To learn more about life in the tele-ICU, we interviewed two nurses who are advancing telemedicine technology across the country. Theresa M. Davis, Ph.D., RN, NE-BC, is the clinical operations director of Inova Telemedicine enVision eICU in Falls Church, Virginia. Lisa-Mae Williams MSN, RN, is the operations director at Telehealth & eICU, Baptist Health South Florida in Miami, Fla.
NN: Can you share a little bit about your nursing career journey or career path?
Davis: I graduated with my Associates Degree in Nursing in 1986 from a community college, it was a stepping stone to begin my nursing career. I quickly began the BSN program, followed by my Masters in Nursing Administration and completed my Ph.D. in 2013. I have done research studies in Technology Acceptance and Healing Touch.
Williams: I started working in the critical care unit as a new graduate and then moved into clinical education as a specialty practice educator for critical care and progressive care. After completing my MSN, I moved into leadership as the nurse manager in the tele-ICU. I was then promoted to Director of Operations.
NN: What do you think will be the long-term impact of the teleICU at your hospital?
Davis: Tele-ICU has introduced a whole new way to communicate. I believe that all patient rooms will eventually have monitor screens to allow instant interactions with the patient’s clinical team. It is always best to have clinicians available in person, however, when that is not possible, patients can have those needed interactions in a timely manner. This will assist with admissions, transfers, discharges, end of life conversations, escalation of care etc. Tele-ICU has also been the model for new telehealth programs. There are many opportunities to connect patients and their providers to deliver care more efficiently.
Williams: Optimized patient care and outcomes are already occurring. I see this continuing and also see the extension of our tele-ICU services beyond the critical care, progressive care, and emergency care environments. Many tele-ICUs already provide services to skilled nursing facilities and long-term acute care facilities. I see our health system providing comprehensive telemedicine services along the entire continuum of care, including to sites that are outside of our organization.
NN: How has the telemedicine transformed your approach to patient care?
Davis: Tele-ICU has taught our team the importance of building relationships, skilled communication and authentic leadership. It played a creative role on how to resolve problems and address issues efficiently. I have also learned the importance of team shared decision making to change workflows to meet the needs of our customers (the clinical team) so that they can be successful when providing care to their patients.
Williams: The tele-ICU nurse role is an expansion of traditional critical care nurse practice. Therefore my approach to patient care involves collaboration with the bedside team from a remote setting
NN: What has been your biggest learning from this experience?
Davis: Healthcare is changing, and we need to be ready. It is important to keep up with technology and innovation. Consumers will drive the future of healthcare. Relationship building and communication are essential elements to deliver safe, high quality care. A leadership team that consists of a physician and nurse leader is critical to the evolution and continued growth of a tele-ICU.
NN: Can you share any specific stories of how telemedicine has improved patient care?
Davis: The presence of an intensivist physician at our community hospitals has enhanced continuity of care and made escalation of care more streamlined for the clinicians in the ICU. TeleICU has provided a whole new nursing career pathway for ICU nurses.
Williams: Telemedicine provides an additional layer of support (safety net) in patient care. The tele-ICU nurse on the night shift was conducting his usual virtual (video assessment) rounds on his patients. While rounding, he discovered a patient who appeared to be deteriorating. (This was at one of our facilities that happens to also have 24/7 bedside intensivists). He immediately called the bedside nurse who was occupied caring for another patient in trouble so she called a code blue. In the meantime our tele-ICU intensivist was in the middle of coding another patient. In addition the bedside intensivist was in the middle of a procedure. So our tele-ICU nurse (ACLS certified) ran the code until the bedside intensivist could arrive. The patient survived. The tele-ICU provided additional support in a particularly challenging night!
NN: How long have you been a nurse, and what significant changes have you seen in the nursing profession since you began practicing?
Williams: I have been a nurse for 13 years. Patients are sicker, and many are being cared for outside the ICU. The nursing profession has had to rise to the challenge to accommodate the this increasingly complex patient care.
Davis: I have been a nurse for 30 years, I have seen significant changes in how we communicate with patients and how we document our assessments and clinical findings. Today’s nursing leaders have taken a stronger leadership role in healthcare. It is important to have nurses at the table to make strategic decisions regarding patient care delivery.
NN: What is the most exciting milestone you’ve witnessed in nursing over the past few years?
Davis: I have really enjoyed seeing nurses become interested in participating in research and evidence based practice. I believe when you create an environment that values inquiry, nurses are more engaged in improving patient outcomes. I also believe simulation labs have created a whole new way for nurses to learn which is exciting and will help to prepare them to be successful in a challenging healthcare arena.