Telehealth Increases Nurses' Workload

Study shows telehealth doubles the tasks nurses complete to assist patients with chronic diseases.

More hospitals and health systems are pushing forward with telehealth initiatives, but a new study indicates that telehealth doubles the tasks nurses complete to assist patients with chronic diseases, significantly impacting their workload amid a nationwide nursing shortage.

The University of Missouri study found that nurses remotely monitoring patients with Type 2 diabetes and hypertension were doing more work than nurses who provide in-person care programs.

The study's principal investigator, Chelsea Howland, RN, a doctoral student at the University of Missouri Sinclair School of Nursing and nursing instructor at Southern Illinois University Edwardsville School of Nursing, reviewed the activities nurses completed to document and analyze blood glucose and blood pressure data transmitted from diabetic patients' in-home telehealth devices to six family medicine clinics affiliated with MU Health Care.

After comparing the results with nursing activities completed during traditional, in-person healthcare appointments, she found the use of telehealth leads to twice as many activities completed by nurses.

For her study, 786 nursing activities were coded for 36 in-home monitoring group patients and 38 traditional care group patients over the 12-week study duration.

The number of nursing activities per patient ranged from 1 to 38 in the in-home monitoring group and 2 to 19 in the traditional care group, averaging 14.1 nursing activities performed for in-home monitoring group patients and 7.3 nursing activities for traditional care group patients, the study says.

"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 says in a press release. "They are entering the data they 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."

While the patients who attended in-person appointments followed up once every three months on average, the telehealth patients submitted their blood glucose and blood pressure levels multiple times a week. Because of increased communications with nurses, the telehealth patients received more guidance to help them monitor their chronic disease more closely, leading to more medication adjustments and lifestyle changes, ultimately resulting in better health outcomes.

"As telehealth continues to become more popular, it can be used to get health behavior intervention tools to the people who need them most," Howland says, "but we also need to keep in mind the strain it puts on nurses that are going above and beyond to make this possible."

Howland's research is unique in that published telehealth studies have included nurses within telehealth's intervention component, such as in a randomized controlled trial using telemonitoring, but none have been done on nurses in a real-world primary care clinic setting, she says.

As such, this study also reveals how nurses have integrated new telehealth systems into their daily routines.

"We can't expect nurses to use these tools successfully without better understanding the impact it will have on their workload," Howland says. "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," she says, "should they be responsible for half as many patients?"