COVID-19 continues to change the way nurses work and approach patient care, and practices continue to evolve as the pandemic drags on and mutations surface. Several new ways of working since the pandemic began are here to stay. Nurses can expect new practices such as team-based care models, remote patient monitoring, telehealth, hospital acuity changes and mandatory vaccines to continue in routine care.
Team-Based Care Models
The coronavirus disease peak necessitated many hospitals, like New York Presbyterian, to create new care delivery models using an integrated team staffing approach. The team-based care module will remain due to not having enough nurses for total patient care models. This model relies on “rich skill mixes” of various team members.
Providers move to more “oversight” roles to spread expertise across several patients. The person with the highest skill level for those patients becomes the team leader, not the person with the most education, highest degree or credentials. The lead then directs the various multidisciplinary team members with clearly defined roles and responsibilities, all functioning cohesively for the patient’s benefit. Critical to the success of this care model is maximizing skill sets among nurses and open, transparent team communication.
Remote Patient Monitoring
Remote Patient Monitoring (RPM), also called remote physiologic monitoring, allows care teams to gather health data from patients at home. This strategy enables more preventive care and reduces hospital admissions to help ease the healthcare burden. More common RPM wearable devices are blood pressure, electrocardiogram, weight, blood glucose and incentive spirometers that provide information for assessment, interventions and evaluation for a variety of chronic conditions.
Devices give patients more personal health control with better outcomes. RPM provides better patient access and gives both patients and caregivers more peace of mind. With fewer visits, patients have less exposure to COVID-19, other illnesses and less travel or time off work costs.
Many RPM program care models are nurse-led through a centralized system, like that at Mayo Clinic. Critical to its success is the role of nurses in assessing for “digital poverty” and low digital health literacy. Not only do nurses monitor and act on patient data, they also teach patients how to use the equipment and when to report problems.
Telehealth
RMP refers to using a specific technology, like a wearable, to facilitate interaction between clinicians and patients. At the same time, telehealth is a broader term for the entire industry that enables remote care. The pandemic continues to change the perspective of telehealth, proving that this technology plays a significant role in all aspects of healthcare.
Nurses use telehealth for many care facets – prevention, triage, symptom management, counseling and education. Some nurses communicate with patients through a portal to direct their care, preventing admissions. Specialized advanced practice providers such as radiation oncology nurse practitioners can expand their practice to rural areas and underserved communities. The explosion in telehealth usage will require all nurses to improve their skill set, evaluate resources and explore creative solutions to improve patient access.
Hospital Acuity
Efforts continue to ensure patients get to the right level of care, reserving admissions for patients with the most acute conditions. Primary care providers and hospital administrators are working together to ensure that our nation’s healthcare system can continue to function. Routine healthcare resources divert to primary care for non-COVID-19 services and urgent care and hospitals for COVID-19 care. In contrast, they will downgrade or suspend specialty care services and non-acute hospital care.
Numerous organizations, including the Veterans Administration and Presbyterian Health System, use an innovative care model called Hospital at Home. This care model provides hospital-level care for higher-acuity patients in their own homes. This model reduces complications, improves outcomes and lowers costs. As a result, the Centers for Medicare & Medicaid Services (CMS) and more payers are reimbursing for acute hospital care at home. This transition requires homecare nurses to gain higher skill sets and offers many critical care nurses another employment option.
Mandatory Vaccines
The number of care facilities requiring employee vaccines and boosters against COVID-19 continues to grow. State, local or employer laws can require vaccines for all staff at different facilities, as well as for providers giving inpatient or ambulatory care. This directive makes vaccination a must in many organizations. Healthcare executives anticipate that mandatory vaccination will continue for years, just like the required annual flu vaccine. The American Nurses Association supports the position of mandated COVID vaccines.
COVID-19 requires a redesign of care delivery to minimize face-to-face interaction and the long-term consequences of lack of preventive services or elective procedures, in addition to the lack of hospital clinicians. Therefore, nurses need to make sure they possess both the technical skills and communication skills necessary to assess and support patients through these changes in healthcare.
Learn more about The University of Texas at Arlington’s online RN to MSN program.
