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My Story as a Telehealth Advanced Nurse Practitioner

I am Marc and I currently work as a Telehealth Advanced Nurse Practitioner for a NHS trust in East London.

Nowadays, technology, social media and the use of apps are part of our daily lives. Through my role, I am able to apply and consolidate all of my past experiences through the help of technology.

As a Telehealth Advance Nurse Practitioner (ANP), I help monitor patients’ vital signs and symptoms at their own homes using technology. Our team monitors hundreds of patients with heart failure, chronic respiratory conditions, diabetes, uncontrolled hypertension and various other long term conditions using BP machine, oximeter, and thermometer. Data are entered in a tablet device (iPad) or sent via text message or by phone. By analysing the data, we are able to paint a picture of their state of health, predict/prevent deterioration and improve their quality of life.

Telehealth services are becoming more popular and has become a necessity nowadays especially in preventing the spread of COVID infection. During the pandemic, we monitored hundreds of patients with COVID in their own homes and those who have been discharged from hospital, even whilst they are on oxygen. It is a very fulfilling and satisfying role especially when you know you have made a difference in our patient’s lives.

A Typical day for a Telehealth Advanced Nurse Practitioner

No day is the same. Most patients are stable but when patients deteriorate we have to pull all stops to prevent an unnecessary hospital admission. The challenging part is predicting deterioration by looking at patterns, for example, a slow increase in a heart failure patients’ weight with increasing symptoms over time, or a COPD patient with slowly deteriorating breathlessness and cough, or a Diabetes patient with high blood sugar levels will all need a timely intervention either by adjusting treatment or increasing their self-management skills. As a remote worker, we use mainly video consultations and this can be challenging especially for those who are not familiar with the technology. Our routines are similar to other community services, we triage in the morning, allocate patients who need follow-up and urgent assessments, meeting at mid-day and do the needed home visits in the afternoon.

Challenges of being a Telehealth Advanced Nurse Practitioner

The most challenging aspect of my role is prioritising patients and predicting deterioration. During the peak of the pandemic, we had to prioritise and triage each a lot of patients and emotions and anxiety levels are also very high. I do find it challenging also to teach patients and families in how to use the technology. We have to be innovative and resourceful to get it to work. For my patients, the trick is to keep it simple. They are now are used to technology and use of tablet devices, including the elderly.

Benefits of working as a Telehealth Advanced Nurse Practitioner

As an autonomous practitioner, I have control over my diary which is something that I like about the role.

The main benefits of this role are the ability to work remotely whilst having the opportunity to learn constantly. Each day presents different challenges and opportunities for me to learn and be better. I also like that I have time to do health education with patients and their families about their condition, how their medications work and discuss realistic goals around lifestyle changes.

How to become a Telehealth Advanced Nurse Practitioner

This role is like a blue moon. There are only very few Telehealth focused roles in the country. However, with our current situation, with Telehealth being regarded as a safe and effective approach in monitoring patients in their homes. I am sure there will be more opportunities that will come up in the future.

As a Telehealth ANP, you need to have the right qualifications & experience. In my case, I have obtained a MSc in Cardio Respiratory Nursing and am an independent non-medical prescriber. I have specialised mainly in respiratory nursing in previous nursing roles, worked as Community Matron for years managing different long term conditions and also have led and managed various hospital and community teams in the past. It is crucial that you are able to effectively communicate with GPs and Consultants the patient’s history and condition and provide any suggestions you think would make a difference. In my role, I am able to recommend changes in one’s blood pressure medication, inhaler treatment, diuretic therapy and diabetes treatment in coordination with the specialist teams or patient’s GP. You also have to have a good understanding of pharmacology and drug interactions. Aside from the specialist teams, knowing how to communicate with patients is also key, including having good listening skills. In this role, we do health education with patients mostly focused on lifestyle changes. Some patients may have been desperately trying to follow but find it very challenging. You need to be like “Sherlock Holmes” and know how to listen, ask questions, understand cues and find the cause of their problem and not just jump to medical treatments. Added to this challenge is you need to all these remotely.

Advice to other Nurses

A nurse’s career is very much a path to lifelong learning. We learn not just from books but mostly from the stories we hear from colleagues and patients and our own experiences.

Never stop learning and growing. Consider working in an advanced practice for any speciality. Broaden your knowledge or specialise in one area and pursue excellence. It does require a lot of studying, commitment and sacrifices but when you are able to flourish in a chosen speciality or field then it will be all worth it in the end.

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