuting NPs may include:
- Attending scheduled virtual visits
- Taking and recording patient histories
- Checking and answering patient emails
- Performing triage to in-person or specialty care
- Escalating care for necessary and/or complex cases
- Diagnosing conditions
- Educating patients on how to use remote monitoring technology at home
- Creating, communicating, and coordinating treatment plans
- Ordering appropriate tests and diagnostics
- Analyzing, communicating, and helping patients take action based on lab results
- Prescribing medications
- Completing rounds (virtually)
- Hosting or attending virtual staff meetings and staff development days
- Synthesizing clinical data for solutions creation
- Educating patients, including on preventive measures
- Engaging in government-mandated reporting (births, deaths, contagious disease outbreaks, etc.)
- Helping patients navigate the complexities of healthcare
- Engaging in follow-up care
- Participating in continuity-of-care activities (inter-provider communication, etc.)
- Providing feedback to various stakeholders regarding telemedicine system
- Helping to create telehealth workflows for various purposes (triage, urgent care, treatment planning, etc.)
- Participating in collaborative care with other practitioners
- Advocating for improvements to virtual care systems and best practices
- Managing or supervising other telehealth practitioners
- Cultivating training or educational sessions on best practices for the delivery of telehealthcare
Required Skills & Knowledge of a Remote Nurse Practitioner
Regardless of whether an NP practices in the digital space or in-person, there are skills and knowledge central to functioning as a high-quality NP.
According to AANP, the following skills and knowledge comprise the standard of care for all NPs:
- Health status assessment skills (such as obtaining medical histories, and evaluating social determinants of health)
- Diagnostic skills
- Capacity to develop comprehensive treatment plans
- Ability to implement developed plans
- Knowledge of proper protocols for follow-up and evaluation of patient progress
- Educating patients and families
- Facilitating decision making within families
- Capacity to promote optimal health
- Providing competent care over time
- Facilitating entry into the healthcare system
- Knowledge to promote an environment of safety
- Capacity to cooperate and collaborate with colleagues
- Documenting and recording visits in a thorough, legal, and compliant manner
- Knowing how to advocate for patients
- Providing evidence-based care
In addition to the skills that every NP must have to provide patient-centered and high-quality care, those who are telecommuting must have a certain level of tech-savvy, as telehealth relies on telecommunications technology.
The Four Modalities of Telehealth
There are four major modalities of telehealth currently recognized and each one requires a different knowledge and skill set to implement correctly.
Live Video Conferencing (Synchronous)
Live video conferring requires that NPs learn and understand proprietary medical video chat software. With the onset of the coronavirus pandemic, publicly available non-public facing video chat software (e.g., zoom) are also acceptable. NPs may also need to be able to help patients troubleshoot software before or during a visit. Telecommuting NPs must understand how to work cameras as well.
Store and Forward (Asynchronous)
Asynchronous telehealth systems are those where pre-documented information is forwarded to a practitioner. Using the medical information available (e.g., digital images, documents, pre-recorded videos, etc.), the practitioner then makes a suggestion, diagnosis, or treatment plan.
Most telehealth NPs will use asynchronous systems to forward information about their primary care patients to a specialist. Using asynchronous systems requires NPs to understand how to upload and send a range of file types through secure email systems. This type of telehealth also requires an NP to exercise judgment regarding whether a patient should be seen in person, or whether digital communication is sufficient to garner an accurate opinion from a specialist.
Remote Patient Monitoring (RPM)
In RPM, technology is being used to gather data about a patient in one physical space. The data is then sent to a practitioner who is analyzing it in another physical space. NPs working with RPM systems must have the capacity to understand, analyze, and help a patient to act upon the data.
NPs may also need to train patients or patient caretakers to correctly utilize and/or how to troubleshoot digital medical technologies. NPs must understand the rates at which this data needs to be tracked, and have to learn when patients should be transferred from the home or care center into higher-level care.
Combining elements of all three of the modalities listed above, mobile health takes a telecommuting nurse’s care from the computer to mobile devices like cell phones, tablets, and PDAs. NPs working with mobile health require all the skills and knowledge listed above.
Certification for Remote Nurse Practitioners
Those who earn positions as telecommuting NPs must be board certified by a national certifying agency like the American Academy of Nurse Practitioners Certification Board (AANPCB) or the American Nurses Credentialing Board.
While the NP does not need to live there, they must also be licensed to practice in the state in which they are delivering telemedicine services. Wirth healthcare companies specifically dedicated to providing telehealth services or those who have a telehealth-first philosophy of care, NPs with licensure in multiple states may have an advantage in gaining employment as a telecommuting NP.
Telehealth-specific certification is not currently required to gain employment as a telecommuting NP but may be helpful to those looking to transition into telemedicine, or those looking to garner a greater competitive advantage in the virtual NP job market. The Telebehavioral Health Institute offers two levels of telehealth certification designed for practitioners of all backgrounds.
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