Is Telehealth More Stressful for Nurses Than In-Person Care?

A new study out of the University of Missouri finds that nurses in some telehealth programs may be doing twice the work that they’d be doing treating patients in person.

Telehealth strategies

Telehealth is often touted as a method for improving workloads and reducing stress on healthcare providers. But a recent study is questioning whether those services actually put more pressure on nurses.

Undertaken by Chelsea Howland, a Doctoral student at the University of Missouri’s Sinclair School of Nursing and published in the Western Journal of Nursing Research, the study found that nurses involved in a remote patient monitoring program for patients living with type 2 diabetes were doing more work than those involved in typical in-person care programs.

“Telehealth can be an effective and convenient service for patients managing chronic diseases such as diabetes or hypertension, but what often gets overlooked is all the work being done by the nurses on the back end to assist patients,” Howland said in a press release posted by the university to accompany the study. “They are entering the data that receive into medical records, identifying instances when patients have abnormal blood glucose levels, reminding patients to self-monitor and submit their data, requesting input from primary care providers and making referrals to other providers for more specialized care.”

Howland, who analyzed telehealth activities at six family medicine clinics associated with MU Health Care, found that nurses engaged in connected health activities were doing twice as much as nurses focused on in-person care, often because they’re involved in daily monitoring and care management rather than the in-person and follow-up visits.

“As a nurse, I am always thinking of new and innovative ways to use technology to help people manage their chronic conditions and live a more healthy, active lifestyle,” she said in the release. “As telehealth continues to become more popular, it can be used to get health behavior intervention tools to the people who need them the most, but we also need to keep in mind the strain it puts on nurses that are going above and beyond to make this possible.”

The study highlights the importance of planning out a telehealth program. Practices and clinics who don’t map out the tasks required in remote patient monitoring – and who don’t understand the value of nurses in these programs – run the risk of alienating those nurses and undermining the value of the program.

This is also the basis for an argument in favor of increased reimbursement for telehealth services, especially in smaller practices and clinics. Proponents say these providers spend a lot more time and effort – and money – in managing a telehealth program, to the point that they need more financial support to make those services feasible.

Others have argued that the right planning – and technology – can reduce those burdens, and that a good telehealth program can ease workflow pressures for nurses.

Left unsaid is that telehealth can greatly improve clinical outcomes by enabling providers to monitor patients daily, even in real time, as opposed to when they’re in the office for check-ups, and can allow providers to adjust care management as needed, to respond to trends at home.

Howland’s study puts the emphasis on proper planning for telehealth, and more research into how these programs affect the nurses who are expected to do much of the work.

“We can’t expect nurses to use these tools successfully without better understanding the impact it will have on their workload,” she said. “Going forward, this research can provide the framework for quantifying how much time nurses spend on these telehealth tasks, especially with the current nationwide nursing shortage. If the nurses are completing twice as many tasks via telehealth, should they be responsible for half as many patients?”

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