Rambur Betty, Palumbo Mary Val, Nurkanovic Mirsada
1 College of Nursing, University of Rhode Island, Kingston, RI, USA.
2 College of Nursing and Health Sciences, University of Vermont, Burlington, VT, USA.
Policy Polit Nurs Pract. 2019 May;20(2):64-73. doi: 10.1177/1527154419836752. Epub 2019 Mar 28.
Value-based care theoretically catalyzes the business case for telehealth. Hence, the purpose of this study was to define the proportion of a statewide nursing workforce who self-reported telehealth or telephonic nursing as their primary work setting in a U.S. state undergoing rapid transitions to value-based care. We conducted a secondary analysis of a 2017 statewide nurse relicensure survey ( = 10,851), overall response rate 99%. The focus of the analysis was registered nurses who reported that they were currently working in Vermont or serving residents of the state ( = 8,457). Analysis was limited to descriptive statistics. We found that 18.4% of respondents ( = 1,556) reported their employment status as "telehealth/ working as a telephonic nurse." Responding to a different question, 17.2% ( = 1,458) defined "telehealth/telephonic" as their primary work setting. Thus, nearly one fifth of nurses practicing in the state were employed in telehealth, a role for which there is scant preparation in nursing education. The multistate practice of roughly one third of these nurses highlights the importance of the Enhanced Nurse Licensure Compact and raises questions about global telenurse practice. Taken as a whole, these findings have profound implications for health care policy development and implementation, ongoing workforce development and analyses, nursing regulation, education, and continuing education. New and renewed skills are needed to provide safe, effective, culturally relevant telehealth, and virtual care.
基于价值的医疗保健理论上推动了远程医疗的商业案例。因此，本研究的目的是确定在美国一个正在迅速向基于价值的医疗保健转型的州中，自我报告远程医疗或电话护理为其主要工作环境的全州护士劳动力比例。我们对2017年全州护士重新注册调查（n = 10,851）进行了二次分析，总体回复率为99%。分析的重点是那些报告他们目前在佛蒙特州工作或为该州居民服务的注册护士（n = 8,457）。分析仅限于描述性统计。我们发现，18.4%的受访者（n = 1,556）报告他们的就业状况为“远程医疗/担任电话护士”。在回答另一个问题时，17.2%（n = 1,458）将“远程医疗/电话护理”定义为他们的主要工作环境。因此，该州近五分之一的执业护士受雇于远程医疗领域，而护理教育中对此角色的准备却很少。这些护士中约三分之一的多州执业凸显了增强型护士执照互认协议的重要性，并引发了关于全球远程护士执业的问题。总体而言，这些发现对医疗保健政策的制定和实施、持续的劳动力发展与分析、护理监管、教育及继续教育具有深远影响。提供安全、有效、具有文化相关性的远程医疗和虚拟护理需要新的和更新的技能。
