Shortly after emergency personnel whisked a young man into a small rural hospital in the Baptist Health South Florida health system in Miami, a tele-ICU physician ordered immediate medications for the patient who was experiencing severe chest pain.
Nurses obtained labs, spoke with the patient's cardiologist, and collaborated on the urgent plan of care to facilitate transfer of the patient to a larger facility with a cath lab.
"From the time of the initial ECG to his arrival in another hospital's CCU - including having a cath and a stent placed to open the clogged artery - the time was less than 3 hours," says Connie Barden, RN/CNS, MSN, CCRN-E, CCNS, a past president of the American Association of Critical Care Nurses (AACN) and co-chair of the AACN tele-ICU task force.
"Not only did the patient receive exquisite and timely care, the nurses felt totally supported in the process."
Linking critical care physicians and nurses to ICUs in remote hospitals is a growing trend. As one of the first tele-ICU clinical nurse specialists in the country, Barden knows the power of the technology, particularly in the hands of certified personnel.
Besides being expert communicators and collaborators, tele-ICU nurses are "super sleuths" of a sort, she says.
"They are able to find patients climbing out of bed, clarify incorrect or missing information in the medical record, help nurses who need information about thorny clinical issues, and strive to make patient care safer and bedside nurses' lives a little easier," explains Barden.
"In our system alone, tele-ICU nurses have prevented 48 falls in just the last 7 months by finding patients trying to get out of bed when they should not be out of bed."
Terms, Technology & Testing
The AACN has adopted the term "tele ICU" to describe the delivery of remote intensive care services where monitoring systems are used.
Tele-ICU nurses monitor critically ill patients and clinical data, providing crucial consulting and coaching to bedside staff at a remote location.
"We have so many under-served areas," says Mary Beth Flynn Makic, PhD, RN, CNS, CCNS, CCRN, research nurse scientist, Critical Care, University of Colorado Hospital.
"If we can provide a remote service that is going to enhance patient care, why not? Not every hospital can have a four-bed ICU with all sorts of technology. If we can augment care in a rural setting, or even in an urban settings with limited resources, why wouldn't we?"
High-tech demands intense preparation, so the CCRN-E tele-ICU certification is not easy.
"Certification is a rigorous process that meets national requirements in a specialty or subspecialty area," explains Kelli Lockhart, certification manager, AACN.
"To become certified by the AACN, a registered nurse must meet specific clinical practice requirements and take an exam based on a national job analysis.
For employers, certification contributes to creating an environment of professionalism and a culture of retention.
For nurses, certification gives a critical sense of confidence and achievement, and positions them for appropriate recognition."
Ramon Lavandero, MSN, MA, RN, FAAN, says a common misconception is that the requirements for CCRN-E are less rigorous than those for CCRN certification.
"Some believe that the main difference between CCRN and CCRN-E certification is where the nurse practices," says Lavandero, senior director, Communications & Strategic Alliances, AACN.
"Eighty percent of the 3-hour CCRN-E exam, which was developed based on a national job analysis of nursing practice in tele-ICUs-focuses on clinical judgment when caring for adults in tele-ICUs," adds Lockhart. "The rest of the exam covers professional caring and ethical practice, and may address any age across the life span."
Administrators of the exam note research is beginning to back up the notion that tele-ICUs staffed by certified nurses can save money for hospitals and improve patient care.
"Studies about the benefits of tele-ICUs are slowly increasing," says Lavandero, who also serves as a a clinical associate professor at the Yale University School of Nursing.
One of the larger published studies analyzed the records of more than 24,000 adult ICU patients after 3 years of deployment of a tele-ICU in a five-hospital healthcare system. The study found a 14.2 percent decrease in hospital length of stay adjusted for severity of illness (Willmitch et al., 2011).
Lavandero anticipates that busy colleagues at the bedside will continue to benefit from the wisdom of tele-ICU nurses and physicians well into the future.
"These professionals offer consultation according to the latest clinical guidelines and published evidence," says Lavandero. "We're eager to see published evidence about the impact on safety, because we're hearing more anecdotal examples of situations where tele ICUs have prevented mishaps such as patient falls."
Committed to Certification
Barden, Flynn Makic, Lavandero, and Lockhart all share a philosophical belief in the power of certification, a process that is worth the effort and ultimately a boon to patient care.
"It has been said there are only two kinds of nurses: certified nurses and those not yet certified," says Lavandero.
"If you work in tele ICU and aren't yet certified, your individual continuing professional development plan should chart the course for you to become certified."
Clinical experience in tele ICU is required to qualify for CCRN-E certification, and Barden believes that patients will benefit, as well as nursing careers.
"In an emerging practice area such as tele ICU, nurses who are CCRN-E certified position themselves well for being hired, because they have demonstrated their professional commitment and accountability."
"I always encourage certification, and white papers have shown that certification does positively impact patient outcomes," adds Flynn Makic.
"Once you are certified, you must maintain all the expectations of certification, including ongoing education, keeping up to date, staying abreast of the literature, and going to conferences. It is not as though you do certification and you are done. You are expected to maintain it, and that only makes you better. That's the beauty of certification."
Greg Thompson is a frequent contributor to ADVANCE.