NHPCO NewsLine Summer 2020 - 18

continued

COVID-19 Considerations
Regarding this current situation
with COVID-19, I can offer a few
considerations for the scope of
the RN role.
One of the things to keep in mind
is that the board of registered
nursing requires that RNs be
licensed in the state in which they
are practicing. So, with
telehealth, this may not be the
state that they are working from
or living in. For example, in our
organization, we have a
registered nurse who works from
and lives in Utah, but our
palliative care program manages
patients in Northern California. In
this case, the nurse had to attain
additional licensure for the state
of California. Some of these
license restrictions have loosened
due to COVID-19 but I would
recommend checking with your
local state board for that
information.
Another consideration for the
scope of the RN's role involves
diagnosing symptoms - that
would be the role of the physician,
the physician assistant, or the
nurse practitioner. Yet, one of the
things that we have found is that
patients are often unable to get
out of their house to get to their
doctors, especially in this time of
COVID-19, and they might be
experiencing brand new
symptoms, maybe even
symptoms of an infection. The
first provider they are reaching
out to is the registered nurse
through our telehealth program.
We must be careful not to

18

Newsline / Summer 2020

diagnose the symptoms, even
though those symptoms might
clearly be tied to something and
it seems like there is a certain
diagnosis that would fit.
However, even without
diagnosing symptoms, the RN is
still effectively able to
appropriately assess the patient
and provide interventions and
education to help manage the
patient in collaboration with their
primary care provider.
RN assessment is key to
gathering enough information
during a telehealth call. One of
the things that we have learned is
the importance of active listening
skills for our staff, since in
telehealth we are not physically
there with the patient to assess
them. We are relying on what the
patient is telling us and what we
can assess.
One of the things that we been
working on for quite some time is
incorporating video visits into our
practice. With COVID-19, we have
had to deploy these changes
more rapidly. Both our nurses
that do telehealth calls and our

nurses that provide home visits
have been given the technology
through iPads to make a video
visits with patients. The
platforms that we are using are
FaceTime, WebEx, or Signal.
For us, an important factor is
how do you determine when to do
a home visit versus a video or a
telephone visit. There are a lot of
different considerations that we
work through when addressing
what kind of visit to do for the
patient. We risk stratify our
patients based on their need. Our
patients are often elderly with
chronic illnesses, so you must
consider if they have the capacity
and the capability to be able to
get onto these platforms.
Additionally, with COVID-19 there
are some patients and some
facilities that have some
restrictions on visitors. We make
visits to assisted living and
boarding care and this has helped
in that arena as well.
I think virtual care is just a
wonderful way to continue to
connect with patients and

There are a lot of different considerations
that we work through when addressing
what kind of visit to do for the patient. We
risk stratify our patients based on their
need.
NHPCO NewsLine Summer 2020

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